RESTRUCTURISATION OF JKN · 2014 2015 2016 2017 ... • bpjs has not yet acted as an ... pbpu...
Transcript of RESTRUCTURISATION OF JKN · 2014 2015 2016 2017 ... • bpjs has not yet acted as an ... pbpu...
Achievement of JKN
MEMBERSHIP: 200+ MILLION PEOPLE
People with chronic, degenerative, and catastrophic diseases
Health Services Structurisation & Standardisation
Cost Control & Quality Control of Health Services
Functional integration of government and private health services
INDIRECT IMPACT:
• Structuring and Strengthening the Domestic Health Market
• Population administration via the single identity number
29 Oktober 2018 RESTRUKTURISASI JKN 2
Structural Deficit
-3,309.11
-8,371.14
-6,319.46
-18,199.73
-20,000.00
-18,000.00
-16,000.00
-14,000.00
-12,000.00
-10,000.00
-8,000.00
-6,000.00
-4,000.00
-2,000.00
0.00
2014 2015 2016 2017
Surplus (Defisit) Tahun Berjalan • Compared to 2015, the 2016 deficit declined due to an increase in contributions;
• In 2017 there is an increase in DEFISIT ALMOST 3X FOLD from 2016;
• A very significant and prolonged deficit indicates that STRUCTURAL DEFISIT has occurred;
• Structural deficits can not overcome by efficiency, but a comprehensive RESTRUCTURISATION is needed, both INA CBG rates, premium, service systems, etc
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JKN PROBLEMS
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KURANG DANA DEFISIT STRUKTURAL
• IMPRUDENT POLICY:• PROBLEM IN HEALTH SERVICES TARIFF:• IMPACT OF SYSTEMIC DISORDERS:
PEMANFAATAN DATA & TEKNOLOGI INFORMASI TERBATAS
ADVERSE SELECTION
EXPECTATIONS ARE UNLIMITED
LOW PREMIUM PAYMENT DISCIPLINE
WEAK COMPLIANCE MONITORING
INEFFECTIVE IN PREVENTING ADVERSE SELECTION
.
TATA KELOLA MENYIMPANG DAN SARAT KONFLIK KEPENTINGAN• SUPERVISION BY MANY INSTITUTIONS BUT
FRAGMENTATIVE AND INEFFECTIVE
• BPJS HAS NOT YET ACTED AS AN ACTIVE PURCHASER
• DJSN HAS NOT FUNCTIONED PROPERLY
PARTISIPASI PUBLIK RENDAH DAN
PBPU CONTRIBUTION COLLECTION HAS NOT YET
AUTODEBIT
MANUAL DRUG PLANNING WITH RKO, HAS NOT USED
CLAIM DATA (BIG DATA)
THE DETAILED CLAIMS AND CAPITATION DATA ARE NOT
UTILIZED IN CALCULATING CONTRIBUTIONS,
BENEFITS, AND POLICIES.
LACK OF FUNDS STRUCTURAL DEFICIT GOVERNANCE AND CONFLICT OF INTEREST
LOW PUBLIC PARTICIPATION & EGOSENTRICUSE OF DATA & LIMITED INFORMATION
TECHNOLOGY
5. DATA & IT
PARTISIPASI PUBLIK & PEMBUDAYAAN JKN
4. GOVERNANCE
1. BENEFIT,2. PREMIUN
3. TARIFF
6. MANDATORY PARTICIPATION & JKN
CULTURE
BASIC COMPREHENSIVE SOLUTION: Restructrurisation of JKN Regulation
Benefits & contributions in accordance with actuarial calculations, costs sharing to prevent over-utilization and fraud, government reserve funds and promotive, preventivestrenghthening.
Tariffs are in accordance with economic prices with quality assurance and service security in accordance with national service standards and national health facilities standards.
Checks & balances: DJSn – BPJS Health position
Automation of administration, monitoring and evaluation
Utilization of data and information for policy making
communication, education, information and enculturation Law enforcement UHC
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6 AREAS OF JKN RESTRUCTURING
SET THE BENEFITS OF JKN
INCREASE JKN PREMIUM
LIST THE HIGHEST HEALTH SERVICES TARIFF BASED ON ECONOMIC VALUE
IMPROVING DJSN-BPJS KES GOVERNANCE
USE OF DATA & INFORMATION TECHNOLOGY
MANDATORY PARTICIPATION AND LAW ENFORCEMENT
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