BPJS, Life Support for People with Diabetes

Diabetes is a disease with high medical costs. BPJS Kesehatan is a way out for diabetics, especially from the lower class of society.

KOMPAS/SATRIO PANGARSO WISANGGENI

Ayu (30) took a blood sample from her youngest child's fingertip, Bianca (2) to check her blood sugar level, when met at her home, Cibinong, Bogor Regency, Monday (3/4/2023) afternoon. Bianca was diagnosed with type 1 diabetes mellitus in late 2022.

In one of the modest houses standing in a corner of Cibinong, Bogor regency, West Java, siblings Alif (4) and Bianca (2) spent time playing together on Monday afternoon (3/4/2023). The weather was hot, so their mother Ayu (30) had left the door of the small house open.

At a glance, Alif and Bianca look normal. They are active and energetic. However, aside from their usual activities, the two toddlers need insulin injections every day. Their bodies cannot produce the hormones that control their blood sugar. They have type 1 diabetes mellitus.

In a single day, Alif and Bianca can receive up to four insulin injections: once before each of three meals and once at night before going to bed. The tips of their fingers are pricked up to four times a day to measure their blood sugar.

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“If Bianca is already asleep, but she hasn’t been injected with her evening dose, yes, I’ll push down her trousers a little so I can inject her. Bianca already feels that she needs an injection, so she says nothing. Sometimes, she wakes slightly, but after that, she falls back asleep again,” said Ayu.

Alif was diagnosed with diabetes in September 2022. A month later, Bianca received the same diagnosis.

The brother and sister seemed to share a genetic condition that is often a cause of type 2 diabetes. However, their test results confirmed that they had type 1 diabetes, which is unrelated to genetics or diet.

Self-insured

Meanwhile, Moh. Faizcenna “Faiz” (19) was diagnosed with diabetes mellitus 13 years ago when he was 7 years old, older than Alif and Bianca. Back then, Faiz urinated frequently, even wet his bed. He was thin and weighed less than 20 kilograms, even though he had a good appetite.

Finally, his father Moh. Arif Novianto (56) decided to take Faiz to see a doctor. Arif uses his own money and not health insurance to buy insulin and food suitable for diabetics.

Arif decided to use BPJS because Faiz needed more insulin.

“For insulin, one [insulin] pen costs between Rp 240,000 and Rp 250,000. Using four pens a month, you can already imagine the total [cost],” he said, adding that the cost of Rp 1 million did not include diabetes-labeled foods, which are expensive.

For almost five years, Arif paid for Faiz’s treatment without health insurance. Just two years after the state-run health insurance (BPJS Kesehatan) program started, Arif decided to use BPJS because Faiz needed more insulin.

KOMPAS/ALBERTUS KRISNA

Father of a child with type 1 diabetes mellitus Moh Arif Novianto shows his son's insulin syringe to Kompas on Thursday (30/03/2023). Insulin is the main requirement for maintaining the health of people with type 1 diabetes mellitus. Arif (19) needs 10 pens of insulin every month

Arif initially found it difficult to use the BPJS program. The change in the health facility category from Type 1 to Type C removed coverage for insulin pens.

“I was confused, because at other hospitals before the system change, [insulin] was covered. Finally [I decided to] stop, [I didn’t take Faiz to] medical check-ups for five months and used the remaining insulin,” said Arif.

After Faiz’s insulin supply ran low, Arif tried again to get insulin free of charge through the BPJS program. He was told to get a referral from a Type C public hospital or military hospital, and only then seek treatment at a Type B health facility.

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For a time, the process was smooth again, but then it hit another snag. The office where Arif worked went bankrupt and the BPJS premiums of all employees, including Arif, fell into arrears. The state health insurance agency helped Arif switch to the BPJS Assistance Recipient (PBI) policy, because Arif was no longer employed.

Now, Faiz’s treatment is fully covered by the state under the BPJS PBI policy. Every month, Faiz receives 10 insulin pens and 10 needles from Pesanggrahan Regional General Hospital.

Thank God, it’s easy for us to get BPJS assistance.

Via (40), also expressed gratitude for the national health insurance, as she needed a regular supply of insulin for her daughter Alisha (8) for the past eight months. Alisha needs an average of three insulin pens each month. “Thank God, it’s easy for us to get BPJS assistance,” said Via.

When Alisha was first diagnosed as diabetes mellitus, her blood sugar level was often so high that the supply of insulin pens provided by the BPJS was not enough. Via had to buy extra insulin herself. However, Alisha’s blood sugar level is more stable now, and the insulin she needs is covered by the BPJS program.

Aside from Arif and Via, Ayu also admitted that it was possible to take care of her two diabetic children with the help of BPJS Kesehatan. Her husband works odd jobs, but this did not hinder Alif and Bianca’s health and survival.

RUNIK SRI ASTUTI

A number of residents queued for access to services at the Sidoarjo Branch of the Health BPJS office, Tuesday (28/3/2023).

Mercy

However, there are a number of basic services that are not covered by BPJS Kesehatan and can burden the finances of these young families.

Soon after her two children were diagnosed with diabetes, Ayu needed to cover the cost of a C-peptide test to determine which type of diabetes they had. This cost almost Rp 2 million at that time. Doctors required the test, but it was not covered by BPJS Kesehatan.

At only around Rp 3 million per month, her husband’s monthly income was not enough to cover the costs of the test. Without assistance from Arif, who heads the Childhood and Teen Diabetes Association, Alif and Bianca would not have gotten their C-peptide tests.

Ayu had to buy the paper strips used to measure blood sugar herself. In fact, it was not cheap. She needed to measure the blood sugar of both her children at least four times a day.

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Thankfully, the cost of these paper strips is supported until 2027 through Changing Diabetes in Children (CDiC), a global partnership program.

Ayu and Arif also complained about the availability of insulin syringes, which should be provided with insulin when claiming BPJS insurance. In reality, however, they have to buy their own syringes.

“So to save money, I rarely change syringes. In the end, Alif developed a fever because the syringe had never been replaced. I once even used the same syringe for Bianca, but actually that’s not allowed,” said Ayu. Now, to buy syringes, Ayu often uses the Paylater feature on the Lokapasar e-commerce website.

Faiz did the same thing, reusing a single syringe many times. “Until [the needle] is dull. Yes, that hurts just a little bit,” he said.

BPJS Kesehatan should be able to bear this. Needles and lab tests, those must be covered.

Aman Bhakti Pulungan, executive director of the International Pediatric Association, agrees that a number of basic services must be added to BPJS Kesehatan coverage.

“If a patient can’t afford [the services they need], it is difficult. Well, BPJS Kesehatan should be able to bear this. Needles and lab tests, those must be covered,” he said.

Regarding this, BPJS Kesehatan president director Ali Ghufron Mukti said syringes should be provided at the same time as insulin. He expressed his hope that people who did not receive syringes for insulin from a health facility would report the matter to BPJS Kesehatan.

This article was translated by Kurnia Siswo.