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The Republic of Indonesia Health System Review Health Sy Health Systems in Transition Vol. 7 No. 1 2017 s t ems in T r ansition Vol. 7 No. 1 2017 The Republic of Indonesia Health System Review The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, The Republic of Indonesia Health System Review foundations, and researchers that promotes evidence-informed health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity. ISBN-13 978 92 9022 516 4 OF THE C PHIL LI IP B P U IN P E E S R D* * E H P T F LI L LO U R OP A EAT S P R SALUBRITA A T E M OF H ENT Health Systems in Transition Vol. 7 No. 1 2017 The Republic of Indonesia Health System Review Written by: Yodi Mahendradhata, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada Laksono Trisnantoro, Universitas Gadjah Mada Shita Listyadewi, Center for Health Policy and Management, Universitas Gadjah Mada Prastuti Soewondo, School of Public Health, University of Indonesia Tiara Marthias, Center for Health Policy and Management, Universitas Gadjah Mada Pandu Harimurti, World Bank Jakarta John Prawira, Center for Health Policy and Management, Universitas Gadjah Mada Edited by: Krishna Hort, Nossal Institute for Global Health, University of Melbourne Walaiporn Patcharanarumol, International Health Policy Program, Ministry of Public Health Thailand Asia Pacific Observatory on Health Systems and Policies i WHO Library Cataloguing-in-Publication data World Health Organization, Regional Office for South-East Asia. The Republic of Indonesia health system review. Health systems in transition. Vol-7, Number -1 1. Health Systems Plans. 2. Health Status. 3. Economics, Medical. 4. Health Care Reform. 5. Public Health. I. Indonesia. ISBN 978-92-9022-516-4 (NLM classification: WA 540.1) © World Health Organization 2017 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from SEARO Library, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed in this publication are those of the authors and may not necessarily represent the decisions or policies of the World Health Organization. Printed in India ii Contents Preface .................................................................................................. ix Acknowledgements ............................................................................... xi List of abbreviations ............................................................................ xiii Abstract ............................................................................................. xxiii Executive summary ............................................................................xxiv Chapter 1 Introduction ........................................................................... 1 Chapter summary ........................................................................................ 1 1.1 Geography and sociodemography....................................................... 1 1.2 Economic context ................................................................................ 5 1.3 Political context ................................................................................... 8 1.4 Health status ......................................................................................12 Chapter 2 Organization and governance .............................................. 18 Chapter summary .......................................................................................18 2.1 Overview of the health system ...........................................................19 2.2 Historical background ........................................................................21 2.3 Organization .......................................................................................24 2.4 Decentralization and centralization ...................................................28 2.5 Planning .............................................................................................30 2.6 Intersectorality ...................................................................................34 2.7 Health information management ......................................................37 2.8 Regulation ..........................................................................................42 2.9 Patient empowerment .......................................................................60 Chapter 3 Health financing .................................................................. 65 Chapter summary .......................................................................................65 3.1 Health expenditure .............................................................................66 3.2 Sources of revenue and financial flows .............................................71 3.3 Overview of the public financing schemes ........................................78 3.4 Out-of-pocket payments ....................................................................92 3.5 Voluntary health insurance ...............................................................94 3.6 Other financing ...................................................................................97 3.7 Payment mechanisms ........................................................................98 iii Chapter 4 Physical and human resources .......................................... 106 Chapter summary .....................................................................................106 4.1 Physical resources ...........................................................................107 4.2 Human resources .............................................................................119 Chapter 5 Provision of services ......................................................... 132 Chapter summary .....................................................................................132 5.1 Public health ....................................................................................134 5.2 Patient pathways ..............................................................................150 5.3 Primary/ambulatory care .................................................................151 5.4 Inpatient care ...................................................................................156 5.5 Emergency care................................................................................158 5.6 Pharmaceutical care ........................................................................160 5.7 Rehabilitation/intermediate care .....................................................162 5.8 Long-term care ................................................................................164 5.9 Services for informal carers ............................................................164 5.10 Palliative care ...................................................................................164 5.11 Mental health care ...........................................................................165 5.12 Dental care .......................................................................................166 5.13 Complementary and alternative medicine (CAM) and traditional medicine ..................................................................168 5.14 Health services for specific populations ..........................................169 Chapter 6 Principal health reforms ................................................... 170 Chapter summary .....................................................................................170 6.1 Analysis of recent reforms ...............................................................171 6.2 Future developments .......................................................................200
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