Implementation of Health Insurance in West Lombok

As Mr. Abolo want to give information input to the Minister of Health about system of health in accordance with fulfilling human right for health/health care, the information should answer the following issues:

1. Which country does have relatively similar condition with Mr. Abolo's? It is importance to consider to assure that the system will relatively suitable to implement in his country.

2. What is the main health problem in the country and how to measure it?

3. What are the vulnerable groups that mostly suffer the health problem ?

4. What and How is the health and health care system implemented in the country?

5. How are the vulnerable groups handled?

6. How does the health financing and funding system work?

7. What is the strategy to overcome limitation of budget for health and health care?

Main Health Problems and How to Measure it in Indonesia.

Health status in Indonesia is generally measured by using the incidence of mortality and morbidity beside life expectancy at birth. However, the main used and regarded as important indicators are infant mortality rate (IMR) and maternal mortality ratio (MMR). CIA World Factbook reported the IMR of Indonesia in 2010 was 28.94 per 1.000 live births and placing Indonesia on the 73rd rank in the world, while the Life Expectancy at Birth in 2010 reported as 71.05 years. Maternal mortality in 2010 was reported as 240 per 100.000 live births. Morbidity in the country is dominated by some communicable infectious diseases like diarrhoea, Acute Respiratory Infection (ARI), tuberculosis, malaria and Dengue Hemorrhagic Fever. It was called as unfinished agendas as there were several programs aimed to solve the problem but until now the problem still exist. On the other hand, some non communicable disease such as cardiovascular diseases, mental illness, chronic diseases like diabetes are starting to rise. Some new emerging diseases like avian influenza, SARS and swine influenza should be also anticipated. Indonesia also faces re-emerging diseases like measles and polio that might be eradicated, but currently they are re-emerging. The last is health threat related with disaster. Hence, they cause the country has double burden of health problem. The Basic Health Research 2007 reported the prevalence of malnutrition for under 5 years old children (under 3 of deviation standard of WHO) was 5.4% while that under 2 of deviation standard was 18.5% (target of MDGs should be under 20%). The incidence of ARI was 25.50% while that of pneumonia was 2.13%. Tuberculosis was suffered by 0.99% people while measles was suffered by 1.18% of people. The research also reported the incidence of diarrhoea as 9.00%. The malaria prevalence was reported as 2.85% and the incidence of Dengue Hemorraghic Fever was 0.62%.

For Non communicable diseases, the research reported prevalence of hypertension in 2010 as 29.8% with 0.8% stroke. Prevalence of heart attack has been 7.2% and diabetes mellitus for people aged 15 years and above as 5.7%. While the prevalence of mental and emotional disorder was 11.6%.

Determinants of the Health Problems

According to social determinants of health theory, the factors of health are: environment (income and income distribution, employment and working condition, food insecurity, housing); behaviour (habit, education status); heredity/intrinsic factor (gender, sex, early childhood development); and health service factors (access and quality of health services). The factors causing maternal mortality was divided into direct and indirect factors. The direct causes are: maternal bleeding, eclampsia, infection, long lasting childbirth and abortion complication. While the direct determinants of infant mortality are: untreated low birth weight, asphyxia, prematurity, infection, sepsis, hypothermia and congenital malformation. Beyond the direct determinants, there are some factors that need attention and urgent intervention. They are called 3 kinds of lateness. The first lateness is late decision making in family level related with medical or non medical assistance, to where the patient should be brought (to the traditional healer or the health professional and other considerations). The second lateness is that related with transportation to access health service facility, and the last one is that to get adequate service in health care facility. These lateness also contribute to late detection of diseases resulting severer condition when access the health service. Some factors that cause morbidity are poor habit of people especially related with personal hygiene, poor condition of environment and health care factor.

Vulnerable Groups for Health Problem

In community, there are some vulnerable groups that potentially suffer some health problems. It was recognized that infant and pregnant women are the most vulnerable group in the community. The other groups are elderly, poor people, alone parent, people with disability, people with mentally ill, homeless and families having member with chronically disease such as tuberculosis, leprosy and so on. The government of Indonesia reported the proportion of poor people in 2010 was 13.3% (31.02 million people). The Basic Health Research reported that the prevalence of disability In Indonesia 2010 for > 15 years old people was 11.6%.

Health and Health Service System in Indonesia

Health system in Indonesia follows hierarchy of referral system that is started from primary health services, secondary and tertiary health services. Generally, health service system in Indonesia was divided into 2 categories, i.e.: 1) Public health Service, and 2) Individual health service. Public health service works on areas that more likely to be public good like communicable disease control program, maternal and child health, environmental health, community nutrition improvement program, health promotion and family planning. While the individual health service works on areas that more likely to be curative and rehabilitative services. According to the National Health System of Indonesia, The government should provide health service that comply the following principles: comprehensive, sustainable, quality, safe, Need and demand based, equitable, apportionment, non discriminative, accessible, effective technology, teamwork, fast and appropriate. It should assure the access of health service for all Indonesian around country especially for poor people, those in remote areas, cross country border, outer part islands and the service that is not attracting private to provide.

For