Strategies in Maintaining Financial Sustainability of National Health Insurance Under A Single-payer System in Indonesia, Taiwan, and Canada: A Comparative Study

Health care is one of the basic human needs and also human rights, which relate directly to determining ones’ quality of life. In the past decades, health care advances, demographic shifting, and health-related lifestyle have been influencing the demand and supply of healthcare in every country. Some people have been struggling and sometimes became poor because they should pay for their health care services. Thus, most countries have been developing universal health coverage, which design to protect peoples’ financial burden as well as furnishing a better quality of care for its population. Designing and maintaining a single-payer public healthcare system is complicated and requires multiple cooperation from stakeholders. Indonesia, Taiwan, and Canada are among countries that implemented this particular system. One of the fundamental elements in administering this type of scheme is financial sustainability, which frequently tends to be a problem since it requires commitment from the government as the payer, healthcare facilities as the provider, and also the population as the user. Lesson learned from the three countries has shown that there are at least three components that ensure the financial sustainability of social health insurance under a single-payer system. First, a sufficient amount of revenue collected to finance health expenditure. Particularly for Indonesia, premium structure and calculation possibly become a significant concern when compared to Taiwan National Health Insurance (NHI). Second, the implementation of adequate prospective payments such as global health and the arrangement of co-payment. Third, designed and supporting systems such as innovation through a health information system and the strong commitment from boards or committees explicitly designed to support the performance of NHI