In 2004 the Indonesian government made a commitment to provide its entire population with health insurance coverage through a mandatory public health insurance scheme. It has moved boldly already provides coverage to an estimated 76.4 million poor and near poor, funded through the public budget. Nevertheless, over half the population still lacks health insurance coverage, and the full fiscal impacts of the government's program for the poor have not been fully assessed or felt. In addition, significant deficiencies in the efficiency and equity of the current health system, unless addressed will exacerbate cost pressures and could preclude the effective implementation of universal coverage (Ue and the desired result of improvements in population health outcomes and financial protection. For Indonesia to achieve UC, systems' performance must be improved and key policy choices with respect to the configuration of the health financing system must be made. Indonesia's health system performs well with respect to some health outcomes and financial protection, but there is potential for significant improvement. High-level political decisions are necessary on key elements of the health financing reform package. The key transitional questions to get there include: [ the benefits that can be afforded and their impacts on health outcomes and financial protection; [ how the more than 50 percent of those currently without coverage will be insured; [ how to pay medical care providers to assure access, efficiency, and quality; [ developing a streamlined and efficient administrative structure; [ how to address the current supply constraints to assure availability of promised services; [ how to raise revenues to finance the system, including the program for the poor as well as currently uninsured groups that may require government subsidization such as the more than 60 million informal sector workers, the 85 percent of workers in firms of less than five employees, and the 70 percent of the population living in rural areas.

The global movement toward universal health coverage (UHC) is accompanied by requests for large increases in government health spending in some countries. This combined with the global economic situation and stagnant economic growth across many low- and middle-income countries make it more critical than ever to place health financing discussions firmly in the context of macroeconomic and fiscal realities. Unfortunately, there is often a disconnect in decision making, with key fiscal decisions made in the absence of a clear understanding on the one hand of the potential consequences for the health sector, and on the other, the consequences for the country’s macroeconomic and fiscal position of increasing or reallocating government spending. Constructive health financing policy dialogue aims to reach a common understanding between health sector leaders and central budget authorities about policy objectives for the health sector and the resources needed to achieve those objectives, how much priority will be given to health in the government budget, and how the health sector will be held accountable for using funds effectively. This common understanding should be built on a realistic picture of the country’s macroeconomic and fiscal context, the constraints and competing priorities in the budget-setting process. When ministries of health and ministries of finance have a common understanding of macroeconomic and fiscal constraints, discussions can focus productively on using funds within the potential health resource envelope in the most effective way to achieve health system objectives. This guidance note outlines the key components of the macroeconomic, fiscal, and public financial management context that need to be considered for an informed health financing discussion at the country level. The guidance note is organized around four sets of questions that are key to placing the health financing dialogue in the context of a country’s macroeconomic and fiscal context. Each section points to measures, resources, and analytical tools that are available to assist in answering these questions for a specific country. The guidance note draws on case studies from 11 countries moving toward or sustaining universal health coverage conducted as part of the Japan†“World Bank Partnership Program on UHC as well as from other country examples.

One of the most urgent development challenges facing many low and middle income countries is the need for adequate financing systems to pay for health care provision to the estimated 1.3 billion impoverished people living in rural areas or working in the informal sector in urban areas. This publication considers ways of improving the financing of health care at low income levels, as part of a global strategy for increased investment in health and poverty reduction. Topics discussed include: global and regional trends in healthcare financing; strengths and weaknesses of community-based health financing, and experiences in Asia and Africa; country case studies using household survey analysis from Senegal, Rwanda, India and Thailand; deficit financing; and the impact of risk sharing on achieving health system goals.

This report summarize the experience since 2008 of the global efforts coordinated by the World Bank to use National Health Accounts (NHA) to better assess sources and allocation of public, donor and private health expenditures and inform countries' health financing policies.

This report assesses how Indonesia is implementing the United Nations Sustainable Development Goals (SDGs) at the subnational government (SNG) level, identifies gaps and good practices, and outlines ways to speed up progress. It assesses the funding mechanisms and robust legal frameworks governing Indonesia’s SNGs and tracks a consistent pattern of progress across its provinces towards most of the SDGs. The report shows why Indonesia needs to find ways to accelerate progress in disadvantaged regions such as Papua, ramp up institutional capabilities, and drive partnerships with the private sector to ensure its SNGs reach the SDG targets.

This report highlights how financial technology or fintech can be leveraged to improve health systems and outcomes. A “Fintech for Health” approach integrates digital financial services with health innovations to help solve health-care affordability, quality, and access challenges. It can be powerful in enabling people to gain access to health care and in preventing health-related bankruptcy. The report draws on examples of this approach from Indonesia, the Philippines, and Singapore. It considers the enabling environment, challenges, future opportunities, and how Fintech for Health can be adapted to diverse contexts to help promote universal health coverage.

Understanding the nexus between employment, living standards and poverty is a major challenge in Indonesia. Trends in poverty are heavily dependent on labour market opportunities and social spending in education and health. The question is how to create opportunities and spend money wisely - a subject of intense debate in Indonesia. The government has brought a renewed focus to poverty reduction since the end of the Asian financial crisis, especially under the current president, Susilo Bambang Yudhoyono. This book shows how Indonesia is travelling with regard to employment, social policy and poverty. It identifies promising new directions for strategies to alleviate poverty, some of which are already showing results.

Despite significant improvements in many health outcomes over the past 60 years, many chronic problems in Indonesia’s health system including financial sustainability, governance and inequities in accessing health care have long been apparent, even before the COVID-19 pandemic. The epidemiological transition associated with demographic and socioeconomic change in recent decades makes Indonesia one of many countries that still struggle to address the issues of communicable, maternal and nutritional diseases while facing an increasing burden of non-communicable diseases. The contributors to In Sickness and In Health: Diagnosing Indonesia investigate challenges and opportunities facing the Indonesian health system and assess hurdles that Indonesians have to navigate in their quest to achieve a longer and better quality of life. Politics shaping recent health policy reforms in Indonesia, barriers to the supply of specialist doctors and quality medicines, availability of accurate health and population data, and the financial toll of the COVID-19 pandemic are among the topics discussed in this book. Accessing essential health services for mothers and children and for those living with disability, discrimination and mental illness, as well as an innovative trial to control dengue, are also examined.