40 Million Residents Not Covered by JKN-KIS Insurance

KOMPAS/HENDRA A SETYAWAN

A person holds up a mobile phone showing the home page of the Health Care and Social Security Agency (BPJS Kesehatan) application for all Healthy Indonesia National Health Card-Health Insurance (JKN-KIS) policyholders on Monday (4/11/2019) at the offices of BPJS Kesehatan in Pancoran, Jakarta.

JAKARTA, KOMPAS - Around 40 million residents are not holders of National Health Insurance. Therefore, there should be a joint commitment to ensure that the universal health insurance can cover all citizens.

As of 31 Oct, there were 222,278,708 participants of the Healthy Indonesia National Health Card-Health Insurance (JKN-KIS). This means that 16.18 percent or about 40 million people are not registered as participants.

In the 2015-2019 National Medium-Term Development Plan (RPJMN), the coverage of JKN participants in 2019 was targeted to reach 95 percent. However, the achievement of the target has been extended to 2024 as part of the 2020-2024 RPJMN.

So, residents must be more aware of the importance of financial protection when sick.

Fachmi Idris, the president director of the Health Care and Social Security Agency (BPJS Kesehatan), which manages the JKN-KIS universal health insurance scheme, said in Jakarta on Wednesday that in addition to the large population and the wide area, the lack of awareness among people about getting health protection is a great challenge in achieving the target.

The ability to pay the premium is also an obstacle, especially because at the beginning of 2020 there will be a sharp increase in the premiums of non-salaried participants (PBPU) or independent participants.

"There are three things that we promote to encourage the achievement of the universal health insurance coverage, namely protection, sharing and compliance. So, residents must be more aware of the importance of financial protection when sick, there is a desire to help others with the mutual assistance system in paying the contribution, and compliance with paying the contribution on time," he said.

KOMPAS/ISMAIL ZAKARIA

People wait to be served on Tuesday (12/11/2019) at the office of the Health Care and Social Security Agency (BPJS Kesehatan) in Mataram, West Nusa Tenggara. BPJS Kesehatan Mataram had achieved 87.5 percent of its universal healthcare target by September 2019.

People have different reasons why they do not participate in the JKN-KIS health insurance. Alex (50), a resident of Bintaro, South Tangerang, Banten, for example, was reluctant to register his family as JKN-KIS participants because they had to wait in a long queue to get healthcare services.

He also doubted the quality of JKN-KIS services. "I am worried that my family will be given low quality generic medicines, so I will seek treatment at a private hospital," he said while seeking treatment at a hospital in South Tangerang.

Audit

The results of the audit of the Development Finance Comptroller (BPKP) on the funding of the health insurance in 2018 showed that there were 50,475 business entities that had not yet cooperated with BPJS Kesehatan.

There are 52,810 employees that have not been registered by the companies. So, there is the potential to get additional members.

There are 52,810 employees that have not been registered by the companies.

However, according to Fachmi, from the data of the number of business entities, 25,000 of them have cooperated, about 15,000 companies have been closed, and 5,000 business entities are registered as micro, small and medium businesses.

"We only have to pursue 5,000 companies more. This month, we hope the registration process can be completed," he said.

In a number of regions, the universal health coverage has not yet reached the target. According to the head of the Mataram office of BPJS Kesehatan, Sarman Palipadang, in Mataram, as of 1 Nov. 2019, JKN-KIS membership coverage in Mataram reached 88.13 percent of 429,454 residents.

KOMPAS/HENDRA A SETYAWAN

Attendants serve customers on 4 Nov. 2019 at the office of the Health Care and Social Security Agency (BPJS Kesehatan) in Pancoran, Jakarta. The premiums for all BPJS Kesehatan policies will be increased in January 2020 under the amendment to Government Regulation No. 82/2018 as stipulated in Presidential Regulation No. 75/2019.

The head of the Mataram health office, Usman Hadi, said the target of the universal health coverage had not yet been achieved due to a lack of awareness among residents about joining the JKN-KIS even though the campaign to take part in the program was often carried out.

The coverage of membership in a number of regions is already high. In the city of Yogyakarta, for example, JKN-KIS universal health coverage was 95.61 percent of 413,961 residents.

Comprehensive Services

According to the coordinator of the BPJS Advocacy Watch, Timboel Siregar, the achievement of the universal health coverage must be interpreted comprehensively, not just related to the achievement of the membership target.

According to the World Health Organization (WHO), there are three important aspects of the universal health coverage: membership, availability of health facilities and services, and financing.

Regarding membership, the target will be more difficult to achieve with an increase in the premium or contribution. The task of BPJS Kesehatan to increase compliance with JKN-KIS contribution payments is also not an easy job.

There are 20 million JKN-KIS participants who are not active. It means that the number of participants who regularly pay their premiums reached 202 million people. Therefore, the target to reach coverage of 95 percent of the population by the end of 2019 is difficult to achieve.

Three important aspects of the universal health coverage: membership, availability of health facilities and services, and financing.

The chairman of the National Social Security Board, Tubagus Achmad Choesni, said that equitable distribution of services for the whole community and the provision of quality services must be achieved in the universal health coverage program.

"JKN-KIS sustainability must be ensured. For this reason, all factors need to be improved, ranging from institutions, harmonizing regulations, to improving service quality including fraud prevention. The availability of facilities must be ensured, including improving the quality of health workers, optimizing the revenues, public education and law enforcement," he said.

A comprehensive improvement of the services should be made following the sharp increase in the premium as stipulated in Presidential Regulation No. 75/2019 concerning amendments to Government Regulation No. 82/2018 on adjustment of contribution for all JKN-KIS participants.

The mostly debated increase in the premium was those of the non-salaried participants (PBPU) or independent participants for the third class service from Rp 25,500 to Rp 42,000 per month.