Many people rely on the JKN program organized by the BPJS Kesehatan. However, existing funds have yet to be optimized. Idle funds have reached into the trillions of rupiah.
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KOMPAS/RYAN RINALDY
An elderly patient interacts with a physician during a medical check at the community health center (Puskesmas) in Tajur Halang, Bogor regency, West Java, on Saturday (31/3). The clinic offered medical treatment for the elderly.
JAKARTA, KOMPAS – Capitation fund absorption in every community health center (Puskesmas) as the first-level healthcare facility is less than effective. Kompas investigation and Supreme Audit Agency (BPK) audit results on regional administrations’ financial reports across Indonesia in 2016 found Rp 3.02 trillion (US$211.4 million) of idle capitation fund at Puskesmas. In many Puskesmas, idle capitation funds can reach up to Rp 2 billion.
Between 2014 (when the JKN program was established) and 2016, BPJS Kesehatan disbursed Rp 30.5 trillion of capitation fund to 20,708 first-level healthcare facilities, including Puskesmas, general clinics, dental clinics and clinics run by private entities and the military/police.
More than half of these capitation funds, totaling Rp 22.7 trillion or around 74.4 percent of capitation funds from 2014 to 2016, were distributed to Puskesmas.
The idle funds of up to billions of rupiah at Puskesmas were not yet used to optimize healthcare services. Long lines of patients and poor services are still commonplace in Puskesmas, wasting lots of time and resources.
Suboptimal capitation fund absorption was found in several Puskesmas Kompas visited. At Pakisjaya Puskesmas in Karawang regency, West Java, for instance, capitation fund absorption in 2017 was only 54.8 percent of the available Rp 2.62 billion. Some Rp 1.1 billion remain unused at the Puskesmas. Meanwhile, services at Pakisjaya Puskesmas remain lacking.
On Saturday (31/3), 66-year-old Aca from Solokan village, Pakisjaya district, complained of a stomachache. A nurse attended to him due to the absence of a general practitioner that day. The nurse said Aca was suffering from a stomach ulcer. The condition of the Puskesmas and its front yard was saddening. The registration area is in the same room as the maternity ward.
In Bogor regency, some patients needed to pay for medicine that should have been covered by the capitation fund. Yeni from Bojong Jengkol in Ciampea district needed to pay Rp 60,000 for intravenous fluids and bandages to clean the wound on her husband Ujang’s leg. Ujang was treated at Ciampea Puskesmas.
Another issue with the huge idle funds without proper monitoring and detailed usage reports is that there may be corruption. The most apparent example was the case of former Jombang regent Nyono Suharli Wihandoko, who was bribed by his subordinates with capitation funds taken from local Puskesmas. Another case involved former Subang regent Ojang Suhandi, who took money from local health agency officers. Some of the money had come from capitation funds.
Unused
BPK commissioner of health, education and culture affairs Harry Azhar Aziz said a BPK audit found a huge amount of unused and idle capitation funds in many Puskesmas. Large funds remain unused in Puskesmas.
“If there are remaining funds, then it was unused. Puskesmas spending is less than optimal or they do not care for their patients.
National Social Security Council (DJSN) member Ahmad Ansyori said poor absorption of capitation funds was related to Puskesmas management under regional administrations. Puskesmas are not fully autonomous in managing capitation funds despite having obtained them directly from BPJS Kesehatan through their bank accounts.
Bekasi regency health agency acting secretary Alamsyah said optimum fund absorption was found only in healthcare services that were funded 60 percent by the capitation fund. Meanwhile, 40 percent for covering operational costs was not optimally absorbed. Operational funds can be used to procure medicine and medical equipment and to fund other activities.
BPJS Kesehatan president director Fachmi Idris said he doubted that the remaining capitation fund in Puskesmas across Indonesia reached trillions of rupiah. “We must check on each Puskesmas to find out how much funds remain in each of them. It cannot possibly reach trillions of rupiah,” he said.
Fachmi said BPJS Kesehatan continued to distribute capitation funds every year despite the presence of unused funds at the Puskesmas due to presidential regulations and the health minister’s regulations.
“We are concerned if 40 percent of the [capitation] funds to be used in increasing healthcare services are not used optimally,” Fachmi said.
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