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TRANSCRIPT
Public fund for healthy and productive living
Asia Pacific Consortium for Public Health Meeting in Bandung Indonesia 22‐23 October 2015
Should the poor get freePublic fund for healthy and productive living
Should the poor get free health insurance while they smoke?
Wahyu Aning Tias & Mubasysyir HasanbasriGadjah Mada Universityj y
Contents• Why we write this• Why we write this
paper• Our content analysisy• Findings• Conclusion• Policy implication• Final notes
Asia Pacific Consortium for Public Health Meeting in Bandung Indonesia 22‐23 October 2015
Why we write this paper?
Public health problems: what?• When individuals have no
control of those making them
The poor and the public health: why do social insurance serve as important public health toolcontrol of those making them
ill and suffering• When there is epidemic
causing social and economic
important public health tool• Poor bring diseases in
community while they do not have access to health carecausing social and economic
crisishave access to health care(cost).
Smoking as public health About this paperSmoking as public health problems: value of public fund in health care cost.• When smoking related lung
About this paper• This paper compare views on
the policy of publicly paid health insurance for the poor g g
cancer absorb high cost of public fund.
pwho smoke.
Method: content analysis
Asia Pacific Consortium for Public Health Meeting in Bandung Indonesia 22‐23 October 2015
Method: content analysis
• National and local online news Kompas, Tempo, Detik, Republika, Vivanews , Liputan 6, okezone, Antara Bengkulu, Tribun Jabar, Suara Merdeka
• Selection criteria: media containing these indonesian words of “the poor”, “smoker”, “smoking”, “health insurance”, “universal precaution”, from 2013 to 2015
• Study focuses on 65 news, columns, and public opinions.p p
Four policy positions and their supporting stakeholders
Universal coverage with no discriminatary exclusion:
STobacco company:
Bagong Suyanto, DjokoSungkono, Abhisam
Demosa, Zulvan Kurniawan(Komisi Penyelamat Kretek)
p yFahmi Idris (BPJS), Zainal
Abidin (IDI)
Individual responsibility or P blic f nd ins rance forIndividual responsibility or taking private health
insurance:Nafsiah Mboi, Ahok, Ali
Gh f M kti T l Ab di
Public fund insurance for quit smoking:
Public fund for healthy and productive living
Ghufron Mukti, Tulus Abadi, Fauzi Bowo
p gWe support this
Four policy positions and their statements about them
Universal coverage with no discriminatary exclusion:
Tobacco company:“Tobacco products contribute more than 95 percent of the
“Poor smokers should not be punished, don’t treat the poor
with penalties” (Bagong Suyanto, poverty observer)
total excise Rp52,6 trillion earned by the country in the first semester 2013” Fachmi
Idris (Director of BPJS Kesehatan)Kesehatan)
Public fund insurance for quit smoking:
Individual responsibility or taking private health insurance:
“Is it fair that this man who willingly smokes 3 packs of cigarette a day
gets free treatment?” (Nafsiah Mboi,
smoking:“Now this paradigm must be changed.
Not how to provide care for patient, but how people do not become ill. So, no longer alleviate health financing, but rather how to encourage themgets free treatment? (Nafsiah Mboi,
Former Health Minister)but rather how to encourage them
healthier” (Jusuf Kalla, Vice President)
Scenario 1 Scenario 2 Scenario 3 Scenario “4”
Typopoor
Smoking Smoking Smoking Publicly paid insurance
ology or w
ho s
Lung cancerLung cancer Lung cancer Smoking
cessation program
of positsm
oke insur
Publicly paid insurance Private insurance
premium
Insurance premium paid by tobacco industry Quit smokinng
ion regand pu
rance
Health careHealth care Health care Healthy &
productive
gardingublicly
DieDie Die
g the paid
Strength and weakness of the four options
Option 1 Option 2 Option 3 Option 4
Waste of public There is no private parties are willing Make poor people
funds Should serve as a challenge for smokers to
change, if they
parties are willing to bear the cost healthy
Better used for something else
g , ywant to use public
fundsSmoking is
considered a luxury item that must be accounted for
Make poor people more productive
personally
To conclude: there are no good reasons to support freeTo conclude: there are no good reasons to support free insurance for the poor who smoke…• The need of prioritization in using public funds inThe need of prioritization in using public funds in country with low productivity and limited resources.
• Potential better health outcome is more important: noPotential better health outcome is more important: no necessary escalating cost of care for unproductive living
• Promoting policy on individual responsibility on self‐Promoting policy on individual responsibility on selfinflicted illness and collective responsibility on public health problemshealth problems.
Final notesFinal notesWe argue that public money should be used in the way that promotes our health. If smoking status can not be p gthe reason for the revocation of rights of smokers for health insurance, this paper supports that health insurance is not seen as just a means to obtain health services. However, it should be used as a tool to fight self‐inflicted illness At least we suggest that BPJS provideinflicted illness. At least we suggest that BPJS provide smoking cessation program for those who smoke.
References Tandilittin H & Luetge C (2013) Civil Society and Tobacco Control in Indonesia:Tandilittin, H., & Luetge, C. (2013). Civil Society and Tobacco Control in Indonesia: The Last Resort. Open Ethics Journal, 7, 11‐18.Sharkey, K., & Gillam, L. (2010). Should patients with self‐inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of medical ethics, 36(11), 661‐665.Persaud, R. (1995). Smokers' rights to health care. Journal of medical ethics,21(5),Persaud, R. (1995). Smokers rights to health care. Journal of medical ethics,21(5), 281‐287.Björk, J., Lynøe, N., & Juth, N. (2015). Are smokers less deserving of expensive t t t? A d i d t ll d t i l th t b d ffi i l l BMCtreatment? A randomised controlled trial that goes beyond official values. BMC medical ethics, 16(1), 28.Veatch, R. M., & Steinfels, P. (1974). Case Studies in Bioethics: Who Should Pay for , , , ( ) ySmokers' Medical Care?. Hastings Center Report, 8‐10.
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