T

he House of Representatives is investigating the performance of the Healthcare and Social Security Agency (BPJS Kesehatan) as the agency has run into financial difficulties as a result of soaring insurance claims.

House Commission IX overseeing health and welfare said that it had set up a working committee that would assess BPJS Kesehatan in order to decide whether it would allow the agency to hike premiums for subscribers. '€œWe will form a working committee on BPJS Kesehatan that will be ready later this month,'€ Commission IX head Dede Yusuf told The Jakarta Post on Thursday.

The commission decided to set up the committee after BPJS Kesehatan asked for House approval for its request to raise the premiums of the National Health Insurance (JKN) program.

Dede said there were measures that the government should take before it increased the premiums.

'€œWe have to evaluate the numbers because when I checked with hospitals, it turns out that most of patients covered by the BPJS are not those subsidized by the government. It means many poor patients are unaware of the program,'€ he said.

Low-income patients, known as Contribution Assistance Recipients (PBI) have a proportion of their premiums paid by the government and together with disabled people, they make up the first category of BPJS Kesehatan participants.

The second group are the Non-PBI participants, consisting of wage-earning workers and their family members, as well as unemployed workers and their family members. They have to pay for their own premiums ranging from Rp 25,500 (US$1.96) per month to get healthcare services in third-class facilities, to Rp 42,500 for second class and Rp 59,500 for first class.

Dede said the House also found irregularities in the data on participants. '€œMuch data doesn'€™t make sense. A small businessman who has two motorcycles is registered as a PBI participant, while those truly in need are not registered,'€ he said.

'€œSo our point is not to totally reject the rise in premiums, but to fix the data first,'€ he added.

Taking the irregularities into account, the House working committee would look at problems with BPJS Kesehatan management and see if it could be fixed without having to resort to hiking premiums.

'€œWith such an audit, hopefully BPJS Kesehatan can save up to 10 percent. I know that because I heard from regional branches of BPJS Kesehatan that they could save more money if they could prevent wasteful spending made by health-service providers and patients themselves,'€ Dede said.

BPJS Kesehatan expects to remain in the red throughout this year, with its claim ratio expected to hover around 100 percent. The claim ratio is the difference between the hospitals'€™ bills for health services provided and the premiums collected by the agency from participants registered in the program.

The agency receives premiums from tax funds to finance low-income people in the scheme, as well as premiums paid by employees and their employers, and those individually registered with the program.

The agency has reported a deficit between claims it has paid and the premiums it has received. In 2014, the deficit stood at Rp 1.54 trillion, with Rp 42.6 trillion paid out in claims and Rp 41.06 trillion received in premium payments.

The agency also suffers from low compliance among premium payers, where they only pay the premiums when they are sick and stop paying once they have recovered.

BPJS Kesehatan finance director Riduan said that the agency could suffer a deficit of Rp 11.71 trillion if it did not raise the premiums it charged to subscribers.

The agency has proposed raising the premiums for PBI participants from Rp 19,225 per month to Rp 27,500 per person per month in 2016.

Some lawmakers in Commission IX flatly rejected the premium rise as they believed it would make it harder for non-PBI participants to pay their premiums.

However, Bambang Purwoko of the National Social Security Board (DJSN), tasked with monitoring the JKN program, said that if Indonesian people could afford to buy cigarettes regularly, then surely they would be able to afford a rise in premiums for something as important as health insurance.

'€œWe have no trouble in buying cigarettes regularly. So it'€™s strange if we complain [about paying health insurance premiums],'€. he told the Post.