Toward Universal Health Insurance in Indonesia: The Role of Civil Society Organisations
The quality of health service in Indonesia is still a major problem faced by the Indonesians, particularly the poor people. Data from the latest Indonesia Demographic and Health Survey 2007 (IDHS 2007) indicates persisting disparity of health status
between the poor and the better off. For instance, the infant mortality rate (IMR) for the lowest wealth quintile is 56 deaths per 1000 live births, which is almost double compared to 26 deaths per 1,000 live births for children of the highest wealth quintile (Statistics Indonesia and Macro International, 2008). In the area of maternal health, the maternal mortality ratio of Indonesia is 420 per 100.000 live birth deliveries, which is ranked in the 12th country of 18 countries of ASEAN and SEARO (Departemen Kesehatan, 2008). These figures confirm the most recent statement of the Coordinator Ministry of
People Welfare, Aburizal Bakrie, who comments on Indonesia’s achievement of the MDGs targets. He said that the periodic achievement of MDGs targets are still as planned, so that the target will be fulfilled by 2015, except for the health sector (Suara Pembaharuan, 2009).
Health financing is one among the problems of Indonesia’s health sector. Based on the IHDS 2002-2003, the main problem in accessing health care by woman is economic in nature (24%), which prevents women to access health facilities (Statistics Indonesia and ORC Macro, 2008). The rural women are found to have more economic difficulties compared to urban women (30% and 16% respectively). This illuminates the lessons learned from World Health Report 2000, which suggests that health care financing is the most important element of health system determining the health status of a country (WHO, 2000). Indonesia, like other developing countries, relies heavily on the out-ofpocket payment system. According to Rokx et al. (2009), there are at least 73,9% of Indonesian population that are uninsured. WHO(2000) recommends that health care financing systems should be able to maximally pool risks and share health care burdens across populations. The social health insurance is one option to choose and leaving the out-of pocket payment system as minimal as possible (Ortiz, 2007).Please