DEVELOPING JPKM PROGRAM in A DECENTRALIZED SETTING

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DEVELOPING JPKM PROGRAM in A DECENTRALIZED
SETTING

• An Experience of Kalimantan Barat
• Pandu Harimurti
• The Province of Kalimantan Barat Health Office

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Kalimantan Barat At A Glance

• 4th Largest
• Low Population Density
• The number of Indigent Population
• Discrepancies in Health Status
• Prospective Payment Coverage

3
Health Sector Decentralization

• Govt Organization Re-structuring
• - Various ways to perceive JPKM Program
• Shift of responsibility (in financing)
• - budding awareness of health as investment
• - generating revenues, effective allocation,
• and mobilizing resources

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JPKM Development

• Dana Sehat based JPKM Program
• JPKM JPS-BK
• Post JPS-BK JPKM

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Dana Sehat-based JPKM Program

• Dana Sehat (Health Funds ) ? Bapels
• Supports Trainings Technical Assistance
• Stunted growth
• The Number of HF Groups
• Coverage

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JPKM JPS-BK

• Health Component Social Safety Net (JPS-BK) ?
  Emergency efforts
• Forming of Pra-Bapels ? recruit non poor ? self
  suffcient Bapels
• Bapims Oversight
• The funds stopped ? Most Pra Bapels

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JPKM JPS-BK (2)

• Problems identified
• The Concept of JPKM not yet fully developed and
  understood
• Requirements for License
• Managerial capacity

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Post JPS-BK JPKM

• Existing Pra Bapel
• Managerial capacity
• Individual enrollees
• Weak Premium Collection mechanism
• Provider payment system
• New district formations

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Post JPS-BK JPKM (2)

• Each Districts is expected to develop at least
  1 Bapel
• Problems
• - Capital for Bapel start-ups
• - Hospitals refusals to be capitated
• - Lack of technical competence both
• Bapels and Bapims personnel

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CHALLENGES

• Decentralization related
• Not-yet-redefined Govt Roles ? esp in Health
  Financing
• Different ways of viewing the JPKM program
• JPKM Program in district health office
  organization structure
• Inadequate capacity of Bapims / Bapels

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CHALLENGES (2)

• JPKM Concept related
• The initial concept
• Limited provider weak bargaining power and
  ability to control, also uninviting benefit
  packages
• Capitation as the only prospective payment
• Bapims role is far from expected

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OPPORTUNITIES

• Health Financing System Development
• - JPKM as the main component
• Regulations Development
• - Districts role in protecting the poor
• - Essential health services
• - Regulations on JPKM operation
• Role of Private Sector

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CONCLUSIONS

• Decentralization has brought both challenges and
  opportunities
• JPKM program still has problems in its concept
• Pre-conditioning is required
• JPKM is inseparable from developing a Health
  Financing System

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THANK YOU !