The government\'s decision to increase the premiums for the National Health Insurance (JKN)-Indonesian Health Card (KIS) programs should be followed by an overhaul of the whole system.
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KOMPAS/RUNIK SRI ASTUTI
Workers demonstrate in Sidoarjo, East Java, on Tuesday (5/11/2019). They demanded an increase in minimum wages, sectoral wages and rejected payment of national health insurance (JKN) premiums.
JAKARTA, KOMPAS — The government\'s decision to increase the premiums for the National Health Insurance (JKN)-Indonesian Health Card (KIS) programs should be followed by an overhaul of the whole system.
At the same time, health promotion and disease prevention efforts need to be continued so as not to further increase health costs.
The advocacy coordinator of the Health Care and Social Security Agency (BPJS Kesehatan) Watch, Timboel Siregar, said in Jakarta on Tuesday the deficit of the JKN-KIS health insurance program could not be overcome by raising the membership fees or premiums.
He said many things needed to be done such as an improvement in the management and data on members of BPJS Kesehatan, health promotion and disease prevention activities, public awareness about the importance of JKN-KIS insurance programs, which are managed by BPJS Kesehatan.
The chairman of the Indonesian Consumers Foundation (YLKI), Tulus Abadi, said that before the planned increase in JKN-KIS premiums was put in place, the government and BPJS Kesehatan should first clear the data of participants that received subsidies from the government (PBI members).
A large number of financially capable people are still included on the list of PBI participants, while many poor and disadvantaged people are still unable to benefit from the government’s subsidy, he added.
In addition, all companies should also register their workers as JKN-KIS participants. Funds for increasing cigarette excise must also be allocated for BPJS Kesehatan to help finance its health promotion and disease prevention programs.
The BPJS Kesehatan deficit is a consequence of the government’s policy to impose low premiums on its participants. The regulation to increase the premium every two years is not implemented. As a result, since operating in 2014, BPJS Kesehatan has continued to suffer losses. Services are not optimal, and health workers and hospitals have often complained about low service fees.
KOMPAS/HENDRA A SETYAWAN
People process premium payments at the Health Care and Social Security Agency (BPJS) at the BPJS office in Pancoran, Jakarta, Monday (4/11/2019). Presidential Regulation No. 75/2019 concerning the amendment to Presidential Regulation No. 82/2018 regarding health insurance has adjusted the premiums for participants of the Indonesia Health Card (JKN)-Indonesia Health Card (KIS) programs.
Communication strategy
The chairman of the National Social Security Board (DJSN) Tubagus Achmad Choesni said the government and BPJS Kesehatan needed to prepare the right communication strategy so that people could accept the increase in premiums.
"The refusal of some circles in society, the increase in non-active participants, and the moving of the members to lower class service occurred because the people’s understanding related to the principle of mutual cooperation and the sustainability of the JKN-KIS program have not been well established," he said.
The government and BPJS Kesehatan need to massively approach religious leaders, traditional leaders and community leaders about the health insurance program.
The principle of mutual cooperation of JKN-KIS in which the financially capable members help those are incapable, and the healthy members can help the unhealthy should be further promoted.
As of Tuesday, rejections over the increase in premiums continued in a number of regions. In Sidoarjo, East Java, around 500 workers from the Sidoarjo Workers Association rallied at the labor department and the local square. "The high increase has a broad impact on the people’s economy," said the chairman of the East Java Indonesian Workers Union, Ahmad Fauzi.
If added with the regional PBI members, the total members whose premiums paid by the government reaches 133 million people.
The president director of BPJS Kesehatan, Fachmi Idris, said, the premiums of poor people were still paid by the government. At present, 96.8 million poor people included as PBI members are guaranteed by the government. If added with the regional PBI members, the total members whose premiums paid by the government reaches 133 million people.
In addition, the independent participants can choose service classes according to their financial capabilities. In principle, all service classes provide the same quality medical services.
According to Fachmi, independent participants with first-class services are required to pay a premium of Rp 160,000 per month. It means that they need to set aside Rp 5,000 per day for the premium payments. For second-class services, the participants need to pay premium of Rp 110,000 per month or equivalent to Rp 3,600 per day. For third-class services, the participants need only to pay Rp. 42,000 per month, equivalent to Rp 1,400 per day.
Disease prevention
During a hearing between House of Representatices Commission IX, the Health Ministry and BPJS Kesehatan, the commission IX member from the Prosperous Justice Party Faction, Kurniasih Mufidayati, reminded that national health development must be based health promotion and disease prevention programs, not on curative as currently implemented.
"If health promotion and disease prevention programs work, the health burden will not be as great as today," he said.
BPJS Kesehatan noted the burden of catastrophic disease in January-August amounted to Rp 15.4 trillion.
The causes of the BPJS Kesehatan deficit include the high cost of funding a number of catastrophic diseases or high costs that can be prevented, such as heart disease, kidney failure and diabetes.
BPJS Kesehatan noted the burden of catastrophic disease in January-August amounted to Rp 15.4 trillion. In fact, during 2018 the cost reached Rp 20.4 trillion. Thus, the burden of catastrophic disease costs is predicted to rise until the end of 2019.
In response, Health Minister Terawan Putranto said the revitalization of community health centers (Puskesmas) would be carried out. In the future , the Puskesmas will not only focus its service on the curative aspect but also on promotion and prevention programs. Health workers in Puskesmas are encouraged to come to the community so that the people will get an easier access to health treatment. (MZW / TAN / NIK / CAS)
