The BPJS Kesehatan and its healthcare partners need to be stricter in controlling healthcare costs. This is to ensure sustainable funding for the National Health Insurance-Healthy Indonesia Card program.
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Kompas/Riza Fathoni
A resident seeks assistance at the Health Care and Social Security Agency (BPJS Kesehatan) office in Sunan Giri, Jakarta, Friday (2/3). BPJS Kesehatan is aiming for 68 million additional participants to achieve its target ahead of the implementation of Universal Health Coverage (UHC) in 2019. This expansion effort is expected to be accompanied by the compliance of participants to make contributions.
JAKARTA, KOMPAS – The Healthcare and Social Security Agency (BPJS Kesehatan) and its healthcare partners need to be stricter in controlling healthcare costs. This is to ensure sustainable funding for the National Health Insurance-Healthy Indonesia Card (JKN-KIS) program.
The effort also needs to be accompanied by an increase in income. Advocacy coordinator Timboel Siregar at the BPJS Watch said that controlling hospital costs would significantly affect BPJS Kesehatan’s funding capacity under the JKN-KIS program.
For example, up to November 2017, the leading cost in the 10 codes for advanced inpatient care under the Indonesia Case Base Groups (INA-CBGs) was the Caesarean section, which can cost trillions of rupiah. “Is it true that all those deliveries need to be done through surgery,” Timboel said in Jakarta on Monday (19/3).
Another effort that must be undertaken is to increase the lower limit of premium payments for salaried employees (PPU), for instance, from a salary cap of Rp 8 million (US$584) to Rp 12 million. Therefore, the contributions the BPJS receives from formal workers can be increased.
Meanwhile, National Social Security Board (DJSN) member Taufik Hidayat said that costs could be managed by reducing cases of readmission, in which patients are asked to visit healthcare facilities more than once for the same diagnosis, thus creating a new bill. Readmission places unnecessary burdens on the healthcare fund.
The effectiveness of the capitation fund provided to puskesmas (community health centers) is also under question. Puskesmas without medical doctors on staff tend to refer their patients to hospitals, resulting in huge costs; however, a large number of puskesmas in the country do not have doctors.
Funding sources
Taufik said that, apart from cost control, another measure that must be undertaken was strengthening the sources of funding. Ideally, this could be done by increasing the premiums. However, the government will not choose this option.
Therefore, the alternative was to optimize the number of PPU participants. Ensuring that companies, including state-owned enterprises (SOEs), complied with registering their employees and regularly paying the premiums was important.
Until now, not all employees of SOEs had been registered as JKN-KIS participants. “Without it, the principle of mutual assistance would be disrupted by the high utilization [of BPJS services] among independent participants whose compliance with paying premiums has not been optimal,” said Taufik.
Timboel said that regional governments must consistently integrate regional health insurance services and pay the premiums. A good example of a mixed policy was for regional budgets to cover the mandatory premium payments for local civil servants and assistance beneficiaries (PBI).
There are eight policy mixes for the JKN-KIS, including limiting the BPJS Kesehatan operational cost, improving claims management at healthcare facilities, improving BPJS Kesehatan’s performance through strategic purchases, and premium fees for activities that carry moral hazards.
Other policies include increasing the salary cap for PPU participants from Rp 8 million to Rp 10 million, improving reference and back-reference systems and resolving regional debts in integrated regional health insurance obligations and premium payments for civil servants. Another policy is to use the cigarette excise to fund the JKN-KIS program.
The Home Ministry must also be stricter in monitoring regional administrations’ compliance with the JKN program. Ahead of the 2019 political year, some regional administrations have excluded a majority of local PBI participants from the JKN program, and have instead provided them with direct funding in order to gain votes ahead of the regional elections.
Finance Ministry director general of budgeting Askolani said the government was preparing a policy mix to resolve the BPJS deficit in 2018, and would monitor their implementation accordingly.
