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Doctors association calls for medical audit on national health insurance
State health insurer BPJS Kesehatan has been told to conduct a medical audit on the national health insurance (JKN) to solve a deficit that has troubled one of the world's largest universal health care programs.
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Healthcare card: The former director of now defunct state-owned health insurance firm PT Askes, Sri Endang Tidarwati, shows a national health insurance (JKN) card in Jakarta, in this file photo. State health insurer Health Care and Social Security Agency (BPJS Kesehatan) began operating the JKN in 2014, uniting several forms of government health insurance that were previously controlled by state-owned companies, including PT Askes. (JP/-)
T
he Indonesian Medical Association (IDI) has recommended a medical audit as an option to solve a perpetual deficit in the national health insurance (JKN) that is expected to reach over Rp 10 trillion this year.
During the 30th National Meeting (Muktamar) of the IDI in Samarinda, East Kalimantan, on Friday, state health insurer Health Care and Social Security Agency (BPJS Kesehatan) was criticized for poor management of the insurance.
IDI chairman Ilham Oetama Marsis suggested that the government body conduct a medical audit at hospitals and public health centers that were care providers of the insurance.
“The deficit in the health insurance program should be prevented because it can affect the health facilities’ services for the public,” Ilham said during the meeting.
The medical audit would be related to the clinical care for patients as provided by medical staff in health facilities.
A medical auditor is tasked with reviewing the accuracy of policies and procedures of medical providers to ensure efficient and cost-effective delivery of care. In the Health Ministry’s guideline for medical audits, it is stated that a medical audit has to be conducted objectively and independently. The auditor team also needs to protect the patients’ confidential information.
Ilham said the deficit could also affect doctors or medical workers because BPJS Kesehatan had been holding payments to providers due to a large amount of bills.
President Joko “Jokowi” Widodo, who also attended the meeting, said he had requested that the Health Ministry and the National Social Security Board (DJSN) involve the IDI in reforming the JKN, which is one of the world’s largest universal healthcare programs, covering more than 200 million people.
“I already learned about the issues with BPJS [Kesehatan]. But I will still invite the [state insurer] for a dialogue since this is a management issue. This is an issue that we need to fix,” he said during his speech at the gathering. (wit)
