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Healthcare Resource Guide: Indonesia

Indonesia Statistics


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Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Reimbursement

Barriers

Trade Events

CS Contacts

Best Prospects

Market Size

Capital: Jakarta

Population: 262 million (2017 est.)

GDP*: $1020 billion (2017 est.)

Currency: Rupiah

Language: Indonesian

Summary

The population of Indonesia in 2017 is estimated to reach 262 million, which placed Indonesia at number 4 in population among the 193 nations of the world.

In 2017, World Bank estimates show that Indonesia will have 14.4 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 in Indonesia’s elderly are 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 killers 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. The total value of imported medical equipment grew from US $726 million in 2015 to US $1,035 million in 2016 and is estimated to reach US $2,030 million in 2018.

Almost 95% of Indonesia’s medical equipment and devices are imported, with most being 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, orthopaedic aids, and hospital furniture. But since 2016, local companies began producing other medical equipment, such as sphygmomanometer, stethoscopes, urine catheter, infant incubator, nebulizer, O2 concentrator, dental chair, EKG, fetal Doppler, syringe pump, infusion pump, operating lamp, medical dressings (i.e. operating gown, bed sheets), rapid tests (i.e. HIV, Hepatitis, pregnancy to name a few), blood-grouping reagents, and first-aid boxes & kits.

In their article “Indonesia continues to be one of the more attractive markets in ASEAN for foreign healthcare companies,” Frost & Sullivan revealed the medical devices market is forecasted to grow 12.5% yearly from 2013 to 2018, and should cross US $1 billion in 2018 with growing business in surgical equipment, diagnostics and medical imaging equipment.

Healthcare is a priority in Indonesia’s national development agenda. Increases in public awareness in healthcare and social conditions and 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, Indonesia Ministry of Health, in 2016, Indonesia has a total of 2,601 hospitals--988 privately managed and 1,613 managed by the public sector. Those hospitals offer 256,426 hospital beds, or 1.12 beds per thousand populations. 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 are dominated by five (5) major groups: Siloam Hospital Group (which is part of Lippo Group), Hermina Hospital Group, Rumah Sakit Mitra (Mitra Group), Awal Bros Hospital Group, and Sari Asih Group. Besides these, Ramsay Sime Darby, Omni, Pondok Indah, and Mayapada hospitals are amongst the top 10 private participants.

As the largest hospital operator in Indonesia, plans to reduce Siloam Hospital Group has adopted the most aggressive stance having announced an IDR1.6 trillion (USD76 million) and intends to grow its total number of hospitals from 17 in 2014 to 50 by 2017. Siloam is planning to open hospitals at Banjarmasin (South Kalimantan), Manado (North Sulawesi), Palangkaraya (Central Kalimantan), Belitung, and Lubuk Linggau (West Sumatera).

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 2016, 164 million Indonesians were covered under JKN (approximately 65%). 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.

Market Entry

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.

Current Trends

Indonesia is an attractive market for the health sector, as its total expenditure continues to grow at a CAGR of 14.7% and estimates to reach USD35 billion in 2017. 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, haematology, and immunology.

Main Competitors

The market for medical equipment and supplies is highly competitive. The U.S. is one of the leading suppliers with shares over 10% of this market in 2016. Other countries competing for market share in the medical equipment and supplies include China, Germany, Japan, Korea, and the Netherlands. Companies from China and 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.

Current Demand

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.

Registration Process

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.

The Indonesian Ministry of Health (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 the Ministry of Health – Directorate General of Pharmacy and Medical Devices Services, which includes all of the following documents that the U.S. companies should supply:

  • Letter of Authorization (LoA) issued by the manufacturer, legalized by the Indonesian Embassy and a notary public in the U.S. and valid for at least five (5) years.
  • Certificate of Free Sale from the authorized institution.
  • Certificate of CE for ‘CE’ mark products or Certificate of ISO for ‘ISO’ mark products, if any
  • Product Information
  • Formula/component/raw materials
  • Brief manufacturing process flow chart
  • Finished product specifications
  • Safety and Efficacy Data
  • Manual Book (instruction for use), which will be translated into the Indonesian language

Reimbursement

The Indonesia Ministry of Health (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, 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 in the path of 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.

Barriers

There are no restrictions on imports of medical equipment; however, imports of used equipment are prohibited. Indonesian import duties for medical equipment can go up to 30 %. Electro-medical and other technical equipment have a tariff of 5%, while medical supplies and plastics are subject to a higher rate (20-30%). In addition, all imported medical equipment is subject to a value-added tax of 10%.

Although Indonesia shows good prospects for the healthcare medical devices market, 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 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 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 the Ministry of Health (MoH) before clearance through Indonesian Customs. This process can be lengthy and can only be conducted by local distributors.

Procurement and Tenders

In 2014, the Ministry of Health 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 affecting the bottom line. Given this we continue to recommend that U.S. companies work with local distributors to best navigate the market.

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.

Indonesian Procurement

Indonesian Language website: https://inaproc.lkpp.go.id/v3/daftar_lpse

Healthcare Procurement

Indonesian Language website: http://www.lpse.depkes.go.id/eproc4

Trade Events

Name of Event: Hospital Expo 2017, Jakarta

Date: October 18-21, 2017

Website: http://www.hospital-expo.com/

Indonesian International Hospital, Medical, Pharmaceutical, Clinical, Laboratories Equipment and Medicine Exhibition

Name of Event: IndoMedicare Expo 2017

Date: November 28-30, 2017

Website: https://kristamedia.com/

International Exhibition on Medical, Dental & Hospital Equipments, Medicine, Health Care, Supplies & Services

Name of Event: CPhI South East Asia 2018

Date: March 27-29, 2018

Website: http://www.cphi.com/sea/

International fair of the pharmaceutical industry. The show is co-located with ICSE, InnoPack, P-MEC and Hi South East Asia, all aspects of pharma are united in one location at CPhI South East Asia.

Name of Event: Hospital Expo 2018, Jakarta

Date: October 2018 (date to be confirmed)

Website: http://www.hospital-expo.com/

Indonesian International Hospital, Medical, Pharmaceutical, Clinical, Laboratories Equipment and Medicine Exhibition

FAQs

How many classes of medical devices 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.

What is the timeline for Indonesia’s medical device registration process?

Depending on the class and subject to timely submission of all required documentation, Product Registration can take between 45 days to more than 6 months, if the Ministry of Health finds the documents submitted were incomplete.

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).

Who can distribute medical devices and supplies in Indonesia?

Importing medical device 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 the MoH. Once the distributor license is obtained, it valid indefinitely, subject to a MoH audit every five years. Imported products must have only one legal importer and distributor in Indonesia.

Can a foreign hospital invest in Indonesian hospitals?

Other than maternity hospitals, foreign investors can hold up to 67% of shares in specialist hospitals. Please refer to the Presidential Regulation No. 44 Year 2016 regarding Negative Investment List (Indonesian acronym: Daftar Negatif Investasi / DNI).

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 the Ministry of Health would be necessary for them to do so.

Is telemedicine currently being used?

There has been an effort to adopt and implement the use of telemedicine. It is considered very important for the future of the country, taking into account the naturally widespread distribution of population in Indonesia with its over 17,500 islands. Telemedicine would greatly reduce the need for experts, both local and from overseas, to travel to Indonesia’s rural areas and islands. Several attempts have been made to provide foreign medical expert assistance to Indonesian medical personnel, but they were unsuccessful, mostly because of the extremely high costs incurred in the application of such technology. The monetary and economic crisis has played a leading role in delaying the use of telemedicine. Another technology, radio-based telemedicine, has also been developed. This method offers low-cost applicative technology in remote places where medical expert assistance is needed. Related pilot studies have been conducted in the eastern part of Indonesia. However, this method can only be applied to intercountry situations and therefore would not have any effect on foreign trade. Frost & Sullivan reported that 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 the Ministry of Health (MoH). This project will remotely monitor pregnant women for early high risk identification using a new tele-health solution.

U.S. Commercial Service Contact Information

Name: Pepsi Maryarini

Position: Commercial Specialist

Email: Pepsi.Maryarini@trade.gov

Phone: (62-21) 5262850

Available Market Research and Best Prospects

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.

  • Surgical equipment, like surgical sterilizers, blood pressure monitors, endoscopy apparatus, dialysis apparatus, transfusion apparatus, anesthetic apparatus & instruments.
  • Diagnostic imaging equipment, like Ultrasound, CT and MRI scanners, X-rays, Medical X-ray films).

Market Size

Healthcare spending (including investment)

 

... as percent of GDP

2.9% (2016)

... of which spent on inpatient services (including long-term care)

33.1% (2015)

... of which spent on pharmaceuticals/consumables

0.68% (2016)

... of which spent on outpatient services

29.8% (2015)

Hospitals, Procedures, Healthcare Professionals UN:

Number of hospitals

2,601 (2016)

…Public

1,613 (2016)

…Private

988 (2016)

Number of hospital beds

256,426 (2016

... available beds per capita

1.12 (2016)

     ...of which in general hospitals

2,045 (2016)

     ...of which in specialized clinics and rehabilitation centers

556 (2016)

Number of surgical procedures

526,010 (2016)

Physicians

103,700 (2016)

...of which surgeons

3,989 (2016)

...of which internists

5,290 (2016)

...of which pediatricians

5,538 (2016)

Dentists

13,435 (2016)

Demographics

Population

256,924,888 (2016)

Life expectancy men/women

Men: 70.1 years / Women: 75.5 years (2016 est.)

Infant mortality

23.5 deaths/1,000 live births

Percent of population older than 65

6.79% - Men: 7,630,251/Women: 9,913,993 (2016 est.)

...projection, 2030

295 million

Annual deaths

6.4 deaths/1,000 population (2016 est.)

...caused by [highest disease burden]

Cerebrovascular disease (stroke): 21.1% (2014)

...caused by [second highest]

Ischemic heart disease: 12.9% (2014)


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