T

he Healthcare and Social Security Agency (BPJS Kesehatan) has revealed that its claim ratio is expected to pass 100 percent by the end of the year, a sign of poor budget management in the national health insurance (JKN) program.

The claim ratio is the ratio between the hospitals'€™ bills for health services and the premiums collected by the agency, both from tax funds, to finance the poor under the scheme, as well as those paid by employees and those who are individually registered for the insurance.

BPJS Kesehatan spokesman Ihsan said on Wednesday that the November claim ratio had reached 99.6 percent.

National Social Security Council (DJSN) member Usman Sumantri from the Health Ministry said on Wednesday that the December claim ratio would reach 101 percent at this rate.

'€œThis is based on the claim-payment tendency from month to month,'€ he said. '€œA 101 percent claim ratio means the money collected from premiums is less than the total service bills. It means that they are running out of money.'€ Usman added that a few months ago the claim ratio was still 91.8 percent.

While the ratio had reached a worrying level, he said that it was not the fault of BPJS Kesehatan.

'€œIt'€™s not that their budget management is not healthy. But our society is not accustomed [to paying for national health insurance regularly and consistently],'€ Usman said.

He reasoned that many people were still waiting until they were sick before they applied for the JKN program.

'€œMoreover, some people pay for the premiums when they are sick, but once they have been cured, they stop paying. So, the premiums collected are low but they still have to pay for sick people,'€ Usman said.

Since the blame for the high claim ratio could not be laid on BPJS Kesehatan, the government would be responsible for injecting funds into the agency should it run out of money, he said.

'€œAs long as the budget is managed well, if there'€™s a budget deficit, then it becomes the state'€™s responsibility,'€ said Usman.

Likewise, Ihsan said that such a high ratio was not necessarily caused by poor budget management in the agency. He also said that the ratio should not trigger panic since it had not passed 100 percent.

'€œThe social security budget comes from premiums [paid to us] and we use this to pay claims [from hospitals]. Therefore, looking at that claim ratio, we could say that our budget is enough to pay for the claims,'€ Ihsan told The Jakarta Post.

Moreover, the agency still had a reserve fund that could be used in case of emergency, he said.

'€œOur organizational budget is used for operational purposes, it comes from our assets and is still healthy,'€ said Ihsan.

Usman also said that the agency should be financially safe for now.

'€œFor now, the situation is still safe because there is still money left from the past, around Rp 5 trillion [US$394.6 million]. That'€™s the safety fund,'€ he said.

To lower the claim ratio, BPJS Kesehatan should push for people'€™s participation and compliance paying premiums, as well as registering for the program well before they are sick, according to Usman.

To encourage people not to wait until they are sick before applying for the JKN program, BPJS Kesehatan has stipulated that a JKN card can only be valid for use seven days after registration.

BPJS Kesehatan director Fahmi Idris said that if the JKN cards were valid immediately on registration, then users would only apply after they became sick.

As of November, BPJS Kesehatan had paid more than Rp 31 trillion in hospital claims.