Promoting public health: Can fiscal policy play a role?
January-March 2015

In Indonesia, we still have high maternal mortality, high child mortality, child malnutrition, etc. Should these be categorized as public health or personal health problems? If it is personal, then BPJS is the one to guarantee it, [since] the underprivileged are guaranteed by the government.

Take tuberculosis. Within the Millennium Development Goals (MDG), we refer to ATM – AIDS, TB and Malaria. Are those diseases public or personal health problems? I think it is a public health issue because if a person has untreated TB, for example, he will spread the disease to others. We know that TB has entered a multiple drug resistant (MDR) phase because it is not controlled properly. So, I think it is a matter of public health.

The consequence is that the government must secure the funds. Do not have BPJS take care of it as a matter of private care. We have to be prepared for the TB rate to increase and to understand that the cost of medicine for MDR diseases is multiplied.

Other cases, such as HIV/AIDS, have been seen in this country as within the domain of private care facilities but funds are still planned in the public health domain. This will create ambiguous funding. And if it is not done properly, it will be put under BPJS, in the social protection system for health. Perhaps the maternal mortality number will not change. Perhaps the TB rate will not decrease significantly, or will even increase.

The budget for the Ministry of Health, as I remember, is approximately Rp 30 trillion ($2.4 billion). But within that, around Rp 5 trillion is generated by working units, public hospitals, which generate direct income. So actually, the funding is around Rp 25 trillion rupiah

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