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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.