Patchwork Approach Persists in Resolving JKN Deficit

The government has injected another round of financial aid to the Healthcare and Social Service Agency (BPJS Kesehatan), to help it overcome the national health insurance (JKN) scheme’s burgeoning deficit. However, such aid will only be effective in the short term.

KOMPAS/RIZA FATHONI

Health Minister Nila Faried Anfasa Moelok (right) talks to the president director of the Health Care and Social Security Agency (BPJS Kesehatan) Fachmi Idris, before a meeting to discuss BPJS Kesehatan’s financial deficit control with Commission IX of the House of Representatives at the House complex in Jakarta on Monday, Sept. 17, 2018. The government will take a number of steps to control BPJS Kesehatan’s financial deficit, including the efficiency of BPJS Kesehatan\'s operational funds and the utilization of Cigarette Tax funds.

JAKARTA, KOMPAS – Many believe that the government is relying on a patchwork approach to resolve the JKN scheme’s lack of funds. The deficit persists even after the government’s financial injection of Rp 4.9 trillion (US$328.77 million) this year.

Financial deficit has been the name of the game at BPJS Kesehatan since the National Health Insurance-Indonesia Health Card (JKN-KIS) scheme was implemented in 2014. The deficit is estimated to be between Rp 800 billion and Rp 1 trillion a month. Since 2015, the government has repeatedly injected funds into the scheme, but they has always been less than the deficit.

The BPJS Kesehatan reported a deficit of Rp 16.5 trillion in 2018, with losses of Rp 12.1 trillion in 2018 and Rp 4.4 trillion in 2017.

However, a separate calculation by the Development Finance Comptroller (BPKP) shows that the deficit in the JKN scheme was Rp 10.9 trillion, Rp 5.5 trillion lower than BPJS Kesehatan’s own calculation.

Soon to be disbursed

Deputy Finance Minister Mardiasmo said the Rp 4.9 trillion in government aid for BPJS Kesehatan would be disbursed in the next week or two. “Currently, we are in the progress [of disbursing it]. It will be in early October at the latest,” he said in a public hearing with House of Representatives Commission IX in Jakarta on Monday (17/9/2018).

As BPJS Kesehatan was suffering from deficits, Mardiasmo said, the payment of claims to healthcare facilities was often delayed. Consequently, many of these facilities protested. In response to this, President Joko Widodo has ordered his administration to immediately disburse financial aid.

The government is also preparing a policy mix that will be effective in October this year. With the policy mix fully implemented, the government hopes to generate funding of between Rp 2.7 trillion and Rp 3 trillion. By the end of this year, the deficit is projected to hover at Rp 8 trillion.

Included in the policy mix, Mardiasmo said, were regulations to increase regional administrations’ role in using the cigarette tax, resolve regional administrations’ healthcare arrears, synergize BPJS Kesehatan with other social security organizers and conduct strategic purchasing at BPJS Kesehatan.

However, the head of the Indonesian Hospitals Association (Persi) Jakarta branch, Koesmedi Priharto, said the deficit would persist if JKN premiums were not increased by the end of the year. Financial aid for BPJS Kesehatan would only be good for the short term, he said.

Ilham Oetama Marsis of the Indonesian Doctors Association (IDI) said the government often used a patchwork approach in resolving problems at BPJS Kesehatan. The IDI proposed a premium scheme for patients to end the deficit.

Systematic solution

The head of the Center of Economic and Health Policy Studies, Budi Hidayat of the University of Indonesia’s School of Public Health, said the government’s financial aid for BPJS Kesehatan would not resolve the core problems. “The deficits happening today were predicted a long time ago,” he said.

To end the deficit, Budi said that systematic solutions would be necessary. This can be achieved by controlling costs and through participation management. The former can be achieved by determining fees and monitoring how participants use their insurance benefits. Currently, it is believed that there are many “abnormal” uses for benefits, leading to a skyrocketing financial burden.

Participation management can be achieved by prioritizing the recruitment of more participants in the wage recipient (PPU) segment. Currently, it is believed that BPJS Kesehatan has yet to promote its program optimally to potential participants in this segment.

BPJS Kesehatan president director Fachmi Idris said the deficit in the JKN-KIS program occurred due to incongruities between participants’ premiums and the actuarial calculation of healthcare costs. Consequently, the healthcare cost per person per month is larger than the premium per person per month. In 2016, for instance, the cost per person per month was Rp 2,026 more than the premium per person per month. In 2017, the gap widened to Rp 5,625.

Fachmi said the deficit could grow even more, in line with increased participation and the use of benefits in the JKN-KIS program for catastrophic diseases, including cancer, kidney failure and stroke.

(ADH)