HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH COVERAGE

Dr.dr.Sutoto,M.KesChairman of the Indonesian Hospital Association

CORE DISCUSSION

SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS

CHANGES IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE

5 (FIVE) INDICATIONS OFWHY INDONESIA WILL BE THE 7TH LARGEST ECONOMY IN THE WORLD

1. Stable economic growth and forecast2. Growth in urbanization. 90% of the national economic growth

is contributed by cities outside of Java.

SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS

is contributed by cities outside of Java.3. 11% of export is not from natural resources (oil and gas) 4. 7% decrease in labor intensive industries.5. 60% of the economy is due to the increase in productivity

Resource: McKinsey Global Institute presentation by Chairman Raoul Oberman, “Indonesia’s Vision for 2030” , Indonesia’s National Economic Committee, Ritz Carlton Hotel, 13/11/13

G 20 MEMBERS

Ist: ECONOMIC LEVEL of INDONESIA IS ASSESSED AS MOST STABLE IN WORLD

90 % WORLD GDP 80 % total WORLD COMMERCE

2/3 % WORLD POPULATION

DEVELOPMENT Of ECONOMICS Of INDONESIA

GROWTH OF URBANIZATION90% of the national economic growth is contributed by cities outside of Java

60 % OF ECONOMIC GROWTH SUPPORTED BY INCREASE IN PRODUCTIVITY

By 2030: 90 Million Indonesians could join the Consuming Class

HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE

1. CORE STRATEGY1. QUALITY IMPROVING QUALITY PERFORMANCE2. EFFICIENCY IMPROVING EFFICIENCY

2. STEPS HOSPITAL STRATEGY TOWARD UNIVERSAL 2. STEPS HOSPITAL STRATEGY TOWARD UNIVERSAL HEALTH COVERAGE /JKN

2. OVERALL HOSPITAL STRATEGY TOWARD UNIVERSAL HEALTH COVERAGE/JKN

STAGES IN IMPROVING QUALITY PERFORMANCE

Primitive: You should do X (X= Regulation, Standard, Incentive)

Medieval : You must do X Medieval : You must do X

Modern: X is norm (X= Check list, Default, Feed back, Loops ex: CP)

Future : X is done (automation)

Atul Gawande, MD, Plenary Speaker, ISQua International Conference 14 Oct 2013. Edinburgh, Scotland

THREE DIMENTION TOWARD UNIVERSAL HEALTH COVERAGE

WHAT DO PEOPLE HAVE TO PAY OUT OF POCKET?

Around 150 million people suffer financial catastrophe each year and 100 million pushed into poverty because of out-of-

FIRST DIMENSION: FINANCIAL PROTECTION• What do people have to pay out of pocket ? • Coverage mechanism VS cost sharing and fee ?

year and 100 million pushed into poverty because of out-of-pocket health care bills (1)

Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

PAYMENT SYSTEM :• CAPITATION FOR PRIMARY CARE • CASE BASE GROUP FOR SECONDARY AND TERTIARY CARE

HOW CAN THE MIDDLE CLASS BENEFITFROM THE UNIVERSAL HEALTH CARE COVERAGE?

COST SHARING TO COVER THEIR DIFFERENT NEEDS

Patients that would like to stay in higher classes can pay the difference with private health insurance

or out-of-pocket payment,Stated in Ministry of Health regulation PERPRES 12 TTG JAMINAN KESEHATAN. Clause 24

COVERAGE MECHANISM (PAID BY BPJS)

COVERAGE MECHANISM (PAID BY BPJS)

COST SHARING

COST SHARING

SHIFT OF THE PATIENT AND THE ROLE OF HOSPITALS IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE

RS BLURS SNRS PT

RS BLURS SN

RS BLURS SNRS PT

PASIEN BPJS PASIEN BPJS

PASIEN BPJS(100% coverage)

PASIEN BPJS (Additional insurance coverage)

PASIEN BPJS (With option to pay balance of

payment owing)

PASIEN BPJS (Additional insurance

coverage)PASIEN BPJS (100% coverage)

IUR BIAYA(With option to pay balance of payment

owing)

TAHUN 2014

TAHUN 2019

TEN LEADING SOURCES OF INEFFICIENCY TEN LEADING SOURCES OF INEFFICIENCY 1. Medicine: underuse of generics and higher than necessary price.

2. Medicine: use of substandard and counterfeit medicines.

3. Medicine: inappropriate and ineffective use.

4. Products and services: overuse/supply of equipment, diagnostic services and procedures.

5. Health workers: inappropriate or costly staff mix, unmotivated workers.

6. Health service: inappropriate hospital admission and length of stay. 6. Health service: inappropriate hospital admission and length of stay.

7. Health service: inappropriate hospital size and low use of infrastructure.

8. Health service: medical errors and suboptimal quality.

9. Health system leakages: waste, corruption and fraud.

10. Health intervention: inefficient mix and inappropriate level.

Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

HAVE EVER

Revenue From Jamkesmas > 50%

STRENGTH AND WEAKNES ANALYSIS

+

HOSPITAL

HAVE EVER

SERVE JAMKESMASRevenue From

Jamkesmas <50%

HAVE NEVER SERVE JAMKESMAS

Revenue From Askesdan Jamsostek >40

%

Revenue From Askes/ Jamsostek <40 %

-

MANAGEMENT SKILL TO CONTROL PHYSICIAN BEHAVIOUR

MANAGEMENT SKILL POSITIVE ADAPTATION

PROCESS FASTERMANAGEMENT SKILL

TO CONTROL PHYSICIAN

BEHAVIOURNEGATIVE

ADAPTATION PROCESS MORE

SLOW

SIX STEPS HOSPITAL STRATEGY TOWARD UHC/JKN

1.1. Develop: New Standards must be based on the national Develop: New Standards must be based on the national standards of hospital accreditation standards of hospital accreditation

2.2. Use of : SPO’s from the international adapted accreditation Use of : SPO’s from the international adapted accreditation

OVERALLHOSPITAL STRATEGY IN THE ERA OF

UNIVERSAL HEALTH CARE COVERAGE

2.2. Use of : SPO’s from the international adapted accreditation Use of : SPO’s from the international adapted accreditation standards, standards, formulariumformularium, Clinical pathways, checklists., Clinical pathways, checklists.

3.3. Train staff competence to execute: new accreditation Train staff competence to execute: new accreditation standards, use of checklists, clinical standards, use of checklists, clinical pathways, pathways, ICD 10 and ICD ICD 10 and ICD 9 CM, INA CGBs and 9 CM, INA CGBs and monitoring level of monitoring level of compliance with compliance with reward program.reward program.

MedicinesMedicines::1.1. Improve: Electronic prescription, new prescribing Improve: Electronic prescription, new prescribing guidance, guidance,

compliance with standards and compliance with standards and formulariumformularium, reduce , reduce duplication, duplication, polipoli pharmacy, drug interactionpharmacy, drug interaction

2.2. Incentives and support for Incentives and support for generic generic substitution substitution

OVERALLHOSPITAL STRATEGY IN THE ERA OF

UNIVERSAL HEALTH CARE COVERAGE

2.2. Incentives and support for Incentives and support for generic generic substitution substitution 3.3. Regulate Regulate promotional activities, promotional activities, rational use rational use etc.etc.

Good Hospital governanceGood Hospital governance::1. Provide 1. Provide more continuity of more continuity of care and monitoring in hospitals, clinics, care and monitoring in hospitals, clinics, clinical clinical staff performance, staff performance, clinical Audit clinical Audit and and other monitoring other monitoring systems. systems. 2. Implement awareness and execution of patient safety programs. 2. Implement awareness and execution of patient safety programs.

Paying Paying providers:providers:Move Move away from fee for service to away from fee for service to remuneration.remuneration.