Ali Ghufron Mukti

Health-financing reforms in southeast Asia: challenges in achieving universal coverage

In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened.

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia

BackgroundAllocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system.MethodsA standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country.FindingsSubstantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services.

A Drug Cost Estimation Model and its Determinant Factors for Breast Cancer Patient Hospitalized in Indonesia

The study offers the drug cost of breast cancer in Indonesia. their associated factors and the magnitude of the factors. The design of research was a cross sectional descriptive analysis using health facilities costing study that was conducted in Indonesia in 2011. The drug cost model was formulated as a cost of illness employing the prevalence based approach from a provider’s perspective.Based on the fitted model, the variables include patient characteristics (age, length of stay, ICU facility usage), hospital characteristics (drug supply problem), hospital location (Java and non-Java). The formula is as follows : Ln drug cost = 13,41 (0,31 X % patient age 40-

The Role of Health Insurance, Borrowing and Aids to Pay for Health Care on Reducing Catastrophic Health Expenditure in Indonesia

Background: Sizable out of pocket payment for health care make a hardship financing for many families and this will lead to a catastrophic expenditure. To pay health services that exceed the financial capacity of households would aggravate the economic stability of the household, which in economic terms is called catastrophic expenditure. When Households fall under the poverty line, their catastrophic spending threshold is zero. For households whose expenditures are above the poverty line, catastrophic threshold value will be difference between total household expenditure minus total minimum basic needs of the household divided by the total expenditure of the household. Based on this definition of catastrophic health expenditure, the research examines determinants of catastrophic OOP health expenditure in Indonesia.Method: This study is based on quantitative data analytic research that uses two data sources IFLS years 200 and 2007 and SUSENAS 2009 and 2010. Results: Probability of catastrophic health expenditure in such households especially being significantly influenced by economic condition. While health condition did not have significant influence to increase catastrophic health expenditure. A part of potentially catastrophic households in Indonesia (which are poor and have health problems) were not being catastrophic because they reduced health expenditure and did not use appropriate health treatment. Health cost subsidies like health insurance, borrowing money, and health care cost aids did not have influence to reduce the occurence of catastrophic health expenditure in Indonesia. Conclusion: Economic condition is the biggest factor in the occurrence of catastrophic health expenditure. Potentially catastrophic households were not being catastrophic because they reduce health expenditure and did not use health care treatment. Health cost subsidies like health insurance, borrowing money, and health cost aids have not reduced the occurence of catastrophic health expenditure in Indonesia.