Monday, August 1, 2016
Indonesia - InaHEA Congress: Preventive Health Care, Higher Tobacco Tax, Health Equity Needed
Yogyakarta. The Indonesian Health Economic Association, or InaHEA, called for a preventive health care program, an increase in tobacco tax and to promote health equity under the national health insurance plan, or JKN, as part of their third annual congress at Alana hotel and convention center in Yogyakarta on Thursday (28/07).
Hasbullah Thabrany, InaHEA chairman and public health care expert, said the congress is a forum for international and Indonesian public health care experts and managers to exchange information.
"This year, we are trying to dig deeper and find solutions for public health care problems. By presenting public health care studies, we hope to be able to convince our politicians and boost the government's confidence in making decisions [to take action]," Hasbullah said.
Since its launch in 2014, the Indonesian government has been running the JKN, giving the public wider access to health services.
As of June 2016, Indonesia’s social security administration body for health BPJS Kesehatan — who's ultimate goal is to increase coverage of the national health insurance plan, or JKN — has over 166.9 million registered members. However, BPJS Kesehatan's deficit reached up to Rp 5.85 trillion ($446 million) and the deficit forecast for this year is Rp 7 trillion, Kompas reported in April.
In order to address these shortcomings, the congress recommended that the Indonesian government revise its insurance coverage and triple the tobacco tax as a preventive and deterrent measure. Tobacco, according to Hasbullah, is one of the main causes for fatal illnesses. Graphic warnings printed on cigarette packs are proven ineffective in reducing cigarettes consumption because the price is already too low at Rp 15,000 per pack, Hasbullah asserted. By contrast however, it is nearly 10 times more expensive in neighboring city-state Singapore.
In a recent study published in Jurnal Ekonomi Kesehatan (Journal of Health Economics), Hasbullah found that 70 percent of his respondents claimed that they will stop purchasing cigarettes if the price reached Rp 50,000 per pack. His study also revealed that Indonesia sold over 348 billion of cigarettes last year alone.
"We need to stop children and poor people from buying cigarettes, so we don't take their tax money to fund health care policies like JKN. By doing this, it won't harm the industry, as people in better financial situations will continue to purchase cigarettes," Hasbullah added.
Hasbullah said he will be meeting with the minister of health and minister of finance to present his findings and recommendations so they will be able to revise existing laws and policies.
The congress also addressed another shortcoming of the JKN policy, which is the absence of health facilities in remote areas across the country as compared to the bigger cities.
Laksono Trisnantoro, congress chairman and professor of health policy at Gadjah Mada University said the JKN policy is still a pro-rich oriented one. The gross domestic product increased from Rp 10 million last year to Rp 12 million this year, but rich people are paying the same amount of insurance coverage, when they can afford to pay more.
"We need new policies in the basic standard package for under developed regions and developed regions [within Indonesia]. Rich people should also be able to pay for private insurance or pay for their own health services if they can," Laksono said.
Ascobat Gani from the faculty of public health at University of Indonesia (UI) highlighted the adequacy of public funding for public health. He expressed his concern about the limited investment in public health care and insisted that the financing program should be comprehensive. Ascobat added that the funds should not only be spent on medical services but also in promotion, prevention, surveillance, mobilizing social and government machinery.
"We should not be too intoxicated with all the talk about health insurance. That is necessary, but not sufficient. We need to strengthen public health units in all of 514 districts in Indonesia. Local public health centers, or Puskesmas, must be advocated," Ascobat said.
"I was an activist when we brought [former president] Suharto down, but I have to say that Puskesmas was in its glory days during this time and children received their vaccines on time. Now we're too busy taking care of the operating cost," Ascobat added.
Budi Hidayat from the faculty of public health at UI agreed, adding that while improving the JKN policy is imperative, Puskesmas must also be strengthened as a preventive step.
"Improvements in state health insurance as well as public health centers must be done simultaneously," Budi said.
The congress will continue until July 30.