Ever since it was launched in 2014, BPJS Kesehatan has been struggling to stay financially healthy. The universal healthcare scheme has been beset by financial deficits and has only been viable because of the massive subsidies injected by the government.

Questions linger over the scheme’s long term sustainability in providing health care to Indonesians, particularly those most in need. As pointed out by BPJS Kesehatan director Fahmi Idris, much of the problem lies with the low compliance rate in paying premiums.

Now in its fourth consecutive year of deficit, it is imperative that the government comes up with an alternative course of action to secure the insurance scheme without putting unnecessary strain on the state budget.

A number of options to secure BPJS Kesehatan financially have been explored. The most popular one revolves around a plan to increase premiums and improve compliance in paying the premium. Another option is using cigarette excise to plug the deficit.

While these proposals appear plausible, deeper scrutiny is needed. Increasing premiums looks logical and may immediately deal with the deficit, but it will leave behind those who are just above the poverty line but do not qualify for coverage by the government.

It goes without saying that improving compliance in paying premiums should be intensified. However, to ensure successful implementation, incentive and disincentive mechanisms are required.

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