Health Services

Health Financing
Health Utilization
 Health services unique
• Uncertainty, (ketidakpastian – power relasi?)
• Asymetri of information, (informasi tidak
seimbang) consumer ignorance (ketidak
tahuan konsumen) siapa yg menguasai
informasi?
• Supply induce demand (“permintaan yang
dipaksaan terhadap konsumen”)
• Externalities (dampak yg ditanggung pihak
lain/kena orang banyak)
 Public Finance Challenge
Pure Private Goods

Curative
Cosmetic Surgery

Kidney Dialysis

2nd class VIP Class

Area Public Subsidy
Family Planning

Vector Control

Preventive Water Supply Most Resources flow

Pure Public Goods

 Jenis Eksternalitas
• Seringkali sistem pasar gagal menghasilkan efisiensi, dan efek
samping yang dihasilkan disebut eksternalitas (externalities)
– Externalitas: Dampak dari aktivitas (benefits or costs)
terhadap individu, dimana individu tersebut tidak secara
langsung terlibat dalam aktivitas tersebut
– Eksternalitas: memberikan dampak negatif (negative
externality); memberikan dampak positip disebut positive
externality.
 Structures for financing and
reimbursing healthcare
• Three main methods of financing health care:
– private health insurance
– social health insurance
– taxation
• Two main methods of reimbursement:
– Retrospective reimbursement, gives weak incentives
for cost containment
– Prospective reimbursement, which can take two
forms: global budgeting and prospectively set costs
per case
 Healthcare systems
Models of Countries using
Healthcare Properties
the model
Systems

Canada, Denmark, Finland,

Taxation-funded Greece, Italy, Norway,
Public model Portugal, Spain, Sweden,
public health service
UK

Public and private providers Austria, Belgium, France,

Mixed model reimbursed by competing Germany, Japan, The
compulsory insurance funds Netherlands, Switzerland

Private healthcare funded USA

Private insurance through premiums paid
into private insurance
model companies
 Public model
Compulsory income -
related contributions or
general taxes
Public insurance or
funding bodies
First level
providers
(gatekeepers)

Second level
providers
(specialist)
 Mixed model
Compulsory income -
related contributions
Public insurance or
private bodies

First level
providers

Fee for service

payments

Second level
providers
 Private model

First level
providers
Consumer
(patients) Voluntary fee
for service payments

Second level
providers
 Kepemilikan Jamkes Tahun 2014
BPJS Kesehatan Jumlah %
PBI 96.000.000 39,2
PNS + Pensiunan +Vet 17.300.000 7,1
Jamsostek 5.600.000 2,3
TNI POLRI aktif 2.200.000 0,9
121.100.000 49,4

Non BPJS Kesehatan Jumlah %

Jamkesda 31.866.390 13,0
asuransi Perusahaan 15.351.532 6,3
Asuransi Swasta 2.856.539 1,2
50.074.461 20,4

total jamkes 2014 171.174.461 69,9

belum punya jamkes 73.847.239 30,1
2014 penduduk 245.021.700 100
10
Determinants of HC utilization
Determinants of HC utilization
Determinants of HC utilization
Determinants of HC utilization