Asia Pacific Summit on Health Insurance (APSHI) 2010

Universal Coverage: Challenges and Opportunities

Sanur Paradise Plaza Hotel, Bali, October 21-23 2010

Background

In 1993, the United States was trying to catch up health care coverage by issuing a program named Health Security for America. This program was led by former First Lady Mrs. Hillary Clinton, now the State Secretary.  Tremendous efforts had been made, yet the universal coverage in the US was failed. For the last 30 years, the US has been behind other developed country in ensuring universal access to health care. Yet, the US already spent about US$ 7,000 per capita per year or 17% of its GDP for health care. The President Obama is now working hard to ensure universal coverage. Will it be successful? The history will tell us. But, there have been tremendous lessons to be learnt by other countries in the Asia and Pacific Region.
 
Several developing countries have achieved universal health coverage at relatively low income settings. Sri Lanka for example has been providing completely free health care at public hospitals to all citizens since 60 years ago. This country uses the National Health Service system that has been practiced in the United Kingdom after the World War II. Although the Sri Lankan income per capita has been below Indonesian income per capita, the commitment to continue providing universal coverage remains firmed.

Malaysia, another former British Colony, also copied the UK system by providing almost free health care to all citizens since its independence in 1957. All Malaysian pay only a nominal copayment of only RM 3 for outpatient care and only RM 5 for each day of hospitalization. The copayment covers everything from specialist consultation, laboratory examination, intensive care, radiology examinations, and all drugs. It is virtually free for the average income per capita of more than 7,000 international dollars.
 
Thailand also following Malaysian to provide universal health coverage for all citizens since 2001 through a combination of social health insurance and a government funded scheme.  Before the universal coverage system was implemented in Thailand, the Thai government had been trying various schemes to covered health care for the poor and near poor for about 20 years. However, all of innovations to mobilize financial sources from the informal sector were in vain.

The Philippines started to implement social health insurance since 1960 by mandating all salaried workers to join two separate national social health insurance schemes for private and public sectors. The coverage increased rapidly after the government unified the scheme into a National Health Insurance Program managed by PhilHealth started in 1997. Obstacles faced in the early periods such as fraud, lack of participations, shortage of fund and other operational problems in a decentralized government were succeeded finally. Nowadays the PhilHealth covers all workers, family members, overseas Filipino workers and their dependants.

Indonesia actually has started a social health insurance scheme since 1968 when all civil servants were mandated to contribute 5% of their salary to finance health insurance. This scheme is now known as Askes. But why, after more than 40 years, health coverage in Indonesia remains low? Almost 20 years ago, Indonesia introduced optional mandatory scheme of Jamsostek and health maintenance scheme modeled after the commercial Health Maintenance Organizations in the US. Indonesia also has introduced various schemes to cover the poor since big crisis of 1998. In 2004, Indonesia enacted the National Social Security Scheme aimed at paving the road for universal coverage. However, until now, there is no workable and feasible road map that can be used for guiding all stakeholders to achieve a universal coverage. Politically, the current Government has launched its will to achieve universal coverage by 2014, but how?

Developing countries in Asia need to learn from experiences of its neighbors to establishing a universal coverage. By learning from neighbors Asian countries could prevent for making unnecessary mistakes. The lessons would be very important for especially Indonesia that recently announces its commitment for universal coverage. Other countries in Asia are also struggling to provide universal coverage. Lessons of failures and success from one country need to be shared to other countries in term of strategies, costs, purchasing, controlling, and ensuring quality of care.

To facilitate taking lessons from Asia-Pacific regions, the Indonesian Association of Health Insurance and Managed Care (PAMJAKI) will conduct the Asia-Pacific Summit on Health Insurance with the Main Theme of Universal Coverage: Challenges and Opportunities. The Summit will be held in Sanur Paradise Plaza Hotel, Bali, October 21-23, 2010.

Goal and Objectives

To disseminate experiences of countries in Asia and the Pacific in achieving universal coverage.

The Objectives are as follow:

• Taking lessons from developed countries such as the United States, Germany, Japan, South Korea, and Australia to achieve universal coverage.
• Taking lessons from developing countries such as Thailand, the Philippine, Malaysia, China, and others.
• To discuss challenges and opportunities for developing countries in Asia to develop universal coverage
• To share lessons from all countries on how the UC is financed, how much is need to finance UC, what are the strategies to develop UC in centralized and decentralized health care system, how to purchase and how much to purchase health care from public and private providers, how to control utilization and expenditures, how to provide the most cost-effective drugs, and how to control quality of care.

Participants

Participants are expected to come from Ministry of Health, local governments, Social Security carriers, health insurance companies, public hospitals, private hospitals, universities, and other relevant stakeholders in Asia and the Pacific. It is expected that 800 participants (25% of which from out side Indonesia) will come and share their experiences.

The Schedule 21st - 23rd October 2010

Day 1:

October 21st. Opening address by the President/Vice President of Indonesia. Lessons learnt from developed countries: the US (it is expected that Mrs. Hilary Clinton will address the lessons), Germany, Australia, Japan and South Korea. Then eight parallels sessions will discuss technical details on specific topics on financing, purchasing, and payment system as attached schedule.

Day 2:

October 22nd. Lessons learnt from Middle Income and Developing Countries: Thailand, Malaysia, Philippine, Sri Lanka, Viet Nam, South American, and Indonesia. Then the afternoon sessions will provide seven parallels sessions to discuss utilization control, decentralization, drugs formulary, and quality control.

Day 3:

October 23rd Workshop柚aking Workable and Feasible Road Map for Universal Coverage in Indonesia. This is a special workshop for Indonesians, but foreigner is could attend the workshop. Other participants and participants from over seas will take field trip or tour in Bali.

Tentative agenda

DATE AND TIME	ACTIVITY	ROOM
DAY 0, October 20th
14.00 - 18.00	Hotel check in and registration
DAY 1, October 21st
08.00 - 08.45	Registration
08.45 - 09.00	Opening ceremony
09.00 - 09.20	Opening Address: The Committment of Indonesia to achieve Universal Coverage of Health Care By Susilo Bambang Yudoyono, President of Republic Indonesia
Plenary Session 1
09.20 - 10.00	WHO Recommendation on Universal Coverage by Guy Carrin, WHO Geneva Switzerland
10.00 - 10.40	Lesson learnt from the US - Pierce Fights for Universal by Hillary Rodham Clinton, The Secretary of State, the USA
10.40 - 11.00	Coffee Break & Visit exhibition
Plenary Session 2
11.00 - 11.20	German Experience on Universal Coverage (the speaker to be announced)
11.20 - 11.40	Japan Experience on Universal Coverage (the speaker to be announced)
11.40 - 13.00	South Korea Experience on Universal Coverage by Bong-Min Yang, Seoul National University School of Public Health
13.00 - 14.00	Lunch Break & Visit exhibition
Parallel Sessions	4 Break Out Room
14.00 - 15.30	Detail Topics will be based on submitted abstract
Session 1	Problem in Taxes and Social Insurance Pooling
Session 2	Experience on Collecting Contribution for formal and informal sector
Session 3	Payment to providers: the key for sustainability
Session 4	Quality Assurance: How to satisfy the public
15.30 - 16.00	Coffee Break & Visit exhibition
Parallel Sessions	4 Break Out Room
16.00 - 17.30	Detail Topics will be based on submitted abstract
Session 5	Regulations and problem of compliances
Session 6	Referral system: balancing primary, secondary and tertiary care
Session 7	Designing and adjusting benefit package
Session 8	The role of private sector in insuring universal access to essential health care
19.00 - 21.00	Gala dinner and cultural event
DAY 2, October 22nd
08.00 - 08.30	Registration
Plenary Session 3
08.30 - 10.30	South Americas Experience on Universal Coverage by Pablo Gotrett, World Bank
	Thai Experience on Universal Coverage by Pongpisut Jong-Udomsuk, Director, Health Systems Research Institute, Ministry of Public Health Thailand -
	Taiwan Experience on Universal Coverage by Chih-Liang Yaung, Minister of Health, Executive Yuan, R.O.C, Taiwan
	Philippines Experience on Universal Coverage by Francisco Duque III, Minister of Health Philippines
10.30 - 10.45	Coffee Break & Visit exhibition
Plenary Session 4
10.45 - 12.00	Indonesian Commitment to Universal Coverage by Dr. R. Agung Laksono Minister of Social Walfare Republic of Indonesia
	Indonesian Commitment to Universal Coverage by Dr. Endang R. Sedyaningsih, Dr.PH Minister of Health Republic of Indonesia
	Indonesian Commitment to Universal Coverage by Drs. H. A. Muhaimin Iskandar, M.Si Minister of Labor Republic of Indonesia
12.00 - 13.30	Lunch Break & Visit exhibition
Parallel Sessions	4 Break Out Room
13.30 - 15.00	Detail Topics will be based on submitted abstract
Session 9	Controlling cost and quality via Information System
Session 10	How to expand coverage to informal sector and rural communities
Session 11	Identification of obstacles in controlling health care costs
Session 12	Fighting the fraud in hospital and primary care settings
15.00 - 15.30	Coffee Break & Visit exhibition
Parallel Sessions	4 Break Out Room
15.30 - 17.00	Detail Topics will be based on submitted abstract
Session 13	Role of Professional Association in ensuring compliance to clinical and management standards
Session 14	Measuring and ensuring competent Human Resources for universal coverage
Session 15	The Role of the national and sub national Governments
17.00 - 17.30	Closing
DAY 3, October 23rd
Parallel session	2 Break Out Room
09.00 - 12.00	Session 16
	Workshop on recommending road to universal coverage in Indonesia (interested and invited guests only)
09.00 - 11.00	Session 17A
	PAMJAKI Organizational meeting (revising charter, election of president of PAMJAKI 2010 - 2014, election of examination board members)
11.00 - 12.00	Session 17B
	Inauguration of New Health Insurance Associates