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Entering its third year, the national health insurance (JKN) continues to be plagued with financial woes. With ever an increasing number of participants, the government has been unable to bridge the widening financial deficit.

The program'€™s operator, the Health Care and Social Security Agency (BPJS Kesehatan), said on Tuesday that this year the agency had continued to suffer from soaring hospital bills. This trend, furthermore, was predicted to continue into next year.

'€œIn 2015, premium payments that we received were not enough to pay claims [from hospital bills],'€ BPJS Kesehatan Planning and Development director Tono Rustiono said. '€œIn 2016, we have calculated and found that premium payments will not be enough to cover health costs.'€

The financial trouble that BPJS Kesehatan is facing could be seen from this year'€™s claims ratio, which stood at 105 percent.

The claims ratio is the ratio between the bills charged by hospitals 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.

'€œIdeally, the claims ratio is 90 percent for the program to be sustainable. These past two years, the claims ratio has always been high, which is why there'€™s always a financial gap,'€ Tono said.

BPJS Kesehatan spokesman Irfan Humaidi said the agency received Rp 48.9 trillion (US$3.5 billion) in premiums and had to pay out Rp 51.4 trillion in total claims as of the end of November, resulting in a deficit of Rp 2.5 trillion. 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.

BPJS Kesehatan predictedRp 53.37 trillion in premium payments and Rp 57.19 trillion in claims by the end of 2015, resulting in a Rp 3.82 trillion deficit.

'€œBut that'€™s just the head-to-head figure between the claims and the premium payments. There are still other sources of income besides premiums, such as cash injections from the central government. Therefore, in terms of cash flow, we can still pay our hospital bills,'€ he told The Jakarta Post on Tuesday.

For instance, the government injected Rp 5 trillion to help the agency pay the bills this year, with Rp 3.5 trillion already having been disbursed.

'€œThe other Rp 1.5 trillion has not been disbursed. Maybe at the end of this year the fund could be disbursed,'€ Irfan said.

In terms of assets, BPJS Kesehatan has accumulated Rp 4.8 trillion in negative assets since JKN started in 2014.

'€œLast year, the negative assets stood at Rp 3.3 trillion. This year it is Rp 1.5 trillion. Cumulatively, it is Rp 4.8 trillion. But the final figure [for this year] has not been calculated,'€ said Irfan.

Looking ahead, Tono predicted that the financial hemorrhaging would continue with next year'€™s claims ratio predicted to stand at 106 percent.

Tono argued that the government'€™s decision to raise the premiums for low-income patients, known as contribution assistance recipients (PBI), starting early next year, would not be enough to stop the bleeding.

Health Minister Nila F. Moeloek said the presidential regulation dictating the raise, from Rp 19,225 to Rp 23,000, would take effect in early 2016.

'€œWe hope that the raise will lessen the gap. It'€™s still not enough, however, because we are hoping for a raise in premiums for PBI to Rp 36,000, but the government could only afford to raise to Rp 23,000,'€ Tono said.

'€œFurthermore, we are proposing to increase premiums for non-PBI participants.'€

Non-PBI participants comprise wage-earning workers and their family members and unemployed workers and their family members who have paid their own premiums. These premiums range from Rp 25,500 per month for third-class healthcare facilities, Rp 42,500 per month for second-class facilities and Rp 59,500 for first-class facilities.

BPJS Kesehatan is proposing an increase in premiums to Rp 30,000, Rp 51,000 and Rp 80,000 for each class, respectively.

'€œBut it'€™s not a done deal yet because we still have to wait for the presidential regulation,'€ Tono said.

The proposed increase in premiums is designed to accommodate the soaring number of participants in the program, expected to reach 188.7 million by the end of 2016, compared to the more than 155 million presently in the program and the 133.24 million participants who registered for the scheme when JKN first started.

Tono promised that an increase in premiums would correspond to an increase in the quality of the program.

'€œWe are improving all aspects of our service, starting from the way people register for the program, pay for their premiums and receive health services. Now people can go to an ATM, a post office and even an Alfamart or Indomaret to pay for premiums,'€ he said.
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