T

he long-awaited and much-delayed social security bill was eventually passed into law last Friday (Oct. 28). The endorsement of the Social Security Organizing Body (BPJS) Law makes it the country’s first social security program representing universal health insurance coverage.

The law will create a single state entity in 2014 that will cover health care. Those with a regular income will have to pay monthly premiums, while the government will pay premiums for people who are poor or unemployed.

In 2015 a second BPJS will cover life insurance, work accident insurance, civil service pensions and old-age pensions.

Under the law, workers and the poor will be provided full protection and coverage even for severe or complicated illnesses.

The BPJS Law requires that the four existing state-owned insurers — Askes, Asabri, Jamsostek and Taspen — make fundamental changes in their operations in order to qualify as BPJS social security providers, including greater budgetary transparency and a change to non-profit status.

The four state-owned insurers currently manage a total of Rp 190 trillion (US$22.2 billion) in insurance funds nationwide.

The euphoria of welcoming the BPJS Law is supposed to be in line with continuous efforts to transform the law into practice. I am of the opinion that some points require sober attention for better social welfare.

First, building trust with transparency is non-compromised. Employees and poor people would benefit from the law so long as the priority focuses upon changing state-owned insurers’ status to nonprofit entities instead of the proposed merger of the four companies.

The status change of the four firms from limited liability companies to nonprofit state corporations is necessary for transparency.

The status change would definitely provide people with greater budgetary transparency, such as open access to key financial data.

These include how much the state insurers were paying out in incentives and benefits to top executives, how many members each of the companies had, how much they were investing, the dividends they were collecting and how they were managing those investments and returns.

The public control over the transformation of insurers’ status should be made public and continuous since the government seems to be reluctant to rapidly transform the four firms into nonprofit state corporations because it would require strict financial auditing processes.

Armida Alisjahbana, the head of the National Development Planning Agency (Bappenas), previously said the process would be lengthy and difficult because the companies were large and could take 10 to 15 years to complete.

There is fear that the BPJS Law promising health insurance would slip through amid the government’s political lip service.

Second, abuse of the BPJS Law must be prevented at any cost. Among the basic dilemmas of social security are how to reward efforts, how to avoid fraud and how to ensure that the system is not misused or abused by the work shy.

Low wages may mean that someone working with a family to keep is no better off, and sometimes worse off, than an unemployed person receiving social security benefits.

Governments may try various ways of tackling this problem, such as setting minimum wages. However, the danger is that unless these are set at low levels, they may deter employment and lead to increases in unemployment.

Another approach is to top off wages directly or indirectly. Direct subsidies may simply increase employers’ profits.

Use of the tax or benefits system to top off wages may decrease incentives and introduce a poverty trap. All such systems are open to abuse and very complicated to administer.

In coming years, attention should also be focused on the growing number of people claiming disability allowances and retiring early on the grounds of ill-health.

There are suspicions that the criteria applied by doctors in assessing disability and grounds for early retirement have become too lax because doctors understandably do not wish to cause friction with their patients.

But the costs and implications of the increased numbers in these categories is forcing authorities to take a tougher line. Once again this involves an intrusive and expensive administrative bureaucracy.

Third comes issues of social service and treatment of customer calls for more professionalism. Workers’ money in Jamsostek that goes to the hospital would not benefit them in times to come, for example, as the service provided remains unprofessional and disgruntled.

Many people still cannot find satisfactory health services and treatment. A lot of patients’ complaints were related to the conduct of health workers, especially nurses, who were ignorant or never updated the patients about their conditions.

Hence, the Ministry of Health has to make sufficient efforts to address the issues brought up. The ministry’s regular meetings with hospital managements to warn them to adhere to health care guidelines proved far from satisfactory.

The government needs to establish a hospital monitoring council that includes government officials, nongovernmental organizations and the public.

Granted, the BPJS Law is still flawed, but we can fix it as we go. Approaching the historic day of Jan. 1, 2014, the most important thing to do now is to inform people about the new law, what rights they would be entitled to and what obligations they need to meet.

The writer, a graduate of the University of Canberra, is a lecturer at Andalas University, Padang.