In-depth Evaluation of JKN-KIS Program Needed

KOMPAS/RIZA FATHONI

People complete administrative procedures for their Healthcare and Social Security Agency (BPJS Kesehatan) health insurance on Monday (12/11/2018) at Siloam Hospital in Semanggi, Jakarta. The National Health Insurance-Healthy Indonesia Card (JKN-KIS) program enables people to obtain the same medical treatment as self-paying patients under a cross-subsidy scheme.

JAKARTA, KOMPAS – In the last five years, many issues have hampered the national health insurance program. The program must be fixed, whether it wants to or not.

The government has called for a comprehensive reevaluation of the National Health Insurance-Healthy Indonesia Card (JKN-KIS) insurance program, which is run by the Healthcare and Social Security Agency (BPJS Kesehatan).

A review of the program is necessary to optimize public health services, and should include the ideal price of premiums, the types of health services and the agency responsible for implementing the social health insurance program.

"Perhaps next year, we sill have to reevaluate the premiums, the criteria for the services and the responsibility of local governments," Vice President Jusuf Kalla said at his office on Tuesday.

Kalla stressed that the JKN-KIS program must be continued as mandated by Law No. 40/2004 on the National Social Security System (SJSN). Problems would continue to emerge in administering public healthcare, no matter who led BPJS Kesehatan.

Financial issues, for example, would continue to arise if the health insurance premiums were lower than the actual cost of the treatment. Therefore, said Kalla, the BPJS Kesehatan’s health insurance premiums should be increased. "Next year, this must be reevaluated," he said.

The review must also cover all aspects of healthcare services. Meanwhile, limits must be placed on the benefits that BPJS Kesehatan covered. "If not, it could cause a crisis like in Greece. That [crisis] occurred because the health services [there] were unlimited," he said.

No less important was the agencies that were responsible for implementing the national health insurance scheme. The central government had also been developing the role of local administrations in implementing the health insurance scheme.

During an Editors in Chief Forum (Forum Pemred) meeting that Kompas chief editor Budiman Tanuredjo also attended, BPJS Kesehatan president director Fachmi Idris said it would be up to the government to decide when to increase the premiums of the JKN-KIS insurance program. "We provide projections on the aspects that must be carried out academically. If the target [revenue] from premiums is not met, additional funds will be injected at the end of the year," he said.

According to the National Social Security Council’s (DJSN) actuarial calculations in 2016, the premium for low-income patients, known as contribution assistance recipients (PBI), and for non-wage workers (PBPU) should be Rp 36,000 and Rp 53,000, respectively. However, the government had set the PBI and PBPU premiums at Rp 23,000 and 25,500, respectively.

KOMPAS/RIZA FATHONI

People complete administrative procedures for their Healthcare and Social Security Agency (BPJS Kesehatan) health insurance on Monday (12/11/2018) at Siloam Hospital in Semanggi, Jakarta.

Three key issues

According to social security council member Ahmad Anshori, the issues hampering the implementation of the JKN-KIS program stem from three interrelated matters: the alignment of premiums and benefits, the availability of health facilities and personnel and the effectiveness of BPJS Kesehatan services.

The shortage of funds for the social security program had greatly affected the quality of subscriber services. "If the premiums cannot be raised because of political considerations, the government should, in the short term, cover the JKN-KIS fund shortage. There is no need for an audit because results are available from the BPKP [Development Finance Comptroller] audit," he said.

The policy mix to manage the JKN-KIS fund shortage has not had any significant impact on BPJS Kesehatan’s financial performance.

Hasbullah Thabrany, the chairman of the Indonesian Health Economists Association, said that the main issue of the JKN-KIS program was the shortage of funds. "Why does the government not acknowledge this [fund shortage]? The government has the authority and ability to fix this problem," he said.

If the government did not cover the fund shortage in the JKN-KIS program, the quality of public health services would decline. This could cause a loss of public confidence in the national health insurance program.

"Eighty to 90 percent of health workers and hospitals complain about sluggish payment. As a result, the services are sacrificed. If the payments were prompt, the private sector would invest and the health services could be improved," said Hasbullah.

The chairman of the United Association of Indonesian Doctors (PDIB), James Alan Rarung, said that if the program was not reevaluated, the public, medical personnel and health facilities would continue to be its victims. Subscriber services were not distributed evenly. "The government should not talk about achieving universal health coverage (UHC) if the poor are still unable to obtain optimal [healthcare] services," he said.

BPJS Watch Advocacy coordinator Timboel Siregar said that the problems occurred because the JKN-KIS program was not implemented in accordance with regulations. For example, it had not followed the plan to adjust the premiums every two years. The deficit had eventually led to restricted benefits for subscribers. Furthermore, the coverage for wage-earning workers (PPU) was not optimal, and many companies had not registered their employees with BPJS Kesehatan.

According to the regulation, all business entities should have registered their employees by Jan. 1, 2015. "There are many outsourcing companies whose employees are not registered with [BPJS Kesehatan]," said Timboel.

The PDIB’s James stressed that a complete evaluation of the JKN-KIS program would require all parties to be open and honest, and to set aside sectoral egos. The JKN-KIS program should not be used as a political "toy" for improving the image of certain parties. The program helped many people and was more important than that.

(NTA/ADH/TAN/EVY)