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Health crisis in waiting?
At the end of the day, health insurance, while important, remains a tool we need in a state of emergency.
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Residents wait in line at the Health Care and Security Agency (BPJS Kesehatan) office in Matraman, Central Jakarta on Nov. 11, 2019. (JP/Dhoni Setiawan)
T
he Supreme Court’s decision to annul premium hikes for the national health insurance (JKN) program will bear overarching consequences, particularly with regard to the sustainability of the program, dubbed the world’s largest universal healthcare scheme. To prove its pro-people commitment, however, the government has no other choice but to respect the ruling and seek every path possible to keep the program running.
That will be a tall order. With little room for the economy to grow, there’s the new coronavirus outbreak, which the World Health Organization has just declared a pandemic, following clear signs of the global spread of the virus in the past weeks.
Finance Minister Sri Mulyani Indrawati has estimated that the budget deficit will potentially increase to between 2 and 2.5 percent of gross domestic product, from the target of 1.76 percent set for the 2020 fiscal year, on account of the epidemic. With such a scenario, which could worsen, more funds need to be allocated to plug the deficit that has been plaguing the health insurance program since its inception in 2014.
The deficit ballooned to Rp 28 trillion (US$1.9 billion) in 2019, excluding the claims the government owes to about 5,000 health facilities, including hospitals. The president director of the Health Care and Social Security Agency (BPJS Kesehatan), Fachmi Idris, once said the deficit would reach Rp 39.5 trillion in 2020 and hit a staggering Rp 50.1 trillion in 2021 if the premiums did not increase.
When the government decided to raise the premiums late last year, it expected Rp 17.3 trillion in surplus in 2020 and Rp 12 trillion in 2021, allowing BPJS Kesehatan, the national health insurance provider, to breathe easier and further improve its services.
About 96.8 million poor people are now entitled to free access to health care and more are to come if the economic doldrum pushes those in the lower-middle income group into poverty. Therefore, the government needs to act quickly to ensure every citizen’s right to health care remains intact.
A cigarette excise is a difficult choice but in this time of crisis, the option should be taken into consideration. The rise in cigarette tax, effective last January, would give the government Rp 5 trillion to Rp 6 trillion to lower the BPJS deficit.
Internally, the government has to tighten its control over expenditures reported by hospitals participating in the healthcare program. There have been reports of inflated claims and other misappropriations of state funds, which could otherwise minimize the deficit.
But more importantly, prevention is always better than a cure. The government needs to redouble efforts to promote healthy lifestyles, which should be a top priority. Policies to support healthy lifestyles, such as a sugar tax, are imperative not only to significantly reduce hospital claims but to also improve the quality of the nation’s human resources.
The ongoing coronavirus outbreak, however painful, is a blessing in disguise in this regard. To protect themselves from the virus, people must maintain their health and hygiene.
At the end of the day, health insurance, while important, remains a tool we need in a state of emergency.
