A recent government Healthcare and Social Security Management Report shows a declining number of hospital visits for advanced outpatient and inpatient programs as of Sept. 30, Kompas reported. 

From January to September, total outpatient and inpatient visits were down to 58.7 million, or 6.5 million visits on average per month. In the previous year, the total visits reached 77 million, or 7.7 million on average per month.

The decrease was also seen in services given to patients with catastrophic illnesses, such as cardiovascular disease, stroke, cancer and kidney failure.

The state-funded National Health Insurance-Healthy Indonesia Card (JKN-KIS) has covered about 1.5 million cases per month in 2020; last year, it saw 1.6 million cases per month. Meanwhile, in terms of costs for handling catastrophic illnesses, this year’s January-September period required Rp 12.7 trillion (US$882 million), down from Rp 16.2 trillion in the January-October period of 2019.

Timboel Siregar from watchdog BPJS Watch said the aforementioned figures confirmed the decrease in the number of hospital visits.

“[This year’s claims] for outpatient and inpatient visits were lower when compared to last year’s. However, the situation might go the other way in 2021 because we could see more sick people and even face complications [from those missing this year’s hospital treatment],” Timboel said on Monday.

The claims system for inpatient and outpatient visits in the JKN-KIS program is called INA-CBGs. The claims are sent by hospitals to the Healthcare and Social Security Agency (BPJS Kesehatan).

The cause of people failing to visit hospitals during the pandemic could be based on fears of contracting COVID-19, said Timboel. The situation could be overcome by telemedicine, but the service has yet to be optimized, he added.

“The JKN-KIS has not even offered telemedicine services yet. Therefore, we really need the Health Ministry to immediately issue a policy on telemedicine.”

Responding to the concerns, Cut Putri Ariane, the Health Ministry’s noncommunicable diseases (NCDs) director, said the decrease in hospital visits could also be caused by BPJS Kesehatan’s new policy, which extends the period of administering medication to every two months to avoid patients going to hospitals too often during the pandemic. 

Apart from that, most health facilities were also focused more on COVID-19 handling, which affects other essential health services, said Cut Putri. Therefore, the Health Ministry issued a guide for health services during the pandemic to help sort the problems.

“At the start of the pandemic, the Health Ministry issued a guide on health services and another guide to screening risk factors for NCDs at integrated health counseling posts [Posbindu]. We have the regulation; now it depends on the health facilities and patients on making it work. Regional administrations are also in charge of implementing this.”

Risk factor screenings for hypertension and diabetes are important to avoid comorbidities such as cardiovascular disease, stroke and kidney failure. 

According to a report titled “Moving Toward Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations From a Review and Multidisciplinary Expert Panel”, which was released in July, NCDs are the leading cause of mortality in Southeast Asia, accounting for an estimated 62 percent (8.5 million) of all deaths. Approximately 50 percent of these deaths occur in people under 70 years of age.

Four major NCDs, namely cardiovascular diseases (CVDs), diabetes, cancers and chronic respiratory diseases, contribute to more than 80 percent of NCD-related premature deaths. Mental disorders are the fifth-leading contributor to NCD burdens and frequently co-occur with the four major NCDs.

Overall, NCDs account for 44 percent of total disability-adjusted life years (DALYs) in Southeast Asian countries, with mental disorders constituting the largest proportion (27 percent). (nkn)

Editor’s note: This article is part of a public campaign by the COVID-19 task force to raise people’s awareness about the pandemic.