Challenges (Opportunity) in

Cardiovascular Services
in Universal Coverage Era
Anwar Santoso
Dept. of Cardiology Faculty of Medicine; University of Indonesia
National Cardiovascular Centre Harapan Kita Hospital
President of Indonesian Heart Association
Jakarta - Indonesia

PARADIGMA PRAKTIK KESEHATAN/KEDOKTERAN SAAT INI:

PENDEKATAN SAKIT!
(PERLU PENATAAN SISTEM PELAYANAN KESEHATAN/KEDOKTERAN DAN
SISTEM PEMBIAYAAN SECARA PARALEL)
SAAT INI

Promotif

Preventif

Kuratif

Rehabilitatif

Orientasi Praktik
Kedokteran/Pelayanan Kesehatan

Under 5-y mortality rates in South-East Asia 1970 - 2010

Chongsuvivatwong V et.al. The Lancet 2010; 377: 429 - 37

Average life expectancy at birth in Southeast Asia 1950 - 2010

Chongsuvivatwong V et.al. The Lancet 2010; 377: 429 - 37

Better economic growth drives

increased CV risk factors

Percentage of Central Obesity based on

Basic Health Research 2007 & 2013

Indonesia Basic Health Research 2013

Prevalence of Dyslipidemia by gender and

residence in Basic Health Research 2013

Male

Female

Urban

Rural

Indonesia Basic Health Research 2013

Prevalences of Hypertension based on

Basic Health Research 2007 & 2013

Predictors of Hypertension in urban

population in Indonesia
Risk factors

ORadj

95% CI

1
2.45
6.95

2.22 2.70
6.14 7.90

0.0001

Blood sugar:
Normal
IGT
DM

1
1.35
1.95

1.19 1.54
1.65 2.30

0.0001

Overweight
BMI > 25

1.80

1.61 2.00

0.0001

Low education
Complete high school vs lower

1.54

1.40 1.68

0.0001

Abdominal obesity

1.52

1.36 1.69

0.0001

Age:
18 34 years
35 54 years
55+ yeasr

(Indonesia Basic Health Research 2007)

Prevalences of Diabetes Mellitus based on

Basic Health Research 2007 & 2013

Indonesia Basic Health Research 2013

Prevalence of Smoking in Indonesia

2007-2013
Series 1
40

36,3

34,2
30

20
10
0

2007

2013

Year
Indonesia Basic Health Research 2013

Prevalences of Stroke per 1000*) by

provinces 2007 - 2013

Indonesia Basic Health Research 2013

Indonesia Future Trend-Economy

Health Expenditure in Indonesia

Indonesia Health Expenditure

National Health Insurance Scheme

Medicines components in
JKN:
Scope of JKN Benefit

Medicines list and proces

covered by BPJS will be
regulated by MoH
(UU SJSN ps 25, Perpres Jamkes ps 32)

Courtesy: dr S. Soeryanata 2015

Distribution of Cardiologist & Internist in Indonesia

(updated 2014)

Courtesy: dr S. Soeryanata 2015

Courtesy: dr S. Soeryanata 2015

Courtesy: dr S. Soeryanata 2015

Courtesy: dr S. Soeryanata 2015

Courtesy: dr S. Soeryanata 2015

Increased awareness of ACS to Action

Courtesy: dr S. Soeryanata 2015

Increased awareness of ACS to Action

Courtesy: dr S. Soeryanata 2015

Courtesy: dr S. Soeryanata 2015

Regional Targets for NCD

Harmful
use of
alcohol
10%
reduction

Physical
inactivity
10%
reduction

Household
air pollution
50%
reduction in
SFU for
cooking

Essential
NCD
medicines
and
technologies
80%
coverage

25% reduction
in NCD mortality
by 2025

Diabetes/
obesity
0%
increase

Salt/sodium
intake
30%
reduction
Tobacco
Risk Factor
use
National System Response
30%
Regional Target
reduction

Drug
therapy &
counseling
50%
coverage

Raised
blood
pressure
25%
reduction

Conclusions
Though good economic prospect in Indonesia financial
budget for health sector is still limited.
Better economic growths and urbanization lead to increased
CVD risk factors
Universal coverage in Indonesia would be reshaping health
care system should be mostly relied on health promotion
and prevention

Conclusions
Each Asia-Pacific country faces a unique set of barriers that
prevent optimal translation of evidence-based guideline
recommendations into practice
Establishing cardiac networks and local/individual hospital
models/clinical pathways will be central to optimization of
ACS medical management in the
Asia-Pacific region