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A Discussion on Psycho-Social Issues Regarding Universal Health Coverage in Indonesia and its Solution

By: Audrey Florencia Theno Andrew William

A Discussion on Psycho-Social Issues Regarding Universal Health Coverage in Indonesia and its Solution The United Nations Sustainable Development Goals (UN SDG) are 17 goals with 169 targets that all UN Member States have agreed to work towards achieving by the year 2030 . One of seventeen goals is the achievement of good health and well-being for all. The World Health Organization (WHO) under the United

Nations

(UN)

specifically

targets

the

availability of a Universal Health Coverage system for all under SDG target 3.8.

Universal health coverage is the goal that all people are able to obtain the health services they need

without

risking

financial

hardship

from

unaffordable out-of-pocket payments (World Health Organization, achieving

2010).

universal

WHO health

aims

to

coverage,

focus

on

including

financial risk protection, access to quality essential health-care services, and access to safe, effective, quality,

and

affordable

essential

medicine

and

vaccines for all. It involves coverage of good health services

-

from

health

promotion,

prevention,

treatment, rehabilitation, and palliative care - as well as a form of financial risk protection (Evans, Hsu and Boerma, 2013).

In Indonesia, the obligation of the government to provide health protection and services is regulated in Law

No.

System

40/2004 (SJSN).

under

As

a

the

National

fulfillment

of

Social the

Security law

and

commitment to provide universal health coverage (UHC) amongst citizens, the government of Indonesia launched the

National

Health

Insurance

(Jaminan

Kesehatan

Nasional - JKN) program in 2014 under the Healthcare and

Social

Security

Agency

(Badan

Penyelenggara

Jaminan Sosial Kesehatan - BPJS Kesehatan).

The

Healthcare

and

Social

Security

Agency

in

Indonesia employs the referral system in administering healthcare to its citizens. The referral healthcare system is the implementation of health services which regulates the delegation of duties and responsibilities of reciprocal health

services,

both

vertically

and

horizontally,

which

must be carried out by participants of health insurance or

social

health

insurance

program,

and

facilities spread throughout Indonesia.

Health Service Flow

Image I (Adaptedfrom BPJS KesehatanBooklet)

all

health

In

January

of

2014,

the

Indonesian

Government

launched a program in which they provided a mandatory, public

health

insurance

program

to

provide

universal

coverage in the country to all its citizens by 2019 (Banerjee et al., 2021). But however that target has not been reached even until January of 2022. One reason why we think that universal

healthcare

in

Indonesia

hasn't

reached

its

maximum potential is due to the lack of infrastructure to accommodate visiting patients when coming into a referral hospital. For example, a patient from Eastern Indonesia would typically be referred to RSUD Dr Soetomo, Surabaya for major medical procedures, where one example of these procedures would be for a kidney transplant. A patient that has undergone a kidney transplant would need to have follow-up

visits

to

monitor

their

recovery

progress.

However, it is not financially sustainable for patients from other cities or even other islands to visit Surabaya every month using out-of-pocket money.

This also undermines the whole purpose of Universal Health

Coverage

accessibility,

and

financial

its

three

affordability

dimensions: and

also

physical

acceptability

are the three cores of universal health coverage. Through various health campaigns and programs, the Indonesian government

has

successfully

acceptability

within

the

tackled

population,

the

problem

physical

of

accessibility

has been improving and will continue to always improve around

the

affordability.

world,

the

question

lies

on

financial

Needless to say no national insurance or any universal health coverage could run without funding especially for those in the lower middle income household.

However, it is sometimes forgotten that what the government

pays

is

only

for

the

treatments

in

the

hospital, only the medical aspect and none of the psychosocial aspect. Within the spectrum of public health also, we

have

to

be

realistic

to

know

that

when

a

person

becomes sick, the whole family or even community could be affected both directly and indirectly.

By doing so, it would also be contrary to WHO’s goal to provide adequate healthcare without the risk of financial hardships. A solution to this problem would be to

build

a

dormitory

for

recovering

patients

at

these

referral hospitals so that referred patients may have the choice

to

either

stay

at

the

dormitory,

or

if

they

are

financially stable, able to go back-and-forth from their hometown to the referred hospital routinely throughout their recovery period. As setting up government offices to help connect people from their place of origin to the place where they seek treatment would bring in too much stakeholders.

The solution to building these dormitories also comes in light with the current President’s plan

to

build

more

infrastructure

as

when

compared to other countries of the same level, Indonesia would

is

still

provide

far

a

behind.

safe,

These

clean,

dormitories

comfortable

yet

affordable and accessible place to stay for the period

of

time

companions referral

are

these seeking

hospitals.

fundamental,

as

It

they

people medical

would then

and

attention

prove

would

their

not

to

in be

have

to

worry about other factors (ex. housing expenses), in a new place and could simply focus on their health and recovery. We should also not forget about

the

high

chances

of

infection

to

sick

people especially those undergoing complicated procedures in these referral hospitals if they are staying

in

unhygienic

conditions

and

also

the

money that the government has spent on those complicated procedures and seeing it not come to life due to infections caused by hygiene.

REFERENCE

Banerjee, A., Finkelstein, A., Hanna, R., Olken, B., Ornaghi, A. and Sumarto, S., 2021. [online] Pubs.aeaweb.org. Available at <https://pubs.aeaweb.org/doi/pdfplus/10.1257/a er.20200523> [Accessed 19 January 2022].

Evans, D.B., Hsu, J. and Boerma, T. (2013) ‘Universal health coverage and universal access’, Bulletin of the World Health Organization, 91(8), pp. 546-546A. doi:10.2471/BLT.13.125450.

World Health Organization (2010) ‘The world health report 2010 - Health systems financing: the path to universal coverage’. Available at: http://www.who.int/whr/2010/whr10_en.pdf.