JKN Service Quality Not Yet Optimal

KOMPAS/FERGANATA INDRA RIATMOKO

Several patients are accompanied by their family members during hemodialysis at Dr Moewardi Public Hospital in Surakarta, Central Java on Saturday (7/4/2018). Everyday, the hospital performs hemodialysis on 76 patients, mostly using social healthcare insurance BPJS. Patients can have the hemodialysis treatment two times a week for free. Those who do not use the BPJS need to pay Rp 900,000 per treatment.

JAKARTA, KOMPAS – Good healthcare services is central to a health insurance scheme. However, the broad public access to healthcare services the National Health Insurance-Indonesian Health Card (JKN-KIS) program provides is not yet accompanied with high-quality services.

This had led to complaints from JKN participants regarding numerous services, including the established quota for JKN participants at hospitals, limited hours of medical services for JKN participants, difficulty finding intensive care units, the need to purchase prescription medicines out of pocket and the months-long wait for medical treatment.

In addition to these problems, limited infrastructure, facilities, medical equipment, competence and availability of medical professionals at community health centers (puskesmas) have contributed to the high rate of hospital referrals.

Until February, 21,843 primary healthcare facilities (FKTP) and 2,314 referral healthcare facilities (FKRTL) have established cooperation with the Health and Social Security Agency (BPJS Kesehatan).

National Social Security Council (DJSN) member Zaenal Abidin said on Monday (9/4/2018) in Jakarta that healthcare facilities should be readied to serve JKN participants. After a citizen registers as a JKN participant, they become eligible for quality healthcare services provided by competent medical professionals at an adequate facility located near their homes.

Zaenal said that only one FKTP puskesmas was available in Natuna regency, the Riau Islands. It was open only until 2 p.m. As a result, local JKN participants requiring medical care outside the puskesmas’ working hours lined up at the emergency rooms of local hospitals.

In the areas covered by the BPJS Kesehatan North Sumatra-Aceh, the referral rate reached 20 percent in 2017, above the standard rate of 15 percent. Referrals were often made, as certain diagnoses required medical specialists, the FKTPs had limited equipment and the FKTPs lacked competent medical workers to diagnose 144 types of diseases.

BPJS Kesehatan North Sumatra-Aceh deputy director Budi Mohammad Arief said that FKTPs were available in every district while spporting puskesmas were available in remote regions. However, their facilities and medical professionals were still below the national standard.

Afifuddin, 32, of Pidie in Aceh, for instance, once accompanied his mother to undergo cataract surgery at Tgk Chik Ditiro Regional General Hospital (RSUD) in Sigli after a puskesmas referred her there. A week after the surgery, Afifuddin’s mother suffered a neurological disorder. However, the local puskesmas could not issue a referral letter, as the cataract surgery referral had been issued less than 30 days before. The puskesmas could only issue another referral letter after the 30-day period following the previous referral letter.

“I was forced not to use the JKN facility, as I could not wait for the [30-day period following the] cataract surgery referral letter to end. My motjer needed immediate medical care,” said Afifuddin.

Fhemmy Fransisca, 33, of Bandung’s Antapani district, also said that she could not depend on the JKN’s facilities, despite her and her family being registered as Class I JKN participants with a monthly premium of Rp 80,000 (US$5.84). She must use her own savings to obtain speedier medical care for her son, who has heart problems.

Limited facilities

Department head Deni Kurniadi Sunjaya of the Public Health postgraduate program at the Padjadjaran University Medical School said the services for JKN participants was not yet optimal because of the imbalance between the number of medical facilities, the medical professionals’ competence and the high demand of participants.

BPJS Kesehatan president director Fachmi Idris said last week that the high rate of medical facility usage among JKN participants was a direct result of open healthcare access. The open access must be complemented by stronger services at primary healthcare facilities to prevent the high rate of referrals. The competence and preventive programs at FKTPs must also be improved to better diagnose 144 diseases.

In addition, BPJS Kesehatan has implemented a Commitment-Based Capitation (KBK) system to boost the effectiveness of capitated healthcare funding system for FKTPs. The three performance indicators for the system are patient contact rate, non-specialist referral ratio and the visitation rate of JKN participants suffering from chronic diseases.

BPJS Kesehatan is collaborating with complaints departments at hospitals by providing information and complaint management officers and complaint forms. “We are also developing an information system for hospital bed availability by integrating the hospitals’ information management system and the BPJS Kesehatan application,” said Fachmi.

Health services director general Bambang Wibowo of the Health Ministry said that he realized not all puskesmas had medical professionals with the competency to diagnose the 144 illnesses the JKN covered. The various causes of the condition included infrastructure, medical equipment and human resources.

Bambang said that the monthly capitated funds the puskesmas received could be used to improve their infrastructure, hire more medical professionals and hold outreach programs. “The regulatory knowledge, leadership, governance and resource integration at puskesmas must be improved,” he stressed.

The ministry has conducted an accreditation program to strengthen puskesmas’ management. Of the 9,825 puskesmas in the nation, only around 4,500 are accredited. The hope is that, as the country heads toward achieving its universal healthcare target in 2019, all puskesmas will have been accredited.

(ADH/EVY/WSI/AIN/SEM/SYA/ETA/RWN/RAM)