Social Health Insurance Development
Social Health Insurance Development as an Integral Part of the National Health Policy:
Recent Reform in the Indonesian Health Insurance System
** Deputy Coordination for Social Welfare, Coordinating Ministry for People's Welfare the Republic of Indonesia,
dan diaktifkan untuk melihatnya
The concept of Social Health Insurance (SHI) has the potential to achieve universal coverage to ensure that every
body will get access to medical care he/she needs. In line with the Indonesian National Health Policy that has
put the rights to health care in the Constitution amended in 2002, recently the Indonesian government has reformed
the National Social Security Law that also provides the foundation for a National Health Insurance Program (NHIP)
is enacted on October 19 th , 2004.
The concept of social health insurance has been poorly understood in Indonesia. Most people understand social health
insurance as program for the poor. This misunderstanding has caused difficulties in introducing Social Health Insurance
in Indonesia; even though a social health insurance program for the government employees has been implemented since
1968, and a social health insurance program for private employees since 1992. Several International organisations,
such as GTZ, European Union, ILO, and WHO provided technical assistance to expand health insurance through social
security reform. The new Cabinet chaired by President Susilo Bambang Yudoyono has a strong commitment to provide
access to health care for every body, a policy that is in line with the concept of social health insurance. As
a start, the Ministry of Health has insured about 60 million of the poorest Indonesians by paying their contributions
to Askes, the insurance scheme for civil servants. The paper will discuss the existing implementation of SHI in
Indonesia, the expansion of coverage to 60 million poorest Indonesians, and the political process and economic
feasibility for expansion of social health insurance coverage for 220 million people. A qualitative analysis will
be presented on political process, conflict of interests, oppositions, and prolonged debates on the expansion of
coverage as a National Health Policy. Short-term evaluation of the existing policy will also be discussed.
UNFPA ( UnitedNations
Paper on Older people In Indonesia:
Population ageing, defined as an increase in
the proportion of older persons (those aged
60 years and above) in the total population has occurred all over the world. In developed countries, population
ageing occurred over a time span of more than a century and hence these countries were able to prepare themselves
for an aged society.
In Indonesia too, population ageing has started emerging as a distinct demographic feature and the proportion of
older persons, which remained around 6 per cent during the period 1950-1990, now exceeds 8 per cent and is projected
to rise to 13 per cent by 2025, and further to 25 per cent by 2050. This means that by 2050 one in four Indonesians
would be classified as an older person, compared to one in twelve at present.
The Demographics of ageing.
Population ageing in Indonesia is the result of the decline in fertility, increase in survival rates and improvements
in life expectancy. The absolute number of older people in Indonesia, both men and women, has increased from 4.9
million in 1950 to 16.3 million in 2000. By 2050 it will increase to 73.6 million. The demographic scenario Indonesia
faces to the year 2050 is therefore characterized by rapid increases in the older population.
Over the next five decades, while incremental changes to population below age 60 years will become smaller, incremental
changes to the older population will become larger. The changing age structure affects the balance between the
younger and older population. The total dependency ratio as well as the child-dependency ratio have been declining
since 1970 and will continue to do so, the former until 2025 and the latter until 2050. In 2050, it is estimated
that there will be 1.4 persons aged 60 years or over for every one person aged below 15 years.
Demographic profile of Indonesia'solder population
A notable aspect of the ageing process in Indonesia has been that the population of the "oldest old"
(aged 80 years or over) has been increasing faster than that of those aged between 60-79 years. What is more significant
is that with faster ageing in the next few decades, the proportion of the "oldest old" in the older population,
will increase from the current 7 per cent to nearly 10 per cent in 2025 and 16 per cent in 2050.
Women constitute a majority of the older population and, in most countries, an even greater majority of the oldest
old population. At present, nearly 60 per cent of Indonesia's oldest old are women and this proportion is expected
to increase to 64 per cent by 2030. While older persons should not stand in need of work, in Indonesia, as in most
developing countries where social security coverage is at best very limited, economic activity can be used as a
proxy for financial security and independence. In addition to a greater likelihood of being single in old age,
older women are also more likely to be economically inactive, having no income of their own. Only 30 per cent of
women aged 65 years or over are economically active as compared to 57 of men aged 65 years and over.
According to the 2000 Census, the proportion of the population aged 60 years or more is 7.9 per cent in the rural
areas and 6.2 in the urban areas. A greater degree of ageing in the rural population is despite the lower life
expectancy and higher fertility in the rural areas. The higher incidence of population ageing in rural areas can
therefore be attributed to patterns of rural-urban migration: more younger persons migrate to urban areas.
UNFPA Indonesia and Country Technical Services Team
for East and South-East Asia, Bangkok November 2007
UNESCAP Country Reports
for the Fifth Asian and Pacific Population Conference
"Population and Poverty in Indonesia"
While Indonesia has been able to reduce fertility and improve the overall quality
of life of the population, poverty still persists in many areas. It has even increased in some areas, particularly
since the 1997-1998 Asian financial crisis. However, even in area where fertility has declined there are still
areas and population subgroups which are in general poorer and for which access to health services, including reproductive
health/family planning services, remains inadequate. As a result, there has been a serious rethinking of the population-development
links in Indonesia during the decade that has elapsed since the convening of the Fourth Asian and Pacific Population
Conference in Bali in 1992.
The purposes of this country reports are: (a) to review the population and development situation, including issues
relating to reproductive health and gender equity, in Indonesia based on the goals contained in the Bali Declaration,
ICPD Programme of Action and other related documents and (b)
to highlight priority population issues relevant to Indonesia in the context of alleviating poverty and improving
the quality of life of the population. Each section will include a review of accomplishments, current status, priority
issues and future directions.
The country report is assembled to review the progress made, lessons learned and obstacles met in the implementation
of Bali Declaration on Population and Sustainable Development (1992), the Programme of Action of ICPD (1994) and
the key future actions adopted by the High-level Meeting in 1998.
Indonesia noted a close relation fragmented between and the outlined theme of the Conference and the aspiration
of Millennium Summit (2000) where our countries' leaders have set a target of reducing the proportion of people
living in absolute poverty by half by year 2015. Bearing in mind the goals and objectives of the UN Millennium
Declaration and the outcome of other major UN Conferences and summits and their reviews, in particular on population
and development, countries are obliged to strive to overcome the obstacles that block the implementations which
includes insufficient financial resources, weak commitments, inadequate institutional capacity and the protection
of vested interests.
The Conference is regarded as a momentum to re-augment both International community's concern, and in the same
virtue our national's as we perceive are experiencing diminution. Since 'population' and 'poverty' are complex
concepts and inter-sectoral issue in nature, therefore it is necessary also to disseminate and to promote pro-poor
population policy to be integrated into national long-term development strategy.
Since the economic crisis of 1997-1998 many Indonesian saw their standard of living drop sharply, and the number
of people living below the poverty line doubled over the course of the crisis. As a result, the implementation
of programme of works set out in some international commitments on population have been further impeded by shortfalls
in government's financial resources.
The effort to restore livelihoods and reduce vulnerability to poverty must
proceed at a variety of levels by ensuring that poverty reduction efforts are an integral element of recovery and
development programming at all levels.
Social development efforts should pay careful attention to demographic
matters, as well as to the culture and political environment. Re-augmenting public opinion to the significance
notion of 'population welfare' is currently of utmost importance. One of the most fundamental features of successful
and effective social programmes is political commitment in which governments
can play a decisive role in re-augmenting public concern on this matter. The awareness drives are needed to generate
a better understanding of complex inter-relationships between population and social development, particularly poverty
alleviation. Furthermore, the consistent implementation of integrated policy of population-based development will
eventually be resulting in the breaking of poverty-population-growth chain.
All the above efforts should ultimately be parallel with the exertion of maintaining and improving the quality
of public services, encouraging regional and local initiatives, followed by decentralized management, and preparation
for embracing wider concerns covering many more social aspects.
The Family and Older Persons in China, Indonesia and Thailand
With population ageing becoming a major issue in low fertility countries, the importance of the family as the traditional
means of support for the elderly takes on special significance. This publication assesses the current situation
and reports on surveys of the impact of household structure and living arrangements on the care and well-being
of older persons in China, Indonesia and Thailand. All three of these countries are expected to have relatively
large proportions of the population in the older age groups early in the next century. The publication contains
a set of implications for policy purposes.
Asian Population Studies Series No. 152
(ST/ESCAP/1998): 1999, 235 pages.