Asian Challenges to the Universal Coverage; The (Im) Possible Dream?

"Universal coverage" for health is an exigent issue as a key factor for the achievement of SDGs. The diverse and abundant experiences on "universal coverage" in Asia are informative.

Japanese government intends to attain the "universal" personal coverage with social health insurance schemes and the public assistance scheme. There are three social insurance schemes; one for the employees and their family, one for the residents and the non-workers, i.e., the self-employed, the unemployed, the workers of the informal sectors, farmers, housewives, etc., one for the elderly over the age of 70. The poor are covered with the public assistance scheme without any charges. There are no barriers to join the schemes and no structural mechanisms for the exclusion. The contents of the care are the same through all schemes.

The social insurance has the limitation concerning the coverage of the person and care to accomplish the universality. “Contribution principle” of social insurance excludes the low income peoples who cannot pay. Moreover Japanese approach that plural social insurance schemes and the public assistance cover the entire population will be valid just in a stable society where the social relations and life style are stable and fixed.

The increasing flexibility and informalization of work and life, and the globalization, cause some doubts about the effectiveness on social insurance schemes. Ultimately Japanese system have suffered from a chronic deficit and personal “uncoverage”

In Indonesia, all residents must belong to one unified social insurance scheme. For the poor and informal workers the duty to contribute will be exempted. This apparatus shall be attractive in the point of "solidarity" of all nationals and holistic approach to social protection. Considering it's huge population, geographical condition, economic development and industrial structure, the success of Indonesia will be a "model" of the "universal coverage".