Indonesia’s Health Profile: Poor Health provides Great Opportunities for Healthcare Improvement

Healthcare spending in 2015 in Indonesia was equal to 2.8% of GDP. This is a return to increased spending, after reflecting a declining trend over the past 4 years. In absolute terms, healthcare expenditure is equal to €17.8 bn, and €69.3 per capita.

Presentation of the Indonesian healthcare market and organization

Indonesia scores poorly on many healthcare parameters such as health status, infrastructure, access to medical services, quality, equity, etc.

The single factor which will dominate the dynamics in the Indonesian healthcare context is the roll out in 2015 of the Jaminan Kesehatan Nasional reform (JKN, i.e. National Health Insurance Program) to be completed by 2019. The JKN is part of a broader reorganization of social security in the country, named Sistem Jaminan Sosial Nasional (SJSN, i.e. National Social Security System).

JKN aims to be a universal health insurance program and will gradually replace a series of (for-profit) programs.

This will have a substantial impact on many aspects, such as the accessibility of care services, the financing of the system, the income stream of care providers, the re-organization of administration and infrastructure, etc.

One of the targets of the new program is to improve the performance and accessibility of the Indonesian healthcare system.

Other key trends which will shape the Indonesian healthcare landscape in the coming 3 years are the expanding middle class and the increasing urbanization. These result in fast growing needs related to better access to and quality of medical care.

Currently, the Indonesian healthcare system suffers from structural issues such as underfinancing, low density of care providers and of hospitals, limited access to drugs in rural areas, and overall inaccessibility and inequity of care provision.

The utilization levels of the Indonesian healthcare infrastructure are very low because of the wide spread poverty, the lack of availability, the low confidence levels patients have in hospital and physician care, and the corruption, amongst other factors.

More than 1 out of 10 hospital admissions happens in private hospitals in Malaysia or Singapore. 35% of the healthcare expenditures by Indonesians are spend abroad.

Needless to say, the upcoming reforms and changes in the demographic and social profile of the country will put substantial pressure on the government budgets for years to come. The patient co-payment which accounts for around 40% of the healthcare expenditures is expected to go up further and reach over 50% in 2017.

Health indicators from childbirth, to morbidity, and mortality

Indonesia is among the worst scoring countries in Asia for most healthcare indicators such as life expectancy, infant mortality rates, maternal mortality, and the population living in poverty or near poverty.

Chronic diseases and cancers are the fastest growing causes of death in the country. By 2020 chronic diseases will be in second position (with 26%) and cancer will have gone up to 16%, causing deaths nationwide.

Mortality and life expectancy

  • Life expectancy at birth is around 70 years, which is lower than in countries like Tunisia, Egypt and Turkey. Within Indonesia life expectancy can vary up to 15 years; e.g. in West Nusa Tenggara the expectancy is around 61 years old, and around 76 in Yogykarta.
Indonesia life expectancy
Indonesia life expectancy
  • Infant mortality is around 23 per 1000 live births.
    • Diverse local beliefs (in God, magic and fate) strongly affect maternal and newborn care practices. Belief in the value of modern medicine for the wellbeing of newborns is growing, yet far from widespread.
    • Cost, availability and quality concerns remain further barriers to using “Western” qualified medical care.
    • There is a village-midwife program to boost birthing safety and reduce infant mortality.
Indonesia infant mortality
Indonesia infant mortality

Causes of death

  • The main causes of death are coronary heart disease, influenza and pneumonia, stroke, lung disease and tuberculosis.
  • Low birth weight represents 2.1% of the deaths.
Indonesia causes of death
Indonesia causes of death

Communicable diseases

  • Approximately 700,000 people are living with HIV in Indonesia and 0.5% of the working population lives with HIV.
  • Around 35,000 people died due to AIDS in 2015.
  • 324,600 total TB cases reported in 2015, including new and relapsed patients.
  • 10,000 deaths annually are attributed to malaria, and several millions are infected by it.
  • Immunization programs include: polio (to maintain the polio-free status), measles, and new vaccines such as HiB, Rubella, Japanese Encephalitis, Rotavirus, Pneumococcal, IPV, and Influenza.
  • Some religious communities are categorically opposed to vaccinations, which raises the risk of previously eradicated diseases resurfacing.

Life style health indicators

  • Approximately 35% of the population smokes on a daily basis in Indonesia.
  • Indonesia ranks towards the higher end in regards to its overweight and obesity prevalence amidst Southeast Asian nations. Around 27% of the population is overweight and 7% is obese.
  • Alcohol per capita consumption is around 7 l of pure alcohol. (In comparison, Germany has a per capita consumption of 14.5 l, and India around 28 l.)
  • 6% of children under the age of 5 years old are considered underweight. This appears within average ranges for a lower middle income nation. In comparison, Malaysia has a 13% prevalence and the Philippines has 20.5%.
  • There are around 10 m diabetes patients in Indonesia, equal to around 6.5% of the population. Additionally, around 5,300 inhabitants are estimated to be undiagnosed. 185,000 adults died in 2015 due to diabetes.

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