Saving Our BPJS
Without an increase in premiums, BPJS Kesehatan’s deficit will only increase. If the recommendations from the Corruption Eradication Committee were applied, they could save Rp12 trillion.
THE chaotic management of the Health Care and Social Security Agency (BPJS Kesehatan) is a result of incomplete planning and hasty implementation. The large number of participants whose costs should not be borne by BPJS Kesehatan, the universal nature of the service provided, the lack of standardization in the relationship between BPJS Kesehatan and the hospitals, and the conduct of hospitals which inflate costs, such as moving patient to higher classes or falsifying the categorization of operations, all will only increase the BPJS deficit.
The BPJS Kesehatan deficit, which continues to mount, is the end result of all of this chaos. The Supreme Court ruling that found in favor of a judicial review of Presidential Regulation No. 75/ 2019 on revisions to Presidential Regulation No. 82/ 2018 on the healthcare safety net only worsened the problems faced by BPJS Kesehatan. This judicial review was requested by a community of Indonesian dialysis patients in December 2019.
The immediate effect of the Supreme Court ruling is on BPJS Kesehatan’s finances. Every year, the deficit of the institution established on January 1, 2014 increases. Since 2017, it has been in double digits. In 2020, it is calculated this deficit will reach Rp25.87 trillion, even taking into account the effect of the sharp rise in premiums at the start of this year. With this Supreme Court ruling, the deficit is bound to increase.
The Corruption Eradication Commission (KPK) studied a number of these problems and put forward a number of recommendations to Health Minister Terawan Agus Putranto in November 2019, not long after his appointment. The KPK study highlighted the number of malpractices and the dysfunction in the running of BPJS Kesehatan. If the KPK recommendations were applied, BPJS Kesehatan could reduce its deficit by Rp12 trillion.
The government subsidizes the BPJS in two ways. Firstly, it pays the premiums for poor people. Secondly it provides injections of state capital to cover the deficit. For the former, the government could rationalize the participants who have their premiums paid to a more reasonable number. At present, it stands at around 30 million. With the old Class III premium at Rp25,500, the contributions that the government should not be paying total almost Rp1 trillion.
The average 88 percent increase in premiums at the beginning of 2020 was intended to reduce this deficit. However, the Supreme Court ruling obliged the government to look for another way. This is no easy task. For example, reducing the range of treatments covered, including dialysis and cancer therapy, has proved to be a very sensitive issue. Limiting the treatment period to a maximum of three days triggered widespread protests from patients’ families.
The problem is the government cannot afford to step back from this universal health service. Therefore, what is required is BPJS managers able to think out of the box at challenging times like now. This is a reasonable demand given that these managers receive large salaries. Those responsible for oversight must also work hard to ensure that these managers are not spoiled and tending to rely on the government to solve their problems.
BPJS Kesehatan participants also have a role to play by paying their premiums on time. They can no longer use the hit-and-run approach: only paying premiums when they fall sick. And hospital managers must put a stop to fraudulent claims. BPJS managers, the hospitals and participants must come together to solve this problem. If they do not, The Supreme Court ruling will only make matters worse with BPJS.