Under Universal Health Coverage Scheme: Indonesian Experience

Transcription

1 Treatment for HIVAIDS Patients Under Universal Health Coverage Scheme: Indonesian Experience Mardiati Nadjib, Budi Hidayat, Atik Nurwahyuni Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia APACPH Conference, Bandung, 22 October 2015

2 Background Indonesia is one of few countries that reported increase of HIV new cases and in the latest 2014 UNAIDS report the country is listed as one of 30 countries (28 low and middle income countries) that contribute to 90% of new cases globally. The country s HIV response has been improved but majority of HIV financing coming from external sources. External donor financing has played significant role in supporting approximately 60% of HIVAIDS program activities... Indonesia is currently facing challenges sustainability of its HIV programs due to the decrease of external funding. Indonesia has implemented universal health coverage known as Jaminan Kesehatan Nasional (JKN) under single payer scheme (namely BPJS) started in January HIVAIDS program intervention is an example of a unique mixture of public health and curative programs. This analysis will help policy makers to summarize and decide inclusion of HIVAIDS program into the universal health coverage, Lesson learned from other countries i.e Thailand under NSHO

3 FINANCING HIVAIDS (USD) (USD) (USD) (USD) Public SHI Total public International Private Grand Total Sources: Public and International Partners: NASA data SHI 2013 : projected from 2012, SHI 2014 : claim data from BPJS SHI claims in 2014 was substantially increased after impmemention of BPJS (single payer)

4 Method This study was using retrospective data before and after implementation of the single payer scheme Jamkesmas claim data and recent JKN claims data (2014). Data Sources: MOH and BPJS Kesehatan for both outpatient and inpatient care was analyzed to determine the claim of opportunistic infection among PLHIV for various cases, and to study changes in access before and after implementationof of the single payer (BPJS) scheme.

5 Current funding mechanism for HIV Services some services are already covered under JKN Interventions Service Component Service elements Current Coverage/Funding mechanism Prevention STI services Diagnostic : STI tests JKN and Public Financing Drugs JKN and Public Financing Condom and lubricant IEC materials Consultation (Medical and Lab Technician fee) JKN and Public Financing HIV Counselling and Testing Diagnostic tests Public financing Central & Sub National Condoms Consultation (Medical and Lab Technician fee) JKN and Public Financing Harm Reduction NSP MMT Public financing Condoms Public Domestic and External Consultation (Medical and LbT Lab Technician i fee) Public Financingi PMTCT Public financing Central & Sub Diagnostic tests National Condoms ARV C section IEC materials

6 Current funding mechanism for HIV Services some services are already covered under JKN Interventions Service Component Service elements Treatment and Care Treatment and Care Screening tests: ARV eligibility Prophylaxis drugs ARV Monitoring tests : CD4 & Viral Load OI Hospitalization OI Drugs Condoms Consultation (Medical and Lab Technician fee) Current Coverage/Funding mechanism Public financing Central & Sub National JKN JKN and Public Financing JKN and Public Financing

7 Claim OI cases for Jamkesmas Inpatient Total Cases 2,050 1,971 Total Claim (IDR) 7,696,823,564 7,558,943,929 Average claim (IDR) 3,756,380 3,837,027 Source: MOH Total OI Claims and CBGs Claims, 2014 Total CBGs claims 2014* (overall) IDR42.6 Trillion Total CGBs claimsfor HIV and AIDS OI Cases only IDR72,081,450, ** Burden of HIV and AIDS claim 0.17% *) source: BPJS **) source: BPJS claims data

8 Claim Proportion by Type of membership TYPE OF MEMBERSHIP % Non Worker 0,96% Poor, Subsidized by Local Gov't 22,67% Poor, Subsidized by Central Gov't 29,22% Non salaried Worker 37,51% Salaried Worker 9,65% TOTAL 100% GENDER Male 61,02% Female 38,98% Source: :BPJS Claim data 2014

9 Prob. Use of HIV Essential Services 2014 Note: 1. CBGs OP was generated from claims with code Q ; for IP from code A 4 15 I; A 4 15 II; A 4 15 III. 2. Denominator was number of JKN members by region

10 CONCLUSION RECOMMENDATIONS Access PLHIV to health care under new scheme has substantially increased Ensuring continuum of care of HIVAIDS program intervention is important, and not fragmented role of outreach program The government will be facing potential increase of burden in the future unless do systematic approach to prevent HIV cases Need to assess potential inclusion of a more comprehensive HIVAIDS care and services into the JKN scheme BUT Aside from JKN scheme, part of the program that related to public health and outreach programs should remain as government responsibility.

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12 Est. Probability of use services PLHIV (OUTPATIENT CARE) Estimasi Prob 2014 digenerate berdasarkan data historis klaim CBGs bulan Jan s/d Des 2014, dan diadjust dengan menggunakan angka completion factors untuk mengakomodir sejumlah kasus yang sudah dilayani namun belum terlaporkan (Incurred But Not Reported, IBNR). Perhitungan dilakukan dengan metode Chain Ladder.

13 Est. Probability Use of Inpatient Care PLHHIV