Only Two Options Remain

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STATE-OWNED insurer, BPJS Kesehatan, has barely had time to enjoy its premium increase. On February 27, the Supreme Court annulled article 34 of Presidential Regulation No. 75/2019 regarding premium increases for independent insurance policy holders.

BPJS Kesehatan CEO Fachmi Idris sees this decision as a momentum to reform the overall National Health Insurance (JKN) program. One way is to adjust services with the available funds. “Not that quality is lowered, but it will be adjusted with the funds which we have,” Fachmi said on Wednesday, March 11.

Does this Supreme Court decision mean that the premium for independent policy holders will go back to the amount before the increase?

If it were true that the annulment is only valid for PBPU (independent professional and informal worker participants), it would be different than if the annulment were valid for everyone (in the Presidential Regulation). We will calculate the cash flow projection in 2020. We have to count how much the deficit would be.

If it turns out that the deficit will go up, how will you deal with that?

If we speak about the BPJS deficit, there are three choices, or a combination of those three choices. First, premiums must be adjusted. Second, services must be adjusted. And the third choice is an injection of funds from the state budget.

Premiums were raised, but now that has been annulled...

Naturally we go to the second choice, services adjustments, or the third choice of funds injection. With the government’s current fiscal climate, an injection of funds would surely be tough. We will also have to consider the longer term. This program’s principle is mutual cooperation, so it’s not possible to depend solely on the government.

Actually, this premium increase annulment is also a momentum. The government already takes its responsibility for poor people. Then it wants to bundle efforts to support those who are ill but are not included in the group that gets aids for premiums, and assure affordable costs.

If the option of a premium increase cannot be realized smoothly, then we automatically have to do a review, go back to the Constitution and define what the basic health needs are. What services can we provide with the money that we have. So, it’s based on the budget.

How would you do that?

A cataract operation is a basic health need. The BPJS would see that adjustments are needed, but not cutting services. Cataract can be treated with technology which fits the ability to cover costs. Basically, the intervention would be sufficient to cover basic needs. We will discuss this in the framework of the Supreme Court decision. Quality will not be lowered, but adjusted to the funds available.

Finance Minister Sri Mulyani asked that the BPJS Kesehatan be transparent regarding its finances and premium increase...

When she ordered the Development and Finance Comptroller (BPKP) to do a full audit on BPJS Kesehatan, we as the ones being audited naturally asked: ‘What is this all about?’ Finance Minister Sri Mulyani wanted to make sure, after the full audit, what the fundamental problems were. There was the potential for fraud, regulation violations regarding hospital classes, for example that those in ‘C’ class are categorized as ‘B’ class in order to charge more. This is what the BPKP found, including BPJS’ collectability problems. However, outside these three items—if fraud is put at zero, class categorization corrected, and BPJS collectability is considered clean—there is still a deficit of around Rp10.5 trillion in 2018. This deficit is in real terms, given that everything else went right. Collectability has to be supported by law enforcement. Our current rate of 60 percent is already good in the persuasive context.

Are there any legal consequences for those who are delinquent in paying their premiums?

Not yet. We relay this through public service prerequisites. Just like the issuance of drivers’ licenses, license plates, or anything that is related to public services, the requirement for not being delinquent in paying JKN premiums can be stipulated.

Is this in place now?

Not for the PBPU. A Presidential Instruction is being set up for this.

What other steps have been carried out by the BPJS after the BPKP audit?

We’ve cleaned up the data on 2.7 million policy holders. We are processing the issue with the hospital classes. The BPKP has asked us to charge extra payment. There is also the capitation fund (monthly payments paid in advanced to basic health facilities based on the number of listed participants), which is left over from the basic health facilities (community health centers), the suggestion is that this can be utilized and carried over. It amounts to some Rp3.5 trillion. Currently a Presidential Regulation is also being prepared to utilize those funds.