Current Market Trends
Population: 265 million (2018 estimate)
GDP: USD1,070 billion (2018 est.)
Currency: Rupiah (IDR)
The population of Indonesia in 2018 is estimated to reach 265 million, which placed Indonesia at number 4 in population among the 195 nations of the world.
In 2018, Statistics Indonesia (in Bahasa Indonesia abbreviation: BPS) estimates show that Indonesia will have 15.4 million people aged 65 years and above. The elderly population is expected to grow over 40% by 2025, which will make Indonesia one of Asia’s fastest aging countries. This will have an enormous impact on an economic and societal level, particularly in the healthcare sector. The most common diseases among the elderly were hypertension, arthritis, stroke, oral health problems, chronic pulmonary diseases, and diabetes. As per a report released by the World Health Organization (WHO), stroke, ischemic heart disease, and diabetes are the top causes of death in Indonesia.
As the fourth most populous country in the world, Indonesia offers great potential for the medical equipment and supplies market. This sector continues to present excellent opportunities for U.S. companies. Indonesia depends on imported medical equipment and supplies to meet local demand. A total import of medical equipment grew from US $1,035 million in 2016 to US $1,450 million in 2017 and is estimated to reach US $2,842 million in 2019.
Almost 92% of Indonesia’s medical equipment and devices are made up of imports, mostly related to more sophisticated medical and surgical instruments and infrastructure like medical lasers and diagnostic equipment. In the past, domestic production focused mainly on the manufacture of basic items like surgical gloves, bandages, orthopedic aids, and hospital furniture. But since 2016, local companies are able to produce other medical equipment, such as sphygmomanometers, stethoscopes, urine catheters, infant incubators, nebulizers, O2 concentrators, dental chairs, EKGs, fetal Dopplers, syringe pumps, infusion pumps, operating lamps, medical dressings (i.e. operating gowns, bed sheets), rapid tests (i.e. HIV, Hepatitis, and pregnancy tests to name a few), blood-grouping reagents, and first-aid boxes & kits.
Healthcare is a priority in Indonesia’s national development agenda. Increases in public awareness in healthcare and social conditions, as well as the expansion of public and private hospitals have led to increased demand for more sophisticated and modern medical equipment and supplies. The central and regional governments continue to build and upgrade healthcare facilities. They are planning to equip community health centers with inpatient facilities and improve their quality of services throughout 34 provinces. The government continues to encourage private sector involvement in developing hospitals.
The number of hospitals and clinics in Indonesia continues to experience significant growth despite the economic slowdown which has seen consumer spending in other areas begin to slide. According to the Directorate General of Health Services, Ministry of Health of Indonesia (MoH), Indonesia currently has a total of 2,776 hospitals-1,767 privately managed and 1,009 managed by the public sector. Those hospitals offer 305,055 hospital beds, or 1.16 beds per thousand people. This rate is very low by world standards. Indonesia still lags far behind its ASEAN neighbors; Singapore, Thailand, Vietnam, and Malaysia average more than 2.0 hospital beds per thousand. Conservative estimates suggest that Indonesia needs an additional 500,000 hospital beds to catch up to regional averages. Indonesia as a whole lacks a robust healthcare infrastructure and qualified staff, particularly in rural areas.
Key private hospitals in Indonesia include Siloam Hospitals (which is part of Lippo Group), Hermina Hospital Group, Mitra Keluarga Hospital Group, Awal Bros Hospital Group, Sari Asih Group, Pondok Indah Hospital Group, Omni Group, Mayapada Group (Mayapada hospitals) and Sinar Mas Group (Eka hospitals) as well as Prodia Group for diagnostic laboratories. Siloam now operates 33 hospitals in 24 cities and 16 clinics in 8 cities throughout Indonesia. Siloam aims to run 50 hospitals by 2019.
Major private laboratory chains are also expanding their operations in terms of capacity and geographic presence. The six major players in the industry are Prodia, Kimia Farma, Pramita, Cito, BioMedika and Parahita. The largest private laboratory chain, Prodia, now operates 283 outlets consisting of 136 Clinical Laboratories, 5 Specialty Clinics, 130 Point of Care (POC) Services, and 11 Hospital Laboratory. Prodia is set to open 5-7 new outlets by 2018. Since the beginning 208, they have opened 3 new outlets. Prodia's strategic initiative for 2017-2020 is to open 33 new outlets throughout Indonesia.
Indonesia began implementing its Universal Health Coverage (UHC) Plan in 2014, locally known as National Health Assurance Scheme (JKN), with the goal of universal coverage of the country’s population by 2019. A report shows that as of April 2018, 195 million Indonesians were covered under JKN (approximately 75% of the population). This program will grow demand for advanced healthcare equipment and medical devices. U.S. manufacturers of medical devices should take advantage of this growing market.
Prior to entering the Indonesian healthcare market, U.S. companies must either establish a foreign investment company in the form of a PT (limited liability company), or appoint a trustworthy local agent and/or distributor. It is mandatory to have an agent and/or distributor in order to serve the Indonesian market. Local agents and/or distributors handle registration for the products and play an important role in developing the market and providing after-sales services. Attending conferences and events is a good strategy for meeting equipment importers, agents, and distributors.
U.S. companies are recommended to have a solid due diligence process in place and to consult with the U.S. Commercial Service prior to signing up agents and distributors. U.S. companies must visit the Indonesian market in order to properly choose an appropriate agent or distributor from Indonesia’s vibrant and experienced international business sector. Appointment of a representative requires care, since it is difficult to terminate a bad relationship. Qualified representatives will not take U.S. principals seriously unless they make a commitment to visiting the market on a regular basis. Patience, persistence and presence are three key factors for success in Indonesia.
According to the Business Monitor International (BMI) Industry Forecast, healthcare spending in Indonesia is expected to grow to US $42.09 billion by 2022 and US $77.95 billion by 2027, a Compound Annual Growth Rate (CAGR) of 10%. This report shows that Indonesia is still an attractive market for the health sector. The implementation of the JKN creates huge demand for advanced medical and surgical equipment like X-Ray machines, CT scanners, MRI machines, defibrillators, gamma knives for incision-free surgeries, as well as different types of drugs related to the expected increase in the prevalence of diabetes and cardiovascular diseases. Profitable submarkets in dental equipment include devices for scaling and polishing, for bleaching, and for orthodontics. As for laboratory equipment, sustainable opportunities are related to tests kits for hepatitis and infectious diseases, and for instruments related to clinical chemistry, hematology, and immunology.
The market for medical equipment and supplies is highly competitive. The U.S. is one of the leading suppliers with over a 10% share of this market in 2018. Other countries competing for market share in the medical equipment and supplies include Germany, China, Japan, South Korea, and the Netherlands. Companies from China and South Korea provide the greatest challenge to U.S. firms as they offer low- priced equipment. Therefore, while quality and after-sales service are essential elements, it is also important to price products competitively.
With the implementation of JKN, Indonesia will see a robust increase in the demand for medical devices and pharmaceutical products. Surgical equipment and diagnostic imaging equipment have the largest market shares and provide huge opportunities for U.S. companies. In addition, U.S. companies could also consider being active in Indonesia’s markets for health infrastructure and household medical devices.
U.S. companies must be prepared to operate in an often uncertain regulatory environment. Product registration can be lengthy, and new and changing requirements can hamper market entry, such as labeling and local content requirements. A strong local distributor or partner is critical to help navigate the product registration process and stay abreast of changing regulations.
MoH controls the process of registering medical devices and household health supplies in Indonesia. In general, products that are FDA-approved and sold in the U.S. will be approved to enter the market in Indonesia.
Medical equipment importers must submit a registration application to MoH’s Directorate General of Pharmacy and Medical Devices Services, which includes all of the following documents that the U.S. companies should supply:
MoH has enacted a new regulation, Permenkes No. 62 Year 2017, concerning Marketing Authorization of Medical Devices, In Vitro Diagnostic Medical Devices and Household Health Supplies on January 13, 2018. This is to replace the previous Ministerial Regulation No. 1190 of 2010 in relation to Medical Device and Household Healthcare Licensing.
The significant change noticed in this new regulation is the approval timeline. Previously, medical device registration in Indonesia could take about 6-8 months. Now, MoH has sped up the process to just 1-2 months between application and approval. The accelerated timeline is also applied for change and renewal registration.
In addition, MoH will be no longer be issuing hard copy certificates. Implementing electronic signatures on product approval is also one method used by MoH to accelerate medical device registration. The registration certificate will be issued in electronic form and can be printed by applicants or other interested agencies through the Indonesian National Single Window portal or http://www.regalkes.depkes.go.id/
MoH is responsible for all procedures related to reimbursement. Thus, those covered by some form of public healthcare insurance can access healthcare services without financial trouble. In fact, public sector hospitals and other public healthcare facilities provide services either at a subsidized rate or free of charge.
Private and other public healthcare schemes reimburse hospitals on a fee-for-service basis. Negotiations between the insurance provider and healthcare service provider play a great role in determining the degree of reimbursement. Insurance providers reimburse the cost of hospital drugs of their members, but only if drugs prescribed are listed in the insurer’s forms. Various public and private health insurance schemes use forms of their own. All these forms are in line with the National List of Essential Medicine (NLEM).
Under JKN, all existing insurance schemes will be merged. The biggest challenge for JKN is the gap between the healthcare benefits covered by the plan and the actual healthcare services available in the country.
Private insurance providers cover both inpatient and outpatient service. High-income and upper-middle-income groups are the largest buyers of private insurance. Many International health insurance companies are present in Indonesia, including leading players such as Prudential, Manulife, Allianz, AXA, and AIA.
In Indonesia, healthcare insurance programs rarely reimburse all medical expenses and often require a high level of co-payments.
Medical device registration in Indonesia is regulated by MoH’s Directorate General of Pharmaceutical Services & Medical Devices; and Directorate of Medical Device Production and Distribution Development. Although there is no restriction on the importation of medical equipment, the Indonesian government prohibits the import of used equipment. Medical equipment is subject to 5-30% import tax. Electro-medical and other technical equipment have a tariff of 5% while medical supplies and plastics have a higher rate (20-30%). All imported medical equipment is subject to a 10% value added tax.
Indonesia shows good prospects for the healthcare medical devices market, however there are challenges that go together with doing business in Indonesia, namely:
1. Corruption and bureaucratic inefficiency are an indisputable presence in the Indonesian market. U.S. companies should be patient and ready to face these challenges.
2. The pricing of the products might also be a challenge for U.S. companies. The Indonesian medical industry has a preference for high-quality products from the U.S., Europe and Japan. The pricing of the product is important, considering the current USD exchange rate, which is slightly unfavorable compared to other currencies.
3. Some regulations regarding medical devices might create a challenge for U.S. companies; for example, the mandatory registration of medical devices at MoH before clearance through Indonesian Customs. This process can be lengthy and can only be conducted by local distributors.
Procurement and Tenders
In 2014, MoH implemented an online purchasing system for medical devices that currently lists over 7,500 types of medical devices across 23 categories, along with distribution costs in an e-catalogue. The e-procurement system allows local medical facilities to purchase devices without a tender, and aims to create transparency and simplify transactions. For U.S. companies, the portal is a means to fast-track exports and bypass red tape. However, to be listed in the e-catalogue, companies have to follow to price caps imposed by the government, which can directly impact profit margins. As private hospitals have access to the catalogue, they now have an upper hand in negotiating prices, which once again affects the bottom line. To manage the new obstacles and capitalize on a growing, thriving and highly-reliant market, U.S. manufacturers need to explore creative solutions with knowledgeable and savvy local distributors more than ever before.
All public tenders are published, but there are often listed specifications that require the knowledge and support of a local company to maximize the chances of success in a given procurement process. In order to apply for public tenders, a company must register at the government’s Procurement Portal INAPROC (https://inaproc.lkpp.go.id/v3/daftar_lpse) to be eligible to submit applications for any ongoing selection procedures.
For tender offers, local distributors and/or agents need to comply with Indonesian standardization procedures, as applicable. Government procurements have a preference for products with local content, to encourage domestic sourcing.
Name of Event: Hospital Expo 2018, Jakarta
Date: October 17-20, 2018
Indonesian International Hospital, Medical, Pharmaceutical, Clinical, Laboratories Equipment and Medicine Exhibition
Name: IndoHealthcare Expo 2019, Jakarta
Date: March 21-23, 2019
International Exhibition on Medical, Dental & Hospital Equipment, Medicine, Health Care, Supplies & Services
Name of Event: Indonesia Dental Exhibition & Conference, Jakarta
Date: September 13-15, 2019
Indonesian International Dental Exhibition and Conference displays the medical products, hospital and medical equipment, medicine and science, science and technology, etc.
Name of Event: Hospital Expo 2019, Jakarta
Date: October 2019 (date to be confirmed)
1. How many classes of medical devices are there in Indonesia?
Medical devices are classified into four (4) classes based on the risk level in case of malfunction / failure/ misuse, namely: Class I (A)-Low Risk / In case of malfunction or misuse the device would not cause serious harm; Class II-A (B) and Class II-B (C)-Moderate Risk / In case of failure or misuse the device can give significant impact on the health of patients, but not a serious accident; and Class III (D)-High Risk / The failure or misuse of these devices can result in serious implications for the patients or nurses/operators.
2. What is the timeline for Indonesia’s medical device registration process?
MoH has enacted a new regulation, Permenkes No. 62 Year 2017, concerning Marketing Authorization of Medical Devices, In Vitro Diagnostic Medical Devices, and Household Health Supplies on January 13, 2018. The significant change noticed in this new regulation is the approval timeline. Previously, medical device registration in Indonesia could take about 6-8 months. Now, MoH has sped up the process to just 1-2 months between application and approval, depending on the class and subject to timely submission of all required documentation.
3. How much is the registration fee for a medical device in Indonesia?
Official guidance on fees for the processing of a Class I (A) is USD115 (IDR1,500,000). Class II-A (B) and II-B (C) is USD230 (IDR3,000,000). Class III (D) is processed for a fee of USD340 (IDR5,000,000).
4. Who can distribute medical devices and supplies in Indonesia?
Importing medical devices and supplies can only be conducted by local companies that already have a Distributor License (Indonesian acronym: Ijin Penyalur Alat Kesehatan / IPAK) for the imported products. A Distributor License is issued by MoH. Once the distributor license is obtained, it is valid indefinitely, subject to MoH audit every five years. Imported products must have only one legal importer and distributor in Indonesia.
5. Can a foreign hospital invest in Indonesian hospitals?
Other than maternity hospitals, foreign investors can hold a maximum share of 67% in general hospitals (for ASEAN investors the maximum figure is 70%). Please refer to the Presidential Regulation No. 44 Year 2016 regarding Negative Investment List (Indonesian acronym: Daftar Negatif Investasi / DNI).
6. Can a foreign hospital provide services in Indonesia? (e.g. advising Indonesian hospitals on efficient operations or patient experience, telemedicine for patients)
Foreign investors may build a whole new hospital or operate an existing local hospital jointly with a local investor. Foreign personnel in hospitals are limited to consultants’ roles and they do not give direct medical services. A recommendation from MoH would be necessary for them to do so.
7. Is telemedicine currently being used?
In order to improve access and quality of Primary Healthcare, MoH has included telemedicine in their 2015-2019 Strategic Planning. Implementation of telehealth in Indonesia has begun with tele-ECG and tele-radiology program initiated by Harapan Kita and Dr. Cipto Mangunkusumo General Hospital. Frost & Sullivan reported, to address the increasing concern of maternal mortality in Indonesia, Philips is running a pilot-project, Mobile Obstetrical Monitoring, in collaboration with local hospital group Bundamedik, the city government of Padang, and MoH. This project will remotely monitor pregnant women for early high-risk identification using a new tele-health solution.
Name: Pepsi Maryarini
Position: Commercial Specialist
Phone: (62-21) 5262850
Due to the increase in the number of hospitals specializing in cancer, cardiology, etc., and the increase of non-communicable diseases, the most valuable business opportunities in the medical devices market are in surgical equipment and diagnostics imaging.
U.S. top three medical equipment export categories to Indonesia are:
Healthcare spending (including investment)
... as percent of GDP
5.8% (2018 est.)
... of which spent on pharmaceuticals/consumables
... of which spent on investment
3.45% (2018 est.)
Hospitals, Procedures, Healthcare Professionals UN:
Number of hospitals
Number of hospital beds
... available beds per capita
...of which in general hospitals
...of which in specialized clinics and rehabilitation centers
...of which surgeons
...of which internists
...of which pediatricians
261,890,872 (2017) / 265,015,000 (2018 est.)
Life expectancy men/women
Men: 69.8 years / Women: 73.6 years (2017)
25.1 deaths/1,000 live births (2017)
Percent of population older than 65
5.65% - Men: 6,767,685/Women: 8,020,036 (2017 est.)
6.54 deaths/1,000 population (2017 est.)
...caused by Cardiovascular Disease
...caused by Communicable diseases; maternal, prenatal and nutritional conditions
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