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Studies shed doubt on future of universal healthcare
Two recently released studies predict that the government will be unable to achieve universal health coverage by 2019
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Two recently released studies predict that the government will be unable to achieve universal health coverage by 2019.
The two studies, conducted by the Gadjah Mada University (UGM) Center for Health Service and the Paramadina Graduate School of Diplomacy, respectively, concluded that it would be impossible for all Indonesian citizens to access health insurance by 2019 due to unequal access in the current national health insurance (JKN) program.
The UGM study, conducted in 2014, identified a huge gap in access between developed and underdeveloped regions.
'It [the gap] is caused by differences in the numbers of hospitals and doctors,' UGM researcher Laksono Trisnantoro said during an event marking the release of the report on Wednesday. 'In the last three years, new hospitals were only built in Java.'
The lack of hospitals in underdeveloped regions had prevented JKN participants from accessing healthcare, leading to low claim rates, the report said.
Laksono cited the example of Central Java, where a single major hospital, on average, claims up to Rp 60 billion per month from the program. Meanwhile, combined, hospitals in East Nusa Tenggara (NTT) claim just Rp 30 billion.
'Then, in 2014, NTT received Rp 700 billion [from the JKN program] for 2.3 million premium payment assistance [PBI] beneficiaries. But it turned out that only Rp 300 billion was spent due to the lack of doctors and hospitals there. So where did the rest of the money go? It actually went back to the Healthcare and Social Security Agency (BPJS Kesehatan),' he said.
Unspent funds in provinces like NTT were later channeled to more developed regions, where there were more people who could pay the premiums themselves, the research found.
However, non-PBI beneficiaries ' 7 million Indonesians as of November 2014 ' absorb more money from government, Laksono said.
Citing data from the BPJS Kesehatan in November 2014, Laksono said that the medical cost for each non-PBI beneficiary was Rp 282,139, while each paid an average premium of Rp 27,062 per month, resulting in a claim ratio of an astounding 1,380 percent.
Meanwhile, PBI beneficiaries average Rp 21,977 for each medical service that they receive, while their premiums, paid by the government, are Rp 27,478 per person a month, which translates to an 88 percent claim ratio.
'The claim ratio is really high for non-PBI beneficiaries because they usually only register for the JKN program once they get sick,' Laksono said.
With such a disparity, the report predicts that only seven provinces will have universal health coverage by 2019: Jakarta, Yogyakarta, South Sumatra, West Sumatra, as well as some regencies in East Java, Central Java and South Sulawesi.
The report by the Paramadina University reached similar conclusions, but focused more on the regulatory weaknesses of the JKN program.
The report, which evaluated the myriad laws governing the program, found that the regulations failed to cover certain groups of people.
'Newborn babies [from the non-PBI beneficiary group] are not automatically covered [by the JKN program]. Also poor people who have not yet been registered, including inmates, orphans and others, are sidelined because their names have to be recommended by officials to be able to become PBI beneficiaries,' said Paramadina University researcher Dinna Wisnu. 'So if there's no change [on the regulations], it's not possible [to have universal health coverage by 2019].'
