As many as 164 hospitals have suffered cash flow problems due to delayed insurance claim payment from BPJS Kesehatan.
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Kompas/Wawan H Prabowo
People wait to be called to the Healthcare and Social Security Agency (BPJS) counter on Saturday (28/10) at Jakarta’s Pasar Rebo Regional Hospital. As of Oct. 1, 182.03 million people, or more than 70 percent of the population, had registered with the National Health Insurance-Indonesian Health Card (JKN-KIS) program.
JAKARTA, KOMPAS – As many as 164 hospitals have suffered cash flow problems due to delayed insurance claim payment from BPJS Kesehatan, the healthcare and social security agency that provides the National Healthcare-Indonesian Health Card (JKN-KIS) programs.
Patient health services could potentially be disrupted if the insurance claims are not settled immediately.
Association of Indonesian Hospitals (Persi) chairman Kuntjoro Adi Purjanto estimated the value of unpaid claims at the 164 hospitals at Rp 3 trillion. "Data provided by Persi members still needs further verification to obtain the exact amount of unpaid claims," he said in Jakarta on Wednesday.
According to data obtained by Persi, 41 private regional hospitals reported Rp 173 billion in unpaid claims. In Jakarta, 29 hospitals reported Rp 470 billion in unpaid claims.
Hospitals with unpaid claims are mostly C and D hospitals whose patients are mostly participants of the JKN-KIS program.
Hospital management are concerned and wonder when the claims will be settled. In addition to private hospitals, state hospitals under the Health Ministry are also experiencing the same problem.
Disrupted services
According to Kuntjoro, the delayed payments may soon disrupt the hospitals’ patient services, as the hospitals will be unable to fulfill their financial obligations to business partners such as pharmaceutical and medical equipment companies. Patients would also be affected in the end.
In Jakarta, Persahabatan Central Hospital (RSUP) president director Ali Toha said the hospital had unpaid claims of Rp 39.2 billion. This amount did not include unverified insurance claims of an estimated Rp 87.4 billion.
Because of the delay, the hospital cannot pay its pharmaceutical and medical equipment suppliers, with several pharmaceutical suppliers threatening to stop deliveries.
In Yogyakarta, RSUP Dr Sardjito said that it had Rp 143 billion in insurance claims that BPJS Kesehatan had not yet paid. "As of Nov. 10, 2017, of Rp 170 billion in total claims, only Rp 27 billion has been paid. So, the remaining unpaid claims total about Rp 143 billion," said Trisno Heru Nugroho, RSUP Dr Sardjito’s legal and public relations head.
Trisno said the unpaid claims mostly covered healthcare services from this year. He added that some of the claims remained unpaid partly because the hospital was unable to complete their administrative requirements.
"Some of the claims have not been paid because there is an administrative process that still has to be completed. But the others are due to an internal problem at BPJS Kesehatan," he said.
Meanwhile, the director of Yogyakarta Regional Hospital (RSUD), Tuty Setyowati, said it had billions in unpaid insurance claims, some of which covered healthcare services provided in 2016.
Tuty said the hospital had asked BPJS Kesehatan to immediately settle the claims payments, as otherwise, the delayed payment would disrupt the hospital’s activities.
In Kudus, Mardi Rahayu Hospital director Pujianto said the claims that BPJS Kesehatan had verified should be paid within 15 working days after the claims had been submitted. However, in reality, claims that had been submitted in April-September had not been paid in full. He said that according to the BPJS Kesehatan’s Kudus office, the claims were still awaiting final verification.
Pujianto said the hospital had to halt the disbursement of funds for expansion to prevent the delayed claim payments from disrupting the hotel’s operations. "This is a burden for us, because 77 percent of the patients are JKN-KIS participants," he added.
Thirty-four public hospitals are also experiencing a delay in claims payments. "I received a report that almost all hospitals are experiencing delayed claims payments, but I don’t know the amount of the unpaid claims," said West Java health office head Dodo Suhendar in Bandung.
When contacted for confirmation, BPJS Kesehatan health services director Maya Amiarny Rusady said in a brief statement that his office and Persi members had met and the problems had been settled.
Persi chairman Kuntjoro said BPJS Kesehatan had agreed to pay all unpaid claims by December.
BPJS Kesehatan’s assistant secretary of public communications and public relations, Nopi Hidayat, assured that all unpaid claims would be fulfilled in December, except for unverified claims.
Nopi said that hospitals and JKN-KIS participants did not need to worry, because the government had guaranteed it would use the national budget to cover any shortfalls in the event that BPJS Kesehatan was unable to pay all claims.
