The Increase in Healthcare Fees

KOMPAS/HENDRA A SETYAWAN

A banner of the Healthcare and Social Security Agency (BPJS Kesehatan) stands at a waiting area on Friday (3/5/2019) at South Tangerang Regional General Hospital in Banten. South Tangerang regional, an accredited partner hospital of BPJS Kesehatan that provides health services to members of the National Health Insurance (JKN) program, has been providing free treatment for the last six years to South Tangerang residents who present their electronic ID card.

The national health insurance program and Healthy Indonesia Card (JKN-KIS) will likely increase their fees for participants in the near future.

The move is reportedly needed to cover the former’s deficit, which continues to swell, and also further support its sustainability. The exact amount of the increase is still being discussed with the House of Representatives and so is the effective date of its implementation. The Finance Minister proposed an increase of healthcare fees for all classes, between 100 percent and 116 percent for classes I and II.

An increase is inevitable given that the low fees have so far been blamed for causing a large deficit in the Healthcare and Social Security Agency (BPJS). Other causes are the failure of participants to pay their premiums and the huge burden of funding for a catastrophic disease. The deficit has been haunting BPJS Kesehatan since it was formed in 2014. The figure has continued to swell, predicted to reach Rp 28 trillion (US$1.96 billion) this year and Rp 32 trillion in 2020, thus threatening the sustainability of the program itself.

In terms of regulations, Presidential Regulation (Perpres) No. 82/2018 on health insurance mandates a review of the program’s fees every two years. The last increase was in 2016. The House and observers have so far approved past proposals for an increase despite differences of opinion regarding the amount. Those who objected, like BPJS Watch, considered the increase proposed by the Finance Ministry to be too high. They also suggested that the increase in fees should closely consider the people\'s purchasing power.

As observers have said, the deficit will continue as long as the contributions are not in accordance with the actuarial contribution calculation.

Of course, we hope that with the increase in fees, the BPJS Kesehatan will be financially healthier and improvements are made in its quality of service. Unfortunately, this increase does not automatically resolve the problem of chronic deficits. As observers have said, the deficit will continue as long as the contributions are not in accordance with the actuarial contribution calculation.

That is, the impending increase will not be the last. The JKN-KIS will still be forced to explore other sources of financing. In addition to increasing the fees, the program must also increase the number of memberships to the provision of bailouts from various sources. Other steps include improving treatment rooms at hospitals and amending the presidential and ministerial regulations (Permen) related to capitation funds.

At present, the steps taken tend to be patchy and BPJS Kesehatan continues to be plagued with problems. Beyond the deficit, BPJS Kesehatan is also faced with massive arrears on hospital bills and complaints related to the quality of its services. Observers highlight the unnatural practices of hospitals and health facilities that only lead to ballooning arrears.

In the end, what is needed is a comprehensive system overhaul, including in the JKN’s management. The finance minister, for example, mentioned the importance of strengthening the role of regional administrations and improving aspects of participation, such as improving the database of participants, optimizing the participation of business entities, improving the payment system and utilizing capitation funds.

KOMPAS/HENDRA A SETYAWAN

Patients and their families wait their turn to see a doctor on Friday (3/5/2019) at South Tangerang Regional General Hospital in Banten. The hospital serves members of the National Health Insurance (JKN) program in its capacity as an accredited partner of the Healthcare and Social Security Agency (BPJS Kesehatan).

Perhaps we also need to be more aggressive in adopting various solutions that have been implemented by other countries with a more advanced JKN system. This includes enforcing rules for non-compliant participants, promoting community health interventions that are promotional and preventive in the first place, as well as educating patients about the value of health and individual responsibility in maintaining health.

In principle, it raises the awareness of all stakeholders to participate in maintaining the sustainability of the program for the common good.