Interview: Dr Endang Rahayu Sedyaningsih
How has the Jamkesmas programme been implemented and what has been achieved to date?
ENDANG RAHAYU SEDYANINGSIH: Jamkesmas is targeted at the poor with the aim of providing increased access to health care and financial protection for the poorest citizens. It offers a comprehensive benefits package, including inpatient and outpatient care, as well as maternal care. In terms of medication, enrolees are entitled to coverage for drugs from specific formularies and preferably opt for generic drugs when filling prescriptions. The Jamkesmas scheme is funded by the central government from general tax revenue. Beneficiaries are not responsible for premium payments nor are they charged a co-payment at the time of visit. The utilisation of health care services both in primary care and hospitals has increased dramatically. Our target population is defined using an administered national survey. We obtain a quota of those eligible from the Central Bureau of Statistics and then receive their names and addresses from local authorities. We distribute the cards and register enrolees into the programme, assisted by ASKES, a health insurance specialist company. Since its enactment, and more specifically over the past couple of years, we have been able to provide coverage for 76.4m people. The scheme contracts with more than 1000 hospitals for service provision, including 320 private hospitals. Total utilisation of services has also increased by 50% for ambulatory care and about 106% for inpatient care.
What plans are there to improve the quality of health care provision in the regions?
SEDYANINGSIH: In addition to hard infrastructure our main concern continues to be the lack of human capital. We are not only facing problems in terms of the number of doctors and practitioners but also in terms of their geographical distribution. Two-thirds of Indonesia’s doctors are based in Java, with almost 30% of them operating in Jakarta. That leaves many of the country’s medical facilities understaffed. Our aim is to make sure that both the necessary infrastructure and medical professionals are provided to improve the national health system. We are taking steps to address this issue, and we, along with local authorities, are providing incentives to doctors to encourage them to relocate to remote areas of the country. We have developed a programme under which newly graduated practitioners are deployed in rural regions, especially in eastern Indonesia, for a one-year term. We educate them in a specialisation under the condition that once they graduate they will return to their regions to practice medicine.
How do you address the concerns of foreign pharmaceuticals companies regarding manufacturing requirements and intellectual property protection?
SEDYANINGSIH: Legislation was introduced which requires companies to manufacture drugs in the country in order to receive a registration number for that drug and distribute it legally. The law was implemented to serve as a level of protection for the consumer and ensure a standard of quality. Some have argued that as a result of economic inefficiencies this law has prevented the availability of certain pharmaceuticals. However, the fact is that the law also states that if the drug is deemed necessary for Indonesia, it does not require manufacturing facilities to be located here. Multinationals should view this legislation as an opportunity to partner with local companies and establish manufacturing facilities with the aim of reducing their costs for both themselves and for their customers.
We acknowledge that industry legislation encourages foreign pharmaceutical companies to partner with local organisations primarily due to foreign ownership limitations. This does present certain challenges with regard to intellectual property rights. We admit that there are some flaws in terms of enforcement, but we continue to work to make the system as transparent as possible. We must work diligently to provide reassurance to multinationals that they can operate without risk and under complete and full legal protection.
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