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Solidarity vs. protection
The plan to implement uniform basic services for all insurance holders has raised concerns that JKN will trap people in low-quality, inadequate healthcare services.
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Handling a crisis: An employee of the Health Care and Social Security Agency (BPJS Kesehatan) helps a policyholder at the agency’s branch office in Jakarta on July 1. (JP/Dhoni Setiawan)
I
t has been quite a rollercoaster ride for the Health Care and Social Security Agency (BPJS Kesehatan). Established in 2014, the agency’s mandate is to provide adequate health care for all Indonesians. This is a herculean task given the poor state of the country’s health system, as even basic care and doctors remain limited in many parts of the country.
In the state-owned insurer’s efforts to provide health services to all citizens, from the poorest to the richest, it has incurred yearly deficits for most of its existence. The figure was Rp 13 trillion (US$910 million) in 2019.
This deficit was reversed only in the early stages of the COVID-19 pandemic in 2020, as people avoided going to health facilities for fear of the virus. The decline in claims gave breathing room for the agency to pay its debts to hospitals and other care providers.
But the government has recently announced plans to eliminate service classes and provide uniform treatment for all policyholders, in anticipation of rising national health insurance (JKN) claims.
The prevailing insurance scheme offers three service classes with different premiums. People whose premiums are covered by the government because of need receive the lowest service class, along with regular civil servants and police and military personnel. Critics have said a one-size-fits-all scheme would encourage those who currently pay for higher service classes to leave the program and opt for private insurance instead – if permitted.
As of 2021, 36 percent of the country’s 235 million JKN policyholders received need-based contribution assistance. Professionals and business owners who paid their own premiums also accounted for a large share of policyholders.
President Joko “Jokowi” Widodo recently issued Presidential Instruction No. 1/2022, which makes JKN membership a prerequisite for access to a number of public services, from passport issuance to buying and selling land. It is set to take effect on March 1. The government says the new regulation will encourage more people to join the state insurance program.
The policy change has sparked protests, as it will, in practice, make JKN membership mandatory for all citizens. This, combined with the plan to implement uniform basic services for all insurance holders, has raised concerns that JKN will trap people in low-quality, inadequate healthcare services.
There should be no qualms about efforts to increase JKN registration, even if the program shifts to a uniform treatment policy. JKN’s main purpose is to ensure basic health care for everyone, and this relies on a measure of solidarity, in which the rich subsidize the poor.
But the government should also synchronize basic JKN health care with private insurance or adopt a copayment system for medical services that go beyond JKN coverage.
Copayments, which are fixed, out-of-pocket amounts paid by policyholders for covered services, and private insurance linkage will provide more options for JKN members if they need more than just basic coverage.
It is also crucial that BPJS Kesehatan improves its accountability and financial prudence. It must be disciplined with its standards and should not rack up bills it cannot afford.
It is more important for the government to sustain basic healthcare for all than to provide quality insurance for only the few.
