T

he government is tinkering with options in anticipation of looming financial trouble in the national health insurance (JKN) program caused by soaring medical bills submitted to the Healthcare and Social Security Agency (BPJS
Kesehatan).

The state agency, which is managing the insurance, has revealed that its claim ratio reached 99.6 percent in November, while the National Social Security Council (DJSN) expected the December claim ratio to reach 101 percent.

The claim ratio is the difference between the hospitals'€™ bills for health services and the premiums collected by the agency from the various groups of people registered in the program.

The agency receives premiums from tax funds to finance the poor in the scheme, as well as premiums paid by employees and their employers, and those individually registered for the insurance.

As of November, BPJS Kesehatan had paid more than Rp 31 trillion (US$2.47 billion) in hospital claims.

BPJS Kesehatan legal and communication director Purnawarman Basundoro said Thursday that the agency was accepting any input to ease the financial burden caused by the high claim ratio.

'€œAll suggestions will be considered and [the premiums] will be revised in the presidential regulation in 2015,'€ he said.

Purnawarman was referring to Presidential Regulation No. 111/2013 that stipulates the monthly premiums paid for all categories of beneficiary.

The current premium for the poor is Rp 19,500, a far cry from the calculation made by Hasbullah Thabrany, the University of Indonesia (UI) Center for Health Economics and Policy Studies'€™ chairman, who said the monthly JKN premium should be Rp 40,000 per person.

'€œFor the poor, the realistic premium for an adequate health service is Rp 40,000. But if you want the best health service, then it is higher, at Rp 60,000,'€ Hasbullah said Thursday. '€œOur current spending on health care is only a quarter of Malaysia'€™s.'€

Purnawarman said the premiums needed to be adjusted to sustain the JKN program.

'€œThe budget management is directed toward a sustainable way for the future, not just sustainable for one or two years. It is our duty to make sure this program can be funded long-term,'€ he said.

The Health Ministry'€™s health care funding center head Donald Pardede said Thursday that the current claim ratio meant BPJS Kesehatan would not be able to sustain its finances in the long run.

'€œAccording to the regulation, the maximum claim ratio is 90 percent. Above that is already unhealthy,'€ he said.

Right now, the ministry was doing some calculations on the payment scheme and its premiums, according to Donald.

'€œActually we have several options. We had suggested the premiums be set at Rp 22,500, but then the presidential decree would have to be revised,'€ he said.

Another option was to adjust the current healthcare service charges in BPJS Kesehatan'€™s Indonesian Case-Based Group (INA-CBG) to increase participation by private hospitals, which would in turn increase the number of people registered in the JKN program.

Earlier this year, the payment scheme was revised following complaints from private hospitals partaking in the program about unfavorable rates for medical services.

Charges for some 39 services were raised, including ophthalmic services, orthopedic surgery and neo-surgery, while charges for 60 other services were decreased to compensate for the increases.

'€œFrom our previous calculations, when we increased the charges for 39 services, we hit a financial barrier. But if the financial platform [from the Finance Ministry] is wider, we will be able to maneuver [around the financial troubles].'€