ENGLISH Version FINAL infografis KESEHATAN

CHALLENGES TO IMPLEMENTING
THE NATIONAL HEALTH INSURANCE PROGRAMME
Supply Side Challenges
Diagnosed Hypertension and
Unmet Needs by Province
45.0
40.0
25.0
20.0
20.0
15.0
15.0
10.0
10.0
5.0
5.0
EAST PAPUAR
LAMPUNG
LAMPUNG
PAPUA
DKI JAKARTA
BANTEN
NORTH SULAWESI
EAST JAVA
ACEH
NORTH SUMATRA
EAST KALIMANTAN
EAST KALIMANTAN
GORONTALO
KEPRI
NTT
SOUTH SULAWESI
NORTH MALUKU
EAST SUMATRA
BALI
CENTRAL KALIMANTAN
JAMBI
SOUTH EAST SULAWESI
MALUKU
SOUTH SUMATRA
NTB
RIAU
DI YOGYAKARTA
BABEL
32
Shortage
Lampung,
Central Java,
East Java, West Java
25.0
CENTRAL SULAWESI
Critical
30.0
EAST SULAWESI
Yogyakarta & Riau
30.0
WEST SULAWESI
EAST JAVA
2
10
35.0
Sick
Treated
.............................................................................
By 2019 almost all provinces will experience a shortage
of doctors, hospitals & nurses
Surplus
40.0
35.0
SOUTH KALIMANTAN
People continue to have to queue to receive medical care
45.0
12
Surplus
West Papua, Papua, NTB,
Yogyakarta, East Java,
West Java East Sulawesi,
Banten, Babel, Bengkulu
Critical
24
Shortage
South Sulawesi,
Lampung, DKI Jakarta,
Central Jawa
22
Shortage
Sources : Riskesdas 2010
The biggest
shortage will be
felt in the supply
of doctors.
Surplus
East Papua, Papua,
North Maluku, North Sulawesi,
Central Sulawesi,
North Kalimantan,
East Kalimantan, East Sulawesi,
DKI Jakarta, Bengkulu, Riau,
Aceh
Provinces that enjoy a
surplus continue to be
plagued by uneven
distribution and quality.
Though there will be a
surplus of midwives,
uneven distribution and
quality will continue to
be a challenge
Critical
Lampung, South Sulawesi
Central Java, East Java
............................................................................................................................................
Doctor
Hospitals
2
Generic Drugs are More Expensive
in Indonesia than in other Developing
Nations
$
$
12.03
12
9
Struktur Harga Obat Generik Bermerek di Indon
8.92
7
Biaya Produksi, Penjualan, Pemasaran, Pajak dan Keuntungan Ret
8
6
6
5
4.97
4
4
2.51
3
Contoh:Struktur
Harga Metformin Bermerk
2
1.28
1.14
Affordable price
9.32
8
10
Ensuring availability
of medicines
Struktur
Harga
Obat Generik
Bermerek
di
Indonesia
Availability
of
Metformin Raw Material Price
6%
3
Biaya Produksi, Penjualan, Pemasaran, Pajak dan Keuntungan
Retail
0.3%
appropriate drugs
Indonesia
Brazil
India
Germany
France
INN Generic Drugs are Cheaper
in Indonesia than in other Countries
(Single Buyer)
14
Tantangan Utama Penyediaan Obat
Untuk Program JKN
1
...........................................................................................................
Challenges to supplying medicines
under the JKN programme
Nurses
0.82
0
0.01
0.58
0.53
0.09 0.13
1.84
2
1.52
0.49
0.01 0.02 0.05 0.02
....................................................................................
10%
17%
8%
Cefotaxime
(dry vial 1g)
Terbutaline
(amp 500Y/1L)
Valsartan
(tabImport
80 mg)
Paclitaxel
(vial 6 mg/1 ml)
Duty
1
Source: TNP2K dan IMS Indonesia
Cefotaxime
(dry vial 1g)
Metformin
(tab 500 mg)
Manufacturing Cost
Improvement of National Drug
Distributor
Discounts
3% Drugs in Indonesia
Contoh:Struktur
Harga
Metformin
Bermerk
Price
Structure
of
Branded Generic
Procurement System
Employee & Overhead Cost
Metformin Raw Material Price Sales & Marketing
6%
12%
0.3%Sales & Marketing Cost
17%
8%
18%
10%
......................................................
Import Duty
Manufacturing Cost
3%
Distributor Discounts
Sales &
Irrational Drug Prescription
Sales & Marketing Employee & Overhead Cost Marketing
12%
Sales & Marketing Cost
Antibiotic Use Admin Employee & Overhead
4%
6%
Pharma Company Profit
19%
Distributor Margin
18%
Pharma Company Profit
9%
Admin Employee & Overhead
VAT
7%
9%
Retailer Margin
4%
6%
18%
VAT
54%
19%
54%
Production
cost
Biaya produksi
Sales
& marketing
Sales
& marketing
Profits
Profit
9%
100%
Source: TNP2K
Tax
Pajak
.....................................................................................
7%
Distributor Margin
Consumer Price
Biaya produksi
VAT
Sales & marketing
Procurement System at
Retailer Margin
Profit
Drug Distribution Facilities
Implementation: Challenges
VAT 2014 e-Catalogue
in Indonesia
9%
Pajak
Consumer Price
Cephalosporins & Combos (Level 3)
Broad Spectrum Penicillin (Level 1)
Source: Drug Availability Study in JKN Era – TNP2K, Harvard Medical School, and IMS Indonesia 2014
18%
100%
Role of the Health Ministry
22
Plan Plan
for the
for the
needneed
for drug
for drug
33
Drugs
Management
Drugs
Management
Information
System
Information
System
11
National
National
Formularium
Formularium
LKPP Role
44
Implementation
of of
Implementation
the ecatalogue
the
e- catalogue
system
system
55
Other
Mechanisms
as stated
Other
Mechanisms
as stated
in Presidential
Regulation
in Presidential
Regulation
70/2012
70/2012
1
2
3
Direct
Procurement
Sumber: TNP2K
Tender
e-Cataloque
NATIONAL TEAM
FOR THE ACCELERATION OF POVERTY REDUCTION