2014年-世界发展银行全球_A_Study_on_the_Implementation_of_Jampersal_Policy_in_Indonesia_78页_2mb

报告摘要

Summary of "A Study on the Implementation of Jampersal Policy in Indonesia"

Core Content

This study, conducted in 2013 by the World Bank and the Center for Family Welfare, University of Indonesia (CFW-UI), evaluates the implementation and impact of the Jampersal (Universal Delivery Care) policy in Garut District and Depok Municipality in West Java Province, Indonesia. The study is part of a broader Japan-World Bank Partnership Program for Universal Health Coverage (UHC), aimed at sharing experiences and lessons from various countries.

Main Objectives

The main objectives of the study were to:

Assess the implementation of the Jampersal policy.
Evaluate the impact of the program on maternal and neonatal health service coverage.
Provide insights for future policy formulation and reform in the context of UHC.

Key Findings

Utilization of Jampersal

High utilization among the least educated, poorest, and rural women, as well as those with delivery complications.
Contrary to expectations, women with existing health insurance (e.g., Jamkesmas/Jamkesda) also used Jampersal at higher rates.
Only 30% of women of childbearing age in Garut and Depok were aware of Jampersal by 2013, indicating poor awareness and socialization.

Impact on Institutional Deliveries

In Garut, institutional delivery coverage increased by 54.4%, with women 2.4 times more likely to give birth in an institution after the program.
In Depok, institutional delivery coverage was already high (92.3%) before Jampersal and remained the same after its implementation.
There was a slight shift in Depok from private to public providers and from private midwives to clinics and obstetricians.

Cesarean Sections (C-sections)

C-section rates increased by 26.4%.
However, the increase was not statistically significant.
C-sections were not always strictly for delivery complications, suggesting a need for better monitoring.
Depok had a higher odds of C-sections than Garut, indicating better access to such services.

Financial and Reimbursement System

Jampersal was financed by central government revenues.
Primary care services had tariffs set by the Ministry of Health (MoH), while hospital services followed INA-CBG guidelines.
Reimbursement processes were cumbersome, with delays in verification and claim payments.
Private providers were reluctant to join due to low reimbursement rates and dissatisfaction with the fees.

Service Quality and Access

Service readiness and quality were important factors. Poor quality led to discontinuation of care and deterrence of others.
Out-of-pocket (OOP) costs were still reported by households, even after Jampersal, for referral transport, drugs, and injections.
OOP costs were often unexplained by users, indicating a need for clarity and transparency in the financial system.

Provider and Human Resources

Puskesmas was the main provider in Garut, while the private sector dominated in Depok.
Despite enrollment, private providers had minimal participation due to low reimbursement.
Dual practice midwives experienced reduced income due to increased workload and lower fees.
Skilled birth attendance increased in rural Garut, suggesting that availability of midwives is crucial.

Key Information

Program Description

Jampersal is a free and comprehensive maternal and neonatal care program.
It enrolled public and private providers at the primary and secondary levels.
The program aimed to increase institutional deliveries and reduce maternal and newborn deaths.

Policy Context

Jampersal was discontinued in 2014 with the launch of the National Health Insurance Program (JKN).
The study suggests reevaluation of the policy to terminate Jampersal, given its positive impact on institutional deliveries.
However, cost-effectiveness and program efficiency need further assessment before discontinuation.

Recommendations

Stakeholder involvement beyond the health sector is essential for successful implementation.
Sectoral collaboration between MoH, MoHA, and MoF is needed to simplify regulations, fund management, and reimbursement processes.
Multisectoral investment in transportation, road infrastructure, and health facilities in geographically difficult areas is necessary to improve access.
Private provider participation requires a well-designed payment system and quality assurance.
Professional associations like the Indonesian Midwives Association (IBL) can help facilitate private sector involvement.
Improving human resources for health (HRH) is critical, especially in remote areas.
Labor market analysis should be integrated into HRH policy planning to better understand supply and demand dynamics.
Monitoring and evaluation should focus on service quality, financial protection, and preventing cream skimming by providers.

Conclusion

Jampersal had a positive impact on institutional deliveries, especially in areas with low coverage like Garut. However, its effectiveness was limited in areas where institutional delivery rates were already high. The study highlights the importance of quality, awareness, and financial mechanisms in ensuring the success of such programs. It also recommends policy adjustments and re-evaluation before the full termination of Jampersal, given the potential for improvement and continued relevance in certain contexts.

Recommendations Summary

Strengthen sector collaboration.
Simplify regulations and reimbursement processes.
Improve access to institutional deliveries through infrastructure development.
Enhance service quality and provider training.
Explore alternative funding mechanisms and monetary incentives for HRH deployment.
Monitor OOP costs and provider behavior to prevent cream skimming.
Re-evaluate policy termination based on cost-effectiveness and program impact.