No More Deficit In Health Care Agency
The health care agency’s cashflow situation is going from bad to worse. Changes to premium payments are needed.
The huge arrears currently piling up at the Health Care and Social Security Agency (BPJS Kesehatan) budget is only the tip of the iceberg. These structural faults need addressing on a fundamental level. Makeshift solutions will not cure the chronic sickness in the cashflow of the agency managing the National Healthcare Guarantee (JKN) program.
With the aim of guaranteeing the right of all citizens to obtain healthcare, the JKN was established based on a realistic concept. At a time of financial constraints, the state asked the people to come together to bear the costs.
Problems began when the government was inconsistent in the way it ran the insurance scheme that the program required. The implementing agency, BJPS Kesehatan, was not supported with the risk management instruments that should be a part of an insurance business.
The premiums are still lower than actuarial calculations. As of the end of last year, the average monthly contribution per investor was Rp5,625 less than the claims paid out to them. This is the main reason why the BJPS Kesehatan cashflow has been negative since the JKN program started in 2014.
The government must be rational. Premiums will have to rise. The failure of additional state capital equity—which totaled Rp14.6 trillion over the last three years—to stem the growing BJPS Kesehatan deficit must serve as a lesson. The government’s refusal to increase premiums because this would be unpopular has only made matters worse.
This month unpaid BJPS Kesehatan’s debts to healthcare providers reached Rp7.69 trillion. It is estimated that the cashflow of the agency that replaced Askes Indonesia will be Rp16.4 trillion in the red.
The government’s latest plan to improve the situation will not solve the problem. Last week, through a revision to Presidential Regulation No. 28/2016 on the Healthcare Guarantee, the government provided a new source of funding for the JKN program: cigarette taxes. This new regulation allocates 75 percent of half the regional tax revenues from cigarettes to fund the BJPS Kesehatan. This could raise around Rp5.4 trillion.
This new regulation could address the problem of poor accountability of cigarette excise management, but for BJPS Kesehatan, this new “medicine” will not be effective in reducing the cash deficit. Not only is the dose too small, but the allocation of cigarette taxes is exactly the same as other short-term solutions. It will cover the deficit this year, but will not guarantee that the cashflow will be positive in the years to come. However, it is feared that the deficit may well rise as the number of participants is targeted to increase by 55 million, from the current 202 million people.
The need for a long-term solution is becoming more urgent. A new roadmap should be drawn up to determine when there will be sufficient funds to cover the constant increase of the poorest healthcare recipients’ needs. Bear in mind that income from this largest group of BJPS Kesehatan participants will be a whooping Rp13,000 per person lower than the actuarial calculation.
There is no need for any further delays to the increase in contributions from independent or middle level to upper participants. However, the size of the discrepancy between premiums from this group and other participants is a new problem. Many class I and class II participants move to class III, especially when they do not need health services. The contributions from the lowest class are Rp27,500 less than they should be.
The government should move quickly to reform the premium structure and optimize the BJPS contributions. After that issue is solved, a larger task awaits: improving the times of service and identifying loopholes for fraud in the implementation of the JKN program.