Ensuring Healthcare Services

A fundamental solution is necessary to address the deficit in the government’s National Health Insurance (JKN) scheme, which has persisted since the scheme was launched on January 1, 2014.

KOMPAS/FERGANATA INDRA RIATMOKO

Patients are accompanied by families members while having dialysis at Dr Moewardi General Hospital, Solo, Central Java, on Saturday (7/4/2018). Every day, the hospital sees 76 dialysis patients, most of whom subscribe to the Social Security Management Agency (BPJS). BPJS subscribes who have dialysis on an average of twice a week can do so at the hospital for free. Patients who do not subscribe to the BPJS are charged around Rp 900,000 per dialysis treatment.

A fundamental solution is necessary to address the deficit in the government’s National Health Insurance (JKN) scheme, which has persisted since the scheme was launched on Jan. 1, 2014.

Kompas reported on Tuesday that the government would inject more funds into to the Healthcare and Social Security Agency (BPJS Kesehatan) to help it reduce the deficit. Some Rp 4.9 trillion (US$328.77 million) will be disbursed in early October at the latest.

BPJS Kesehatan has suffered monthly deficits of between Rp 800 billion and Rp 1 trillion since the National Health Insurance\'s Indonesian Health Card (KIS) program was implemented in 2014.

Since 2014, BPJS Kesehatan’s expenses have been higher than its revenue. The gap between expenses and revenue has reached Rp 16.47 trillion, more than 20 percent of its 2017 revenue. In 2017, BPJS Kesehatan’s revenue, sourced from premiums paid by income earners and others, was Rp 74.24 trillion and its expenses Rp 92.82 trillion.

The JKN program is a fulfillment of the constitutional promise of proper healthcare insurance for all. Such a universal healthcare system requires everyone to pay premiums for it to work effectively.

Under a joint responsibility system, the healthy provide help for the sick and everyone must have disease prevention awareness. On such a foundation, a universal healthcare system should work.

The JKN is currently facing a clear problem, namely that the total amount of monthly premiums do not cover the total amount of monthly healthcare costs. In the past two years, the gap has widened. Increasing premiums may not be a popular move, but it must be seriously considered. People would surely understand if it was coupled with better services. BPJS Kesehatan should also seek more participants, including by using digital services.

Cost control is another major issue. In practice, healthcare service providers and BPJS Kesehatan may disagree on the medical treatment for certain illnesses. Clear regulations that do not hinder advancements in the development of medical and health sciences would be helpful.

One of the things that the government has yet to do effectively is encourage people to take care of their health and avoid infectious and degenerative diseases with dire impacts.

As long as such structural problems persist, the same issues will continue cropping up in the JKN scheme. This will lead to worsening healthcare services, as is evident by the numerous complaints by JKN participants. On the other hand, there are also allegations of healthcare service providers giving unnecessary medical treatment in order to make bigger payment claims.

We hope that the JKN scheme will continue to improve as people are in dire need of it amid increasing healthcare costs. Finding a comprehensive and fundamental solution should not be delayed.