Actuarial Costing of Universal Health Insurance and Coverage in Indonesia
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World Bank, Washington, DC
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This series is produced by the Health,
Nutrition, and Population family (HNP) of the World
Bank's Human Development Network (HDN). The papers in
this series aim to provide a vehicle for publishing
preliminary and unpolished results on HNP topics to
encourage discussion and debate. The cost of a health
insurance program will largely be determined by the size and
composition of the covered population, the benefit package,
cost sharing arrangements, the current and future supply of
health care providers and facilities, and the provider
payment mechanisms used. This note summarizes in broad
strokes the subset of the possible Universal Coverage (UC)
transition scenarios and their related costs in Indonesia.
These scenarios were selected based on initial discussions
with key stakeholders, and further broad-based discussion
with stakeholders will be needed to finalize the design,
financing and transition options. This note shows how
decisions regarding the transition steps, benefit package
and the choice of eligible population affect public Health
Insurance (HI) expenditures as Indonesia transitions to UC.
This work follows closely the earlier World Bank report
health financing in Indonesia; a road map for reform.
Palabras clave
ABORTION, ACCESS TO HEALTH CARE, ADMINISTRATIVE COSTS, ADMINISTRATIVE EXPENSES, ADVERSE SELECTION, AGE DISTRIBUTION, AGE GROUPS, AGING, ANTENATAL CARE, ANTENATAL VISITS, BASIC HEALTH SERVICES, BEDS, BURDEN OF DISEASE, C-SECTION, C-SECTIONS, CAPITAL COSTS, CAPITATION, CAPITATION FEE, CAPITATION PAYMENTS, CENTRAL BUDGET, CHILD CARE, CHILD HEALTH, CHOICE OF PROVIDERS, CITIES, CITIZENS, CLINICS, COMPLICATIONS, COST CONTROL, COST OF CARE, COST OF MEDICAL CARE, COST SHARING, COST-SHARING REQUIREMENTS, COSTS OF CARE, DECISION MAKING, DELIVERY SYSTEM, DEMAND FOR HEALTH, DEMAND FOR HEALTH SERVICES, DEMAND FOR SERVICES, DEVELOPING COUNTRIES, DOCTORS, ELDERLY, EMPLOYMENT, EPIDEMIOLOGICAL CHANGES, EPIDEMIOLOGY, EQUAL TREATMENT, EXPENDITURES, EXPENSIVE FACILITIES, FEE FOR SERVICE, FEE SCHEDULE, FEE SCHEDULES, FINANCIAL BARRIERS, FINANCIAL CATASTROPHE, FINANCIAL IMPACT, FINANCIAL INCENTIVE, FINANCIAL RISK, FREE CHOICE, GROSS DOMESTIC PRODUCT, HEALTH CARE, HEALTH CARE EXPENDITURES, HEALTH CARE FACILITIES, HEALTH CARE FINANCING, HEALTH CARE PROVIDERS, HEALTH CARE RATIONING, HEALTH CARE SPENDING, HEALTH CARE SYSTEM, HEALTH COST, HEALTH COVERAGE, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH FINANCING, HEALTH INSTITUTIONS, HEALTH INSURANCE, HEALTH INSURANCE PROGRAM, HEALTH INSURANCE SCHEME, HEALTH INSURANCE SYSTEM, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROGRAMS, HEALTH PROMOTION, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH SPENDING INCREASES, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH SYSTEMS STRENGTHENING, HOLISTIC APPROACH, HOSPITAL, HOSPITAL BEDS, HOSPITAL OUTPATIENT SERVICES, HOSPITALIZATION, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, ILLNESS, IMPROVEMENTS IN SERVICE QUALITY, INCOME, INCOME COUNTRIES, INCOME GROUPS, INFORMAL SECTOR, INFORMAL SECTOR WORKERS, INPATIENT CARE, INSURANCE PREMIUMS, INSURERS, INTERNATIONAL COMMUNITY, LACK OF INFORMATION, LIVE BIRTHS, LOCAL GOVERNMENTS, LOW INCOME, MANAGED CARE, MATERNAL DEATH, MATERNAL HEALTH, MATERNAL HEALTH CARE, MATERNITY CARE, MATERNITY SERVICES, MEDICAL CARE, MEDICAL CARE COSTS, MEDICAL CONDITIONS, MEDICAL COSTS, MEDICAL EQUIPMENT, MEDICAL EXPENSES, MEDICAL INSURANCE, MEDICAL PROCEDURES, MEDICAL SERVICES, MEDICAL SYSTEM, MEDICAL TECHNOLOGIES, MEDICAL TECHNOLOGY, MEDICINES, MIDWIFE, MIDWIVES, MINISTRY OF HEALTH, MORAL HAZARD, MORTALITY, NATIONAL GOVERNMENT, NATIONAL HEALTH, NATIONAL HEALTH INSURANCE, NATIONAL LEVELS, NATIONAL POLICY, NATURAL RESOURCES, NUMBER OF BIRTHS, NUTRITION, OUTPATIENT CARE, PATIENT, PATIENTS, PAYMENTS FOR HEALTH SERVICES, PHYSICIANS, POLICY DECISIONS, POLICY MAKERS, POOR HEALTH, POPULATION DISTRIBUTION, POPULATION INCREASE, POPULATION PROJECTIONS, PRACTITIONERS, PREGNANCIES, PREGNANT WOMEN, PRESCRIPTION DRUGS, PRIMARY CARE, PRIVATE DOCTORS, PRIVATE HEALTH INSURANCE, PRIVATE HEALTH SERVICES, PRIVATE HOSPITALS, PRIVATE INSURANCE, PRIVATE INSURANCE POLICIES, PRIVATE INSURERS, PRIVATE SPENDING, PROGRESS, PROVIDER PAYMENT, PUBLIC EXPENDITURE, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC HEALTH INSURANCE, PUBLIC HEALTH PROGRAMS, PUBLIC HEALTH PROVIDERS, PUBLIC HEALTH SERVICES, PUBLIC HEALTH SPENDING, PUBLIC HEALTH SYSTEM, PUBLIC HOSPITALS, PUBLIC INSURER, PUBLIC PROVIDERS, PUBLIC SERVICES, PUBLIC SPENDING, PUBLIC SUPPORT, QUALITY CONTROL, QUALITY OF CARE, QUALITY OF SERVICES, QUALITY SERVICES, RADIOLOGY, REIMBURSEMENT RATES, RICHER COUNTRIES, RURAL AREAS, SERVICE PROVISION, SEX, SEX DISTRIBUTION, SOCIAL HEALTH INSURANCE, SOCIAL ISSUES, SOCIAL SECURITY, SOCIOECONOMIC STATUS, SUPPLY OF HEALTH CARE, SURGERY, TRANSPORTATION, UNIVERSAL HEALTH INSURANCE COVERAGE, URBAN AREAS, VULNERABLE GROUPS, VULNERABLE POPULATIONS, WORKERS, WORLD HEALTH ORGANIZATION, YOUNG AGES