JKN Health Insurance Tariff Remains a Problem
JAKARTA, KOMPAS – National Health Insurance-Healthy Indonesia Card (JKN-KIS) beneficiaries often discriminated against at hospitals, partly because of the health insurance services’ low tariffs. Therefore, insurance tariffs should increase while hospitals need to improve their operations.
These statements were issued by Hasbullah Thabrany, a National Health Insurance consultant and Daniel Budi Wibowo, the chairman of the Health Insurance Compartment of All Indonesia Hospital Association, in Jakarta on Monday.
Hasbullah said KN-KIS health insurance beneficiaries were entitled to a quality service and should not face discrimination from hospitals. In reality, there are a number of hospitals that still impose service quotas, limit service times to JKN-KIS beneficiaries and even ask for advance payments.
The services received by the JKN-KIS participants are also lower in quality. In the long run, it will undermine public trust in the JKN-KIS insurance program. However, hospitals are not solely to be blamed.
The poor service occurs due to the tariff rates in Indonesia Case Base Groups (INA-CBGs) -- the service tariff system grouped on the basis of similarity in diagnosis -- are still inadequate. The hospitals carry out such bad practices to prevent them from suffering big losses.
According to Hasbullah, the difference in service tariff between public and private hospitals is only between 3 and 5 percent. In fact, public (government) hospitals do not pay the salaries of their employees, whereas private hospitals have to pay salaries, invest in medical equipment and pay income tax.
Service payments of private hospitals, therefore, should be at least 30 percent higher compared to those charged by public hospitals to enable them to provide better services. "If the payment is adequate, private hospitals would be more motivated to become a partner with BPJS Kesehatan," he said.
Not cooperating yet
The low insurance tariff is said to be one of the reasons why about 500 of the 2,700 hospitals have not cooperated with the Healthcare and Social Security Agency (BPJS Kesehatan), which operates the JKN-KIS health insurance services. The existing JKN-KIS tariffs are still inadequate to cover the investment for the expensive hospital facilities, the salary of employees and the relatively high operating costs.
Therefore, according to Daniel, the tariffs should be high enough to spur investment for the opening of new hospitals in areas that have not been covered by good health services.
Prior to the JKN-KIS era, hospitals applied service rates based on the fee-for-service system. In this retrospective system, payouts were set after a service was provided. With this system, service providers could get unlimited profits. All services were offered to patients and there was no standard tariff. The JKN program implemented a prospective payment pattern, where the tariff had been set before the service was provided.
On the other hand, the implementation of a tiered referral system is not optimal, due to staff limitations, facilities and the competence of BPJS’s members.
Daniel said the most important thing for hospitals was to control quality and costs by reducing operational costs. Beyond the tariff and quality of the hospital facilities, the slow verification of claims and payments by BPJS Kesehatan, the hospital officers\' understanding of the diagnosis code and the JKN-KIS procedure still hamper many hospitals.
The director of RSUD Labuang Baji public hospital in South Sulawesi, Andi Mapptoba, said his hospital faced many administrative problems when providing services to JKN-KIS patients. For example, the patient is not a member of the JKN-KIS program and only carries a letter stating that he or she is poor, in addition to the fact that many JKN-KIS members cannot be covered by BPJS Kesehatan because they did not pay their insurance premiums.
The disbursement of the claims by BPJS Kesehatan is often delayed due to incomplete patient documents. As a result, hospitals must charge between Rp 2 million to Rp 4 million per patient. The unachieved profit target is calculated as debts.
Imelda Liana Ritonga, the owner of Imelda Pekerja Indonesia Hospital in Medan, said the disbursement of the claims from BPJS Kesehatan due in September 2017 was still on time according to the provisions, ie 14 working days after signing the documents. However, the payment claims due for October are still pending, causing the hospital to bear service fees for the August, September and October periods.
"This further adds to operational costs of the hospital. We also have to increase capital," Imelda added.
Despite the complaints by hospital operators, BPJS Kesehatan data showed that hospital satisfaction rates toward the JKN-KIS program reached 76.2 percent.
The director of BPJS Kesehatan, Fachmi Idris, said it had so far paid all the hospital claims. The delay often occurred due to the incomplete claim documents, he added.
In the midst of inadequate tariff issues, BPJS Kesehatan wants to prevent fraudulent claims by reviewing all claims. From the auditing review, BPJS can save up to Rp 2.9 trillion. "If there is a disagreement between BPJS Kesehatan and the hospitals, we take it to the medical committee and the experts. However, if there is a bill, but no action (phantom billing), it will not be tolerated," said Fachmi.
(REN/BKY/KRN/NSA/ADH)