Ok

1. The Latest Figure of NHA
dr. Kalsum Komaryani, MPPM
Director of Centre for Health Financing and National Health Insurance
Ministry of Health, Republic of Indonesia
Jakarta, 21 September 2021

2. National Health System
(Presidential decree
No.72/2012)
Health Effort on Personal
and Community
01
02
04
05
03
06
07
Research and Development
on Health
Health Financing
Health Workforce
Pharmaceutical, medical
devices and food supply
Management, information
and regulation on health
Community empowerment

3. Health Financing Goal
Health financing aims to provide
sustainable health financing in
sufficient amounts, allocated fairly,
and utilized effectively and efficiently
to ensure the implementation of
health development in order to
increase the health status of the
community as high as possible
(Article 170, Law 36/2009).
Sufficient and
sustainable
financing
Fair
allocation
Effective and
efficient
spending

4. Financing Sources
Government
APBN
Households Donor
Private
Allocated, among others, for:
• JKN contribution
• Private health insurance
premium
• Over the counter
medicines
• Medical check-up
• health care (eg: vitamins)
Aids for health
programme such as
HIV/AIDS, TB, MNH,
malaria, nutrition,
health system
strengthening,
pandemic
responses, health
workforce, etc
Allocated, among others,
for:
• JKN contribution
• Private health
insurance premium
• Direct employee
arrangements
related to health (eg:
reimbusement,
medical allowances)
• Company clinics
• infrastructure
• Information system
Allocated, among
others, for:
• Public health efforts
in MoH & other govt
institutions
• JKN contribution for
subsidized members
• Regional health fund
transfers (DAK)
• Health
administration
• Information system
• Health services
delivery in other
govt institutions
APBD
Allocated, among others,
for:
• Public health efforts in
provincial and district
level
• JKN contribution for
subsidized members
accding to Presidential
Decree 64/2020
• Infrastructure
• Operational cost
• Health administration
• Information system

5. Allocation
Public Health
Efforts
(UKM)
Personal
Health Care
Efforts (UKP)
Promotive and
preventive services
Curative and
rehabilitative services
Infrastructure
and
Administrative
Supply side
financed through JKN
(National Health
Insurance) system,
additional voluntary
health insurance
allowed
financed through
central and local
government health
budgets

6. NHA definition
A systematic and
comprehensive tracking of
the flow of funds in a
country's health system for
a period of one year
National purpose
As a tool to monitor activity indicator performance in the Strategic Plan of
the Ministry of Health, namely :
"Development of Health Financing and Insurance" with the aim of
producing technical policy input for the development of health
financing and JKN.
One of the activity indicators is “National Health Account (NHA)
document produced”
 Global Health Expenditure Database
(GHED) provides health expenditure data
from 190 WHO member countries.
 WHO works closely with member
countries to update the database
annually.
01
02 International purpose
NHA use
as a strategic tool for
country’s health system
monitoring from a
consumption perspective

7. NHA
Dimensions
Principle:
CONSUMPTION = PROVISION = FINANCING
Total Health Expenditures:
Current spending + Capital formation
Core
Accounting
Framework
Health
Provision
Health
Financing
Healthcare
Consumption
Extended Dimension:
Beneficiaries (HB)
[Disease, age, sex, etc.]
Core Dimension:
Healthcare Function (HC)
Core Dimension:
Financing Scheme (HF)
Extended Dimension:
Core Dimension:
Healthcare Provider (HP)
Extended Dimension:
Financing Agent (FA)
Revenue of Financing sources (FS)
Factor of Provision (FP)
Capital Formation (HK)

8.  Identifying data
 Developing database
 Data entry
 Data cleaning
 Identifying Double counting
 Translating the data into SHA
2011 dimensions
 Disaggregation process
 Developing data template required
 Requesting data from several institutions
 Conducting the survey
 Downloading the data from accessible
website
 Analysis for national and
international needs
 Discussion for result analysis to
stakeholders that provide the data
 Obtaining the same understanding
between NHA team and the
stakeholders
 Dissemination
 Workshop
 Publication
www.ppjk.kemkes.go.id
NHA Production in Indonesia: Stages and Process
01 02 04
Data
Collection
03
Data
Management
Result &
Endorsement
Analysis &
Triangulation

9. Indonesia Health Spending, 2019
National Health
Insurance (JKN)
IDR 112,1 Trillion
Work Accident
Security (JKK)*
IDR 1,2 Trillion
Private Schemes**
IDR 77,3 Trillion
15,8%
OOP Scheme
IDR 157,5 Trillion
32,1%
MoH Scheme
IDR 21,1 Trillion
4,3%
Other Ministries Schemes
IDR 9,5 Trillion
1,9%
Subnational Schemes
IDR 111,6 Trillion
22,8%
SHI Schemes
IDR 113.3 Trillion
23,1%
Total Health Expenditure
2019
IDR 490,3 Trillion
Public Schemes
IDR 255,5 Trillion (52,1%)
Non-Public Schemes
IDR 234,5T Trillion
(47,9%)
Data Source: NHA Indonesia 2019
Notes:
*JKK is only accounted for health services and treatment due to work accident
**including private health insurance, corporations, NPISH

10. 0.00
50.00
100.00
150.00
200.00
250.00
300.00
350.00
400.00
450.00
500.00
2012 2013 2014 2015 2016 2017 2018 2019
4.7% 5.0% 4.7% 5.6% 5.8% 4.7% 4.7% 4.3%
1.6% 1.7% 1.3% 2.2% 2.3% 1.9% 2.1% 1.9%
16.4% 17.3% 16.7%
17.7%
21.5% 21.6% 22.2% 22.8%
6.7%
8.4%
14.7%
17.6%
19.3% 22.2%
22.8%
23.1%
2.5%
3.4%
3.2%
2.8%
3.0%
3.2%
3.1%
3.5%
0.8%
0.7%
0.7%
0.9%
1.1%
1.1%
1.1%
1.2%
15.7%
15.0%
15.1%
12.9%
11.3%
11.6%
11.0%
11.1%
51.6%
48.5%
43.7%
40.2%
35.8%
33.7%
33.0%
32.1%
Rp
Trillion
MoH Other Ministries Subnational
Social Health Insurance Private Health Insurance NPISH
Corporation Households' OOP
260.7
287.5
324.6
358.3
399.3
423.9
454.1
490.3
Rp 255,5 T
(52,1%)
Rp 234,8 T
(47,9%)
Non-public
Schemes
Public
Schemes
Indonesia Health Expenditure, 2012 – 2019
Rp Trillion
0
50
100
150
200
250
300
350
400
2012 2013 2014 2015 2016 2017 2018 2019
4.7% 5.0% 4.7% 5.6% 5.8% 4.7% 4.7% 4.3%
1.6% 1.7%
1.3% 2.2% 2.3% 1.9% 2.1% 1.9%
16.4%
17.3% 16.7%
17.7%
21.5% 21.6% 22.2% 22.8%
6.7%
8.4%
14.7%
17.6%
19.3% 22.2%
22.8%
23.1%
2.5%
3.4%
3.2%
2.8%
3.0%
3.2%
3.1%
3.5%
0.8%
0.7%
0.7%
0.9%
1.1%
1.1%
1.1%
1.2%
15.7%
15.0%
15.1%
12.9%
11.3%
11.6%
11.0%
11.1%
51.6%
48.5%
43.7%
40.2%
35.8% 33.7%
33.0%
32.1%
Total Health Expenditure (Constant)*
Skema Kemenkes Skema K/L lain Skema Pemda
Skema Askes Sosial Skema Askes Swasta LNPRT
Korporasi Skema Pembiayaan RT
260.7
273.9
293.3
311.4
338.7 344.8 355.8
378.0
*Baseline: constant prices in 2012
Constant prices are used to determine economic growth by using
prices in a certain year as a basis (revaluation of inflation)
Data Source: NHA Indonesia 2019

11. *Baseline: constant prices in 2012
1,287
1,403
1,544
1,619
1,714
1,829
77
109
124 106 117 115
215 249
332 349 381 416
357 403 449 500 498 505
-
150
300
450
600
750
900
1,050
1,200
1,350
1,500
1,650
1,800
1,950
2014 2015 2016 2017 2018 2019
In
Thousands
(Rupiah)
Health Expenditure per Capita (In real/current prices)
Total Belanja Kesehatan Pemerintah Pusat
Pemda Askesos
Total Health Expenditure Central Government
Local Government Social Health Insurance
1,163
1,219
1,309 1,316 1,342
1,410
70 95
105
86 91 88
194 216
281 284 298 321
323 350 381 406 390 390
-
150
300
450
600
750
900
1,050
1,200
1,350
1,500
1,650
1,800
1,950
2014 2015 2016 2017 2018 2019
In
Thousands
(Rupiah)
Health Expenditure per Capita (In constant prices)*
Total Belanja Kesehatan Pemerintah Pusat
Pemda Askesos
Total Health Expenditure
Local Government
Central Government
Social Health Insurance
Health Expenditure per Capita in Indonesia, 2014-2019
Data Source: NHA Indonesia 2019

12. Share of Total Health Expenditure as GDP
Indonesia: stagnant
2.00
2.2
3.00
3.8 3.7
3.5
4.5
2.8
6.7
7.4
2.5 2.6
3.1
3.8 3.9
4.5 4.6
5.1
5.9
6.6
.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
%
Total Health Expenditure as GDP, 2012 & 2018
2012 2018
2.1
1.9
2.9
3.5 3.5
4.4
3.3
2.4
6.3
7.3
2.2
2.4
2.9
3.8 3.8
4.4 4.5
4.8
5.9 06
Current Health Expenditure* as GDP, 2012 &
2018
2012 2018
*not included capital expenditure
Data Source: NHA MoH Indonesia and Global Health Expenditure Database-WHO

13. Share of Public Schemes per GDP (%)
0.4
0.7
0.9
1.2
1.7
1.9
1.7
1.5
2.8 2.8
0.8
1.1
1.4 1.5 1.6
1.9
2.3
2.5
2.8
3.00
Current Health Expenditure* as GDP in Public
Schemes, 2012 & 2018
2012 2018
0.8 0.9 1.00
1.3
1.9
2.1
1.8 1.7
3.2 3.1
1.1
1.5
1.7 1.7
2.1 2.1
2.4 2.5
2.8
3.00
Total Health Expenditure as GDP in Public
Schemes, 2012 & 2018
2012 2018
*not included capital expenditure
Data Source: NHA MoH Indonesia and Global Health Expenditure Database-WHO

14. Indonesian Health Expenditure by Revenue of Financing Schemes, 2019
Total Health Expenditure 2019
490,3 T
Public
255,5 T (52,1%)
Non-Public
234,8 T (47,9%)
MoH Scheme
21,1 T (4,3%)
Other Ministries
Scheme
9,5 T (1,9%)
Subnational Schemes
111,6 T (22,8%)
Social Health
Insurance Scheme
113,3 T (23,1%)
Households’ OOP
Scheme
157,5 T (32,1%)
Other Non-public
77,3 T (15,8%)
Central
Government
19,0 T (89,99%)
Donor
2,1 T (10,01%)
Provincial
Government
12,4 T (11,1%)
District/City
Goverment
9,7 T (8,7%)
Corporates
24,3 T (21,4%)
Households
28,8 T (25,4%)
Households
157,5 T (100%)
Corporates
68,0 T (88,1%)
Households
6,7 T (8,7%)
District/City
Goverment
1,7 T (2,3%)
Donor
470,3 M (0,6%)
NPISH
307,2 M (0,4%)
Central
Government
89,5 T (80,2%)
Central
Government
9,5 T (99,8%)
Donor
14,5 M (0,2%)
Provincial
Government
2,7 T (2,3%)
District/City
Goverment
10,4 T (9,2%)
Central
Government
47,1 T (41,7%)
District/City
Goverrnment, 4.5%
Provincial
Government, 3.1%
Central
Government,
33.7%
Donor,
0.5%
NPISH, 0.1%
Corporates,
18.8%
Households,
39.4%
Data Source: NHA Indonesia 2019

15. Indonesian Health Expenditure by Healthcare Function, 2019
Total Health Expenditure 2019
490,3 T
Public
255,5 T (52,1%)
Non-Public
234,8 T (47,9%)
MoH Scheme
Rp 21,1 T
Other Ministries
Scheme
Rp 9,5 T
Subnational Scheme
Rp 111,6 T
Social Health
Insurance Scheme
Rp 113,3 T
Households’ OOP
Scheme
Rp 157,5 T
Other Non-public
Scheme
Rp 77,3 T
In-patient
curative
Rp 2,5 T (12%)
Out-patient
curative
Rp 2,5 T (12%)
Preventive care
Rp 7,6 T (36%)
Governance
Administration
Rp 2,5 T (12%)
Capital
Rp 6,0 T (28%)
In-patient
curative
Rp 1,5 T (16%)
Out-patient
curative
Rp 2,4 T (25%)
Preventive care
Rp 2,6 T (28%)
Governance
Administration
Rp 1,6 T (16%)
Capital
Rp 1,4 T (15%)
In-patient
curative
Rp 18,6 T (17%)
Out-patient
curative
Rp 26,5 T (24%)
Preventive care
Rp 34,0 T (31%)
Governance
Administration
Rp 10,2 T (9%)
Capital
Rp 22,3 T (19%)
In-patient
curative
Rp 60,8 T (54%)
Out-patient
curative
Rp 42,5 T (38%)
Preventive care
Rp 5,1 T (4%)
Governance
Administration
Rp 4,7 T (4%)
Capital
Rp 188 M (0,2%)
In-patient
curative
Rp 34,5 T (45%)
Out-patient
curative
Rp 28,5 T (37%)
Medical
Supplies
Rp 3,7 T (5%)
Preventive care
Rp 8,0 T (10%)
Governance
Administration
Rp 2,2 T (3%)
Capital
Rp 366 M
(0,5%)
In-patient
curative
Rp 59,7 T (38%)
Out-patient
curative
Rp 46,4 T (29%)
Medical
Supplies
Rp 25,0 (16%)
Preventive care
Rp 26,4 T
(17%)
In-
patient
curative
36.2%
Out-
patient
curative
30.3%
Medical
Supplies
5.8%
Preventive
care
17.1%
Governance
Administration
4.3%
Capital
6.2%
Data Source: NHA Indonesia 2019

16. Figures of Preventive Care in Indonesia, 2019
In-patient
Curative
36.22%
Out-patient
Curative
30.33%
Medical
Supplies
5.85%
Governance
Administration
4.32%
Capital
6.19%
Preventive
Care
17.09%
Health Expenditure by Healthcare Function,
2019
Total Health Expenditure: 490,3 T
Ealry Detection
3.55%
Immunization
9.17%
Other
Preventive
Care
11.11%
Healthy
Condition
Monitoring
43.67%
KIE
Programs
19.92%
Epidemiological
surveillance and
risk and disease
control
12.58%
Preventive Care Spending: 83,8 T
Preventive spending per capita : Rp312.603
Data Source: NHA Indonesia 2019

17. Indonesia Total Health Expenditure by Healthcare Provider, 2019
Total Health Expenditre 2019
490,3 T
Public
255,5 T (52,1%)
Non-Public
234,8 T (47,9%)
MoH Scheme
21,1 T (4,3%)
Other Ministries
Scheme
9,5 T (1,9%)
Subnational Scheme
111,6 T (22,8%)
Social Health
Insurance Scheme
113,3 T (23,1%)
Households’ OOP
Scheme
157,5 T (32,1%)
Other Non-public
Scheme
77,3 T (15.8%)
FKTP 3,0 T
(15,2%)
Preventive &
Administration
Provider 9,3 T
(44,2%)
Hospital 5,8 T
(27,3%)
Related to Health
Education Provider
3,0 T (14,3%)
FKTP 2,7 T
(27,9%)
Preventive &
Administration
Provider 4,7 T
(49,3%)
Hospital 2,1 T
(22,5%)
Related to Health
Education Provider
0,03 T (0,3%)
FKTP 30,7 T
(27,5%)
Preventive &
Administration
Provider 40,5 T
(36,3%)
Hospital 40,4 T
(36,2%)
FKTP 16,5 T
(14,6%)
Preventive &
Administration
Provider 5,0 T
(4,3%)
Hospital 91,8 T
(81,1%)
FKTP 51,9 T
(33,0%)
Medical Goods
Retailers 25,0 T
(15,8%)
Hospital 80,6 T
(51,2%)
FKTP 9,7 T
(12,5%)
Medical Goods
Retailers 3,6 T
(4,6%)
Hospital 54,0 T
(69,9%)
Hospital
55.7%
FKTP
23.7%
Medical
Goods
Retailers
5.8%
Preventive &
Administration
Provider
14.1%
Related to
Health
Education
Provider
0.6%
Data Source: NHA Indonesia 2019

18. Improving Health Financing
Public and Non Public
Government Health Budget Condition:
Central government has allocated more than 5% of APBN for health and
regional government have reached to 10% of APBD
Public and non public health expenditure 2019:
public spending Rp. 255,5 T (52,1 %)
non public spending Rp. 234,8 T (47,9 %)
An urge to mobilize non public Health Financing
Advocate; should not be seen
as upper limit

19. Conclusion
 NHA results have provided a comprehensive figures on health financing structures,
patterns, transformations, and performance for policy makers. Despite Total Health
Expenditure in nominal terms increased year by year, however share percentage as
GDP was relatively stagnant. On the other hand, public spending on health has
increased sharply in the last 5 years and households direct health spending (OOP)
has gradually declined due to the implementation of JKN.
 NHA figures is expected to be available T-1, however the required data still not
supported by an information system which can be accessed automatically and
available on time. Coordination, consolidation and dissemination need to be
continued.
 Further analysis and studies on NHA figures are required to generate better input
for policy formulation. NHA combined with other data such as costing data,
macroeconomic data, and health status data will produce stronger
recommendations for health financing policies in Indonesia.

20. S A L A M S E H A T
TERIMA KASIH
S A L A M S E H A T
THANK YOU
@ppjk.kemkes
puspjk@kemkes.go.id
ppjkkemenkesri@gmail.com
ppjk.kemkes.go.id