Nila F. Moeloek - JP/Jerry Adiguna

As the National Health Insurance (JKN) program continues to face financial difficulties, the government is mulling over three options to increase the premiums for regular participants, comprising wage-earning workers and their family members and self-employed individuals who pay their own premiums.

The government decided to raise the premiums for regular participants after considering that the premium increase for low-income patients, known as contribution assistance recipients (PBI), from Rp 19,225 (US$1.46) to Rp 23,000, would not be enough to stop the financial bleeding suffered by the program'€™s operator, the Health Care and Social Security Agency (BPJS Kesehatan).

'€œThere are three alternatives that we might choose. But it'€™s not official yet because it will be echelon I officials [who discuss the matter],'€ Health Minister Nila F. Moeloek told reporters on Tuesday.

The first option is to keep the current plan of increasing the premiums for all three classes of non-PBI, regular participants.

Currently, 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.

The government is planning to increase the premiums to Rp 30,000, Rp 51,000 and Rp 80,000 for each class, respectively, as stipulated by Presidential Regulation No. 19/2016, starting from April 1.

The proposed increase in premiums is designed to accommodate the soaring number of participants in the program, which is expected to reach 188.7 million by the end of 2016, compared with the more than 155 million in 2015 and the 133.24 million participants who registered for the scheme when JKN first started in 2014.

Despite the existence of the presidential regulation, the plan is not set in stone yet, according to BPJS Kesehatan spokesman Irfan Humaidi.

'€œWe will discuss it during a coordination meeting, considering there are some recommendations from the House of Representatives and us,'€ he told The Jakarta Post.

House Commission IX overseeing health has urged the government to postpone the increase until next year, saying that the government had to improve the quality of health services before it could require people to pay more.

The House also demanded the BPJS Kesehatan increase the number of non-PBI participants and submit reports on the distribution of JKN cards before it approved the government'€™s plan.

Taking that into consideration, the government is considering two other options.

'€œWe can delay [the premium increase] for the third class or we could put all [of the burden] onto the first class because rich people should participate [in easing the burden],'€ Nila said.

BPJS Kesehatan legal and communication director Bayu Wahyudi previously said that JKN participants who did not receive monthly salaries, such as businesspeople, were the biggest contributor to the agency'€™s financial burden as they had a claim ratio of 280 percent, compared with 80 percent for those who receive monthly salaries.

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.

Seeing how the claims ratio exceeded 100 percent for the past year, there is always a financial gap. For the JKN program to be sustainable, the claims ratio needs to be less than 90 percent.

Irfan said he had heard that the government was considering the second option of delaying the increase of the third-class premium.

'€œThe only class for which a premium increase will be delayed is the third class,'€ he said.

However, if the increase is delayed, then Bayu predicted that the financial gap would continue this year, with BPJS Kesehatan expecting a deficit of Rp 9.79 trillion.
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