JKN Service Quality Not Yet Prime

KOMPAS/FRANSISKUS PATI HERIN

An unidentified resident of Piliana village, Tehoru district, Central Maluku regency, Maluku, shows the Healthy Indonesia Card provided by the government on Monday (5/11/2018). Of the 130 cards received by residents of one of the inland villages, only one card is active, meaning a number of people who are sick cannot get medical treatment because they cannot afford to pay for the cost of treatment.

JAKARTA, KOMPAS –  Conceptually, the national health insurance program is very good. However, many problems in its implementation still need to be resolved.

The National Health Insurance-Healthy Indonesia Card (JKN-KIS) program offers many public benefits. The health insurance scheme has significantly improved public access to healthcare services without cost constraints.

However, many technical problems that emerged in 2014 at the outset of the health insurance program have continued till today. Waiting hours to be served, difficulty in getting referrals and rooms in intensive care units (ICUs); shortage of medicines, and non-functional membership cards are among the many issues that prevail.

Nuraeni, 38, a JKN-KIS member in Makassar, South Sulawesi, said she felt the benefits of the health insurance program when she underwent a Caesarean section for the birth of her second child, and when her child needed surgery to treat an intestinal disease. "All services were good and I received treatment until I recovered. No money was paid," said the cleaning worker of Rappocini district.

However, this is different from the experience of Heriyanto Sihombing, 47. The property marketer who lives in Kebon Jeruk, West Jakarta, had to queue for hours when seeking healthcare services at a 24-hour public health center at Kebon district.

The Class II JKN-KIS member nearly brought a blanket so he could sleep in line from 6:30 a.m. to 11:30 p.m., as he was suffering from a sore throat, cough and flu. "There was only one doctor, while there were hundreds of patients," he said. In fact, long queues at hospital pharmacies have become normal for the JKN-KIS program.

Hendra Sebayang, 60, who has heart disease and received outpatient treatment at Harapan Kita Heart Hospital, said that he was fine with waiting for a short while. "The important thing is that they have all the medicines I need," said Hendra, who had to queue from 8:00 a.m. to 1:30 p.m. to obtain his medication.

In Surabaya, Mujihadi, 62, a patient at Dr. Soewandi Hospital, felt that he did was not served as well as self-paying patients.

Mujihadi, who works as a peddler in Prestasi Park, said he had queue for about three hours before he was served. He said the doctor only examined him briefly.

In Maluku, almost every JKN-KIS card that the government distributed to the residents of Piliana village in Tehoru district, Central Maluku, were inactive and could not be used. Meanwhile, the villagers could not afford to pay for their medical treatment with. Dance Latumutuani, 39, a Piliana villager, said that last year he took a fellow villager for treatment at

Masohi General Hospital. When he provided his KIS card, the receptionist said that the card, which had never been used, was inactive.

"As a result, it was useless for people to have the KIS card," he said. After checking further, it turned out that of the 130 other villagers that had KIS cards, only one was active. In 2017, the Piliana village administration had paid Rp 16 million to the health agency to register its residents with the JKN-KIS program.

Complaints

The JKN-KIS health insurance program is under the management of the Health Care and Social Security Agency (BPJS Kesehatan).

BPJS Advocacy Watch coordinator Timboel Siregar said that the most frequently received complaint was that patients and their families had to obtain their own hospital rooms.

KOMPAS/FRANSISKUS PATI HERIN

An unidentified resident of Piliana village, Tehoru district, Central Maluku regency, Maluku, shows the Healthy Indonesia Card provided by the government on Monday (5/11/2018).

Timboel said this was against the regulations, because BPJS Kesehatan should obtain hospital rooms on behalf of its members. “They are paid to do this. The patient\'s family has a very weak position when they are dealing with a hospital,” he said. Therefore, he strongly urged BPJS Kesehatan to provide a 24-hour customer services at hospitals so a patient can complain immediately if something happens and not have to deal directly with the hospital.

Timboel acknowledged that problems existed in the availability and distribution of health facilities as well as healthcare workers. However, this should not be a problem. BPJS Kesehatan needed to be innovative in providing good service so that its members would be satisfied.

Indonesian Dialysis Patient Community (KPCDI) chairman Tony Samosir said the JKN-KIS program had greatly helped patients with kidney failure that needed regular hemodialysis. However, patients still experienced many shortcomings. For example, hemodialysis patients in generally poor condition were still required to first obtain a referral from a puskesmas (community health center).

In addition, not all JKN-KIS members received the full benefits of their insurance. Many were unable to obtain medication or check-ups. As a result, they received substandard services and treatment.

"[The insurance] only covers hemodialysis. Medicines and laboratory tests are not. Whereas according to the policy, they are included. This happens because the coverage is too low," said Tony. The insurance coverage for hemodialysis at type D hospitals was around Rp 750,000, which was too low to cover the full costs of hemodialysis, medicines and laboratory tests.

Laksono Trisnantoro, a professor of health policy and administration at Gadjah Mada University, said that JKN services were only good in big cities, which had many health facilities and qualified health workers. However, in the regions, despite paying the same premiums, JKN participants could not access medical facilities and services of the same quality as those in a big city.

Indeed, he said, some aspects of the JKN were transferrable. However, only financially able participants could take advantage of this. "If you want to say that the JKN service is good, where is it [good], and If it’s bad, where is it [bad]? Not all places are equally good or bad," he said.

Health Minister Nila Moeloek said that they country’s wide and heterogeneous geography was a challenge for the equal distribution of health services. Each region needed different solutions depending on their needs.

One effort it continued to push for was to improve the availability of primary health facilities. In 2017, 110 healthcare centers were built in border regions. This year, around 250 healthcare centers were developed and the development of 240 other healthcare centers was planned for 2019.

Indonesian Health Economists Association chairman Hasbullah Thabrany said that it was difficult to measure the quality of health services that JKN-KIS participants received, because the information on health services was asymmetrical.

Measurements on quality healthcare services were necessarily different among healthcare providers and patients. The quality of services could only be based on these different points of view.

(ADH/FRN/E17/REN/SYA/COK/JUM/E12/E08/E21/E07)