The government’s commitment in managing the National Health Insurance is in question. The low liquidity of the Healthcare and Social Security Agency is inseparable from the regulatory route the government has taken.
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JAKARTA, KOMPAS — The government’s commitment in managing the National Health Insurance is in question. The low liquidity of the Healthcare and Social Security Agency (BPJS Kesehatan) is inseparable from the regulatory route the government has taken.
National Social Insurance Council expert staff Hasbullah Thabrany said that if the government was committed to the National Health Insurance (JKN) as a priority program, the premium of a participant should be increased to meet the actuary’s calculations. However, this was not done in a bid to prevent uproar.
If the premium were not increased, the only option would be to fulfill the necessities of the BPJS Kesehatan in whatever way possible so that it could pay hospital bills smoothly. “I estimate the liquidity of BPJS Kesehatan is 15 percent of the total obligation,” Hasbullah said on Tuesday (20/3) in Jakarta.
In the past few years, economic growth has been on an increasing trend. The electricity and fuel subsidies were also high, this year above Rp 98 trillion. “For several years, there was inflation and health costs rose. If increasing the premiums is seen as a burden to the public, then where has the [earnings from] economic growth gone?” said Hasbullah.
Indonesia Cancer Foundation chairman Aru Wisaksono Sudoyo said the JKN made it easier for the public to access healthcare services. The financial obstacles of the past no longer exist today. However, the high number of claims and the costly coverage for chronic diseases have affected BPJS Kesehatan’s capacity to pay medical bills.
Kompas/Wawan H Prabowo
People fill out forms and submit documents in this Mar. 3, 2017 file photo to register for the Healthcare and Social Security Agency (BPJS Kesehatan) program at Persahabatan Hospital in Jakarta.
Earlier payments
In order to help solve the liquidity of BPJS Kesehatan, the government is making an effort to ensure early premium payments for poor people who receive health insurance assistance. “Usually, the government pays the premium of assistance beneficiaries at the end of the month,” said deputy finance minister Mardiasmo during a special interview with Kompas.
Under Social Affairs Minister Decision No. 5/2018 on Health Insurance Assistance Recipients Year 2018, 92.4 million people receive government assistance for their health insurance premium, which totals Rp 2.1 trillion per month.
Mardiasmo said that the Finance Ministry had disbursed the funds for premium to BPJS Kesehatan on Jan. 5 for January, then on Feb. 5 for February, on Feb. 19 for March, on Feb. 26 for April and on March 7 for May.
“If the government still encounters financial problems at BPJS Kesehatan later, the government may make earlier payments for the following months,” he said.
BPJS Kesehatan’s financial problems incur from its annual deficit that the government has to plug. In 2015, the government provided Rp 5 trillion in state capital injection to BPJS Kesehatan. In 2016, the government again injected Rp 6.8 trillion. Last year, the government provided Rp 3.6 trillion in state capital injection.
This year, BPJS Kesehatan reported a deficit of Rp 800 billion to Rp 1 trillion per month. So, the deficit for a full year would reach Rp 9.6 trillion to Rp 12 trillion.
Mardiasmo said the government had made other efforts in drafting nine policy mixes. Four of these would require a revision to Presidential Regulation No. 12/2013 on Health Insurance. The others implement prevailing regulations.
If all policy mixes were implemented, Mardiasmo was convinced BPJS Kesehatan’s deficit could be settled. Yet, it would require high discipline and synergy among all stakeholders.
The policy mixes need to be regulated under either a presidential regulation or a ministerial regulation. Once the policy mix regulation was issued and implemented, BPJS Kesehatan spokesman Nopi Hidayat said that BPJS Kesehatan could be more flexible, for example in its purchasing strategy.
Hasbullah said the policy mix would only lift the current problem, but the problem would continue to grow and accumulate. This was because the core problem of BPJS Kesehatan was its lack of funding, which has not been resolved.
