THE PNPK IS Still Not Completed
Minister of Health 2014-2019, Nila F. Moeloek:
SHE was the health minister who spent the most time dealing with the national health insurance program provided by the Health Care and Social Security Agency (BPJS Kesehatan). Established December 31, 2013, the eye doctor faced a tattered national health system. Nila Moeloek was required to make regulations, especially the national guidelines for medical services (PNPK), which would then be used as a reference for treating patients.
By the time she left office, Nila had only managed to formulate half of the 74 guidelines needed. The long process of creating a PNPK exhausted the health ministry, due to the many overlaps between associations and within doctors’ professions for handling diseases. “Compiling the PNPK involves many professions,” she said during a phone and correspondence interview on June 4.
Nila’s successor, Terawan Agus Putranto, was unable to provide an explanation of the problems with the PNPK, which had incurred the BPJS a deficit of Rp15.5 trillion last year. Terawan has not answered Tempo’s requests for an interview. “Our leadership asked for the interview to be postponed,” the Ministry’s Chief of Communication and Public Services, Widyawati, said last week.
What are the main problems in drafting the PNPK?
There are several still being compiled by professions’ organizations, but they are not completed yet. In 2016, there were three PNPKs with provisions from the health minister, and each was discussed and coordinated for the professional organizations to review. Each PNPK draft was discussed in four, five meetings, followed by legalization by the ministry’s bureau of law and organization and then the minister’s regulation.
The PNKP on cataract is being highlighted upon. Is it true that it is not set out in the health minister regulation?
That is not true. The PNPK on cataracts was issued in 2018, No. HK.01.07/MENKES/557/2018 on the national guidelines for the management of cataracts in adults.
Has there been a meeting with the Indonesian Ophthalmologist Association (Perdami) that refused to use the PNPK?
I met with Perdami several times. We discussed the criteria for the timing of cataract surgery and the cost for a cataract procedure within the BPJS.
The guidelines for a caesarian and medical rehabilitation are also not completed yet. Why is that?
A cesarean section is not a disease that requires guidance. It is just one of the several procedures for conditions related to pregnancy. As for medical rehabilitation, professional organizations have proposed service standards. It has not been agreed yet. The documents are currently being processed by the legal bureau.
The Corruption Eradication Commission recommends improvements in the grouping of diseases for the Indonesia Case-Based Groups (INA CBG’s). Is it true that the groupers refer to Malaysia, making the claims more expensive?
From the start, the national health insurance system for the payments of advanced referral health facilities has used the related group diagnosis tariff pattern, which we know as the INA CBGs. In carrying out the tariff pattern, categories become necessary to ensure that the tariffs are suitable with the disease groups. There are several types of groupers in the world. One of them is United Nations University, developed by the National University of Malaysia. The Malaysian grouper is chosen because their epidemiological diseases are similar to Indonesia. There is a transfer of knowledge, and it’s free.
In 2016, the health ministry established its own grouper—involving all associations of medical specialists so that the grouping matches the epidemiology and disease characteristics in our country. Since March 2020, the grouper has been tested in 32 selected hospitals with good management information systems. The hospitals also conduct bridging between V-claims and E-claims, have a good medical records and adequate human resources, and are willing to become an object of trial.
There are many differences in the classification of diseases between the BPJS and the hospital, which influences claims. What have you improved?
The INA CBGs tariff team regularly meets with the Health BPJS, to equalize their perceptions of diagnosis or procedure, in order to prevent disputes. The results are explained in a circular or in minutes, which are agreed by both parties. It should be binding in the terms of claims verification by the Helath BPJS, and implemented nation-wide. We have made this agreement three times.