JKN Participant’s Access to Health Services Expanded
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Kompas/Wawan H Prabowo
People wait their turn to have their files processed at a Healthcare and Social Security Agency (BPJS) counter at the Pasar Rebo regional general hospital, Jakarta, on Saturday (28/10/2017).
JAKARTA, KOMPAS — National Health Insurance-Healthy Indonesia Card Insurance (JKN-KIS) program participants’ access to health facilities, especially in remote areas, border regions, islands and eastern Indonesia, will be expanded with the construction of a number of new hospitals.
Director-general of health services of the Health Ministry Bambang Wibowo said in Jakarta on Tuesday that the ministry would build three vertical hospitals in Wamena (Papua), Ambon (Maluku) and Kupang ( East Nusa Tenggara) and dozens of non-class hospitals (pratama).
The construction of the new hospitals will be completed by 2019. Since 2014, an average of 10 pratama hospitals have been built a year.
Vice-President Jusuf Kalla acknowledged that there are a number of problems, such as low premiums, in the JKN-KIS program. The tariff was still too low because it had not adjusted to the increase in inflation and local governments have yet to support the program.
"The rise in hospital tariffs should be considered because it has yet to be adjusted to inflation. The tariff has not been increased for three years while costs for health services have increased," Jusuf said.
He also hoped that the existing health programs in the regions can be combined with JKN.
Remote area
According to Bambang, the construction of vertical and pratama hospitals is needed in order to provide more health facilities for JKN-KIS participants. Thus far, JKN-KIS participants’ access to health services in remote areas, border regions, islands and eastern Indonesia is still limited.
The pratama hospitals, which are under construction, have 50 beds each, while the vertical hospitals, which are of the B category, have 200 beds each.
There are nine provinces where the ratio of beds to citizens has not met the standard of 1: 1,000 or one bed for 1,000 residents. The nine provinces are Lampung, West Java, West Kalimantan, Central Kalimantan, West Sulawesi, West Nusa Tenggara, East Nusa Tenggara, North Maluku and Papua.
Since 2015, as many as 49 pratama hospitals have been built to give the people more access to health facilities. Nine of those are located in the western region to open community access to health services.
Bambang acknowledged that there is still an imbalance between the demand for services from JKN-KIS participants and the available health services.
The government tries to balance it by building new hospitals and improve the existing health facilities as well as provide more medical staff and budgetary resources.
"The Health Ministry has built 14 referral hospitals at national level, 20 referral hospitals at provincial level, and 110 referral hospitals at regency levels to strengthen the tiered referral system.
“The government’s budget for the special allocation funds for health facilities will reach Rp 15.8 trillion this year. The government also provides scholarships for doctors to become specialists and sub-specialists," said Bambang.
In addition, the government is also trying to meet the needs of the medical staff. One of them is through the establishment of the Nusantara Healthy Program and compulsory service for doctors and specialists.
Health financing
The secretary-general of the Association of Indonesian Doctors (IDI), M Adib Khumaidi, said existing health facilities were still mostly unable to meet the standards due to lack of financing to improve the services.
As a result, JKN-KIS participants often receive sub-standard services that may have a long-term impact on finances and health.
Therefore, the financing of the JKN program needs to be improved so that the health facilities can provide adequate services and fair remuneration for health workers.
The deputy for Human Development Policy Support and Development Equalization at the Vice President Secretariat, Bambang Widianto, said the JKN-KIS program with single payer like in Indonesia should have a better referral system. First-level health facilities (FKTP) should be able to handle more than 120 diagnoses of disease as required by the Health Ministry.
According to Adib, at present, upgrade, preventive and screening programs are focused on the public health services (puskesmas). The number of JKN-KIS participants at puskesmas is high. To give more access, participants should be channeled to private clinics and individual physicians.
BPJS’s Advocacy Coordinator Watch, Timboel Siregar, said BPJS Kesehatan should also improve its services to JKN-KIS participants. It should therefore not only work to verify claims, but also provide information and assist the participants in getting a better service. This could prevent potential fraud in hospital service claims.
