The World’s Largest Universal Healthcare System: Pushing Against the Headwinds with Affordable Biotechnology
In 2010, an estimated 56% of Indonesians— predominantly state employees and those with private coverage— had some form of health insurance. Traditionally, Indonesia’s healthcare macrocosm was characterized by fragmentation, with private insurance provision for those who could afford it, minimal coverage for the poorest in society, and non-governmental intervention filling in the gaps between public and private schemes.
However, 2014 marked a watershed year for the world’s fourth populous country: Indonesia took a large leap forward, proposing to achieve universal healthcare coverage (UHC) with the introduction of the National Health Insurance Program (JKN). The JKN was conceived to unify the various insurance schemes under an umbrella security agency and provide coverage for all Indonesians, including the large swathes of the population previously not covered by any public insurance schemes. This ambitious program intends to usher in the world’s largest single player healthcare program within a span of 6 years.
The UHC rollout in 2014 was met with the inevitable teething troubles of a new system. Critics raised concerns about Indonesia’s capacity to implement such a large-scale undertaking, especially considering the nation’s weak infrastructure, chronic shortage of medical professionals, and questionable fiscal sustainability.
For now, the system is indeed biting off more than it can chew. Under the JKN, Indonesia has seen a surge in the number of patients who signed up to pay nominal monthly premiums (ranging from $1.70 to $4.10) for broad medical coverage. And as previously uninsured pockets of the population have begun to make use of healthcare services, more medical infrastructure and human resources are being demanded. Yet, there is a chronic undersupply of funding, healthcare services, and medical professionals in the country. This, coupled with the highly unequal distribution of healthcare services across the archipelago, has undermined the universality of the JKN program. Thus, as the UHC looks to gain a more solid foothold, Indonesia’s healthcare sector must learn to cope with its new model of supply and demand.
Ivy Teh, the managing director of the Economist Intelligence Unit, contends that as Indonesia pushes against these headwinds, the development of cost-effective biotechnology may act as the keystone to the UHC’s success. This is because the JKN must deliver its services to a potential market size of nearly 250 million people with only a limited budget; thus, in order to maintain fiscal sustainability for the social health insurance schemes, cost of medical infrastructure must be kept down without compromising its quality. One significant way to do this is for biotechnology companies to tailor their products to resonate more with the nation’s demand for cost- efficiency. Moreover, affordable biotechnology would also allow room in the national budget for the government to open up new healthcare facilities, especially in rural areas where medical infrastructure is scarce. In short, the symbiotic relationship between biotech firms and policymakers will be instrumental to the long-term survival of the JKN.
Taking a step back, in the wider context of global health, we see that funding gaps are not only pertinent to Indonesia, but also to the rest of the developing world. South Africa is still figuring out ways to pay for the long-awaited rollout of its national health insurance program. Thailand’s scheme, like Indonesia’s, is running out of money. India needs to find funds for a healthcare system that would protect the poorest communities from the financial shock of medical emergencies. Thus, globally, we can expect value-based segmentation strategies to prevail in the biotech industries as emerging universal healthcare schemes emphasize the cost-effectivity of medical devices.
In short, the prospect of more comprehensive healthcare systems around the world is truly exciting for the scientific community, as it fosters innovation in the field of biotechnology. As the developing world struggles economically with the implementation of broader public health initiatives, scientists are asked to step forward and design more affordable biotechnology. This highlights the profound societal implications of biotechnology on the global healthcare landscape. Thus, if there’s one lesson we learned from Indonesia’s JKN program, it’s that the future of biotechnology is headed in the direction of cost-effectivity.