A

s the government expects more and more people to register for its National Health Insurance (JKN) program, a recent study has predicted a disastrous future for the healthcare program due to financial mismanagement.

The study, conducted by the University of Indonesia (UI) public health department using data from the Healthcare and Social Security Agency (BPJS Kesehatan) covering up until May 2015, predicted an accumulated deficit of Rp 173 trillion (US$12.9 billion) by 2019 if the government continues using the current payment scheme for the JKN program.

'€œIn 2015 alone, there will be a deficit of Rp 12 trillion. If the government is unwilling to take risks and overhaul the JKN program, then it should prepare that amount of money to keep the program going. But that'€™s [...] only a temporary [solution],'€ UI public health expert Budi Hidayat said during a presentation of the study in Central Jakarta.

BPJS Kesehatan has been stricken with financial difficulties since late last year. It suffers from a deficit of claims it has paid against 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 premiums, the agency reported.

In an effort to bridge the deficit, BPJS Kesehatan has sought to increase subscriber premiums. The proposal is currently being discussed by relevant parties including the Health Ministry, the Finance Ministry, the National Social Security Board (DJSN) and experts.

BPJS Kesehatan has proposed a hike in premiums for both low-income participants, known as contribution assistance recipients (PBI), who have their premiums paid by the government, and non-PBI participants, consisting of wage-earning workers and their family members, as well as unemployed workers and their family members who have paid their own premiums.

It is proposed that monthly PBI premiums be raised to Rp 27,500 next year, up from Rp 19,225. The agency could not confirm the premium hike for non-PBI participants.

Budi said that the hike in premiums had to be accompanied by a revision of the standard healthcare tariff system (INA-CBG), which follows a fee-for-diagnosis reimbursement model. He said the current tariff is too high while the premium is too low and thus not sustainable for the future of the JKN program.

'€œRight now, the most government spending on the JKN program goes to the INA-CBG, almost 34 percent, while only 18 percent goes to funding primary healthcare providers under the capitation system,'€ said Budi.

Through the capitation system, the government pays a fixed amount of money for primary care to promote preventive services. Citing data from the BPJS Kesehatan in November, for example, 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.

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.