• Indonesia has made major improvements in health outcomes.
  
  
• Indonesia’s health delivery capacity has expanded significantly.
  
  
• Indonesia’s health spending is relatively low and the country gets reasonable ‘value for money’ in terms of some health outcomes as well as relatively good financial protection.
  
  
• The reform needs to build on the system’s strength’s and address its weaknesses.
  
  Strengths
  
  
  • Favorable demographic circumstances
  • High educational and literacy levels
  • Government commitment for reform
  • Low levels of health spending
  • Reasonable financial protection and consumer satisfaction
  • Experience with health insurance programs
  • An extensive primary care delivery system
  • Generally good availability of pharmaceuticals.

Weaknesses

• Half the population lacks health insurance coverage
• Government health subsidies disproportionally benefit the rich
• Health financing and delivery systems are highly fragmented
• Some health outcomes are poor
• Demographic, epidemiological, and nutrition transitions will place significant pressures on future health care costs and delivery system needs
• Significant geographic disparities in health outcomes, availability and use of services persist
• Human and physical infrastructures are limited and face quality and efficiency problems.
• Significant improvements in the quality and costs of pharmaceuticals, which account for some one-third of health spending, are needed
• Decentralization has confused the roles and responsibilities of the different levels of government and the intergovernmental transfer system does not yet fully recognize differences in need and fiscal capacity
• Critical data for decision-making are lacking
• Design features of the Jamsostek and Askes programs result in high out of pocket costs for program beneficiaries and preclude effective operation
• No comprehensive studies of the health outcome and financial impacts, real costs, and future sustainability of the Askeskin/Jamkesmas programs.

• Indonesia’s reform process needs to address both broad policy concerns such as the final system design and transition options as well as numerous ‘devils in the details’ including the design of the basic benefits package; groups eligible for public subsidies; identification and collection of premiums from informal sector workers; how medical care providers will be paid; how the reform will be financed; who will administer the program; and, how will better health outcomes, financial protection, consumer responsiveness, quality, efficiency, equity, and financial sustainability be assured.