The Challenge
Indonesia has one of the largest national health insurance programs in the world, with over 80% of the country’s population covered under Jaminan Kesehatan Nasional (JKN). Expenditures under JKN are increasing more rapidly than revenues as coverage expands along with a growing demand for and utilization of health care. The payment arrangements applied in JKN may also partially explain the dominance of more costly hospital-based treatment, which accounts for over 80% of JKN expenditures. Improving the efficiency of JKN expenditures is necessary for sustainable progress towards UHC, and improving the financing arrangements for services through more strategic purchasing is an important part of a more effective response.
The Opportunity
Strategic purchasing of health care services ensures that countries get more value for money spent. Essentially, this enables health systems to achieve the highest, equitable health outcomes possible by covering more people with better services and better financial protection – with considerations to any resource constraints. As more countries move towards universal health coverage (UHC), strategic purchasing can help ensure that funds are directed to where they will have the most impact.
The Government of Indonesia now faces a range of options on how to continue to increase coverage, efficiency, quality, and sustainable financing. USAID’s Health Financing Activity (HFA) is a 5-year technical assistance project aimed to strengthen local capacity in financial analysis, stakeholder engagement, learning and decision making. The recent expansion of national health insurance (JKN) in Indonesia brings increased opportunities to influence provider behaviors via financial levers, including more strategic health purchasing (SHP).
Our Work
Under the USAID Health Financing Activity (HFA), R4D will lead a series of activities that aim to improve strategic health purchasing mechanisms and capacities. Known for global leadership in strategic purchasing, R4D will support two activities (1) piloting of new strategic purchasing arrangements for priority programs including Tuberculosis (TB) and maternal and newborn health (MNH) and (2) fostering an enabling environment for SHP.
Piloting of strategic purchasing arrangements for TB and MNH (SHP)
In partnership with the Indonesian Ministry of Health Center for Health Financing and Insurance, R4D will lead the design and implementation of strategic health purchasing pilots for the priority areas of TB, MNH, and HIV. Working in collaboration with multi-stakeholder technical working groups, R4D is responsible for facilitating a multi-stakeholder process to assess service delivery challenges related (at least partially) to existing purchasing arrangements, commission analyses, and design feasible options for the pilot programs. To ensure success within these pilot programs, R4D will also create and maintain monitoring systems for the pilots, provide technical and logistic support to ensure the outcome evaluation and implementation research efforts are successful, and capacity building initiatives across the pilots.
Enabling environment for SHP
R4D will provide technical and logistical support to high-level health financing governance groups to clarify strategic purchasing responsibilities and institutionalize evidence-based proposals into the decision-making process. R4D assistance will emphasize building capacity to improve strategic purchasing governance for JKN and other sources of health funds. R4D will coordinate dialogue between the governance groups to synthesize the overall vision and agenda for SHP, priority setting for health financing, and JKN sustainability efforts.
Strategic Purchasing of TB Services through National Health Insurance in Indonesia
R4D is examining the link between incentives for TB diagnosis and treatment, provider behavior, and service delivery patterns and designing strategic purchasing solutions under Indonesia’s national health insurance payment system, Jaminan Kesehatan Nasional (JKN). Download the summary infographic.
Strategic Purchasing of Maternal and Newborn Health Services through National Health Insurance in Indonesia
R4D is designing solutions to incentivize better health care under Indonesia’s national health insurance payment system, Jaminan Kesehatan Nasional (JKN). Download the summary infographic.
Photo Credit: Oscar Siagian for CHMI/Bidan Delima
