The Jakarta Post
The National Health Insurance (JKN) passed its five-year anniversary on Jan. 1, marking significant progress from covering only 46 percent of the population in 2014 to 81 percent at the beginning of this year.
Covering more than 215 million people, it has become the largest single-payer health insurance in the world.
Many studies and surveys have shown that the insurance, which is managed by the Health Care and Social Security Agency (BPJS Kesehatan), has improved health services for millions, including for expensive treatment that was previously out of reach for those in the middle to lower income brackets.
A recent study by researchers from the University of Indonesia’s School of Medicine and published in the prestigious medical journal Lancet, shows that fatal cases of cardiovascular disease, the most common killer in the country, decreased from between 20 and 30 percent of all cases to only 15 percent after the JKN started at the Cipto Mangunkusumo Hospital, a major hospital in Jakarta.
That is still not good enough, however, missing the target of 5 percent envisioned by the government five years ago.
BPJS Kesehatan is also failing to curb its annual deficit, which soared to Rp 10.9 trillion (US$754.5 million) in 2018, with many hospitals starting to complain about late payments of bills. To prevent even worse bleeding, the government has decided to plug the funding gap with the tobacco excise, a measure that has been criticized for encouraging people to smoke instead of quitting.
This is the right moment to review the health insurance scheme, which has become a significant source of income of public and private hospitals in the country.
While hospitals are complaining about late payments, BPJS Kesehatan is also struggling to collect contributions from members. The insurer’s records show that about 12 million people are in arrears with their insurance fees, and several regional administrations, which also are required to support the insurance scheme, have also delayed payments. There should be a better system with penalties for late payers to create a deterrent effect.
There have also been reports about mounting claims and suspected over-claiming by hospitals. BPJS Kesehatan has been reluctant to name any hospitals characterized by poor accountability, but the suspected over-claims have prompted the BPJS to issue a regulation to stop coverage for some treatments, including some cancer medicine and cataract surgery. The Health Ministry has ordered BPJS Kesehatan to maintain the coverage.
BPJS Kesehatan should be more transparent in revealing hospitals and other healthcare providers that lack accountability in issuing claims.
Such cost control measures need to be implemented, along with health campaigns, because the insurance’s capacity to shoulder the country’s healthcare needs cannot be taken for granted. Prevention, instead of cure, should remain the underlying health policy.