Tara Marchelin, Jakarta – The government has to find an immediate solution for the deficit suffered by the national health insurance agency, or BPJS Kesehatan, after the Supreme Court annulled a presidential regulation issued to double its tiered premiums, a lawmaker said on Thursday.
The statement came from Rahmad Handoyo, a member of the House of Representatives' (DPR) Commission IX, which overlooks health and human resources, and a politician from the Indonesian Democratic Party of Struggle (PDIP).
"Public health services will be affected if the government can't find an immediate solution. Hospitals might turn away patients covered by the national health insurance in favor of those who pay their own medical bills," Rahmad said in a discussion at the DPR complex in Jakarta.
Saleh Partaonan Daulay, another Commission IX member from Golkar, said the commission in the past three years had always warned the government against raising the premium, an advice they chose to ignore.
"The government should not try to raise the premium again. They should heed the Supreme Court's decision," Saleh said.
Alternative solutions
Rahmad said the government could use cross-subsidy with the energy sector to cover the insurance agency's deficit.
"The government can rechannel money from the electricity subsidy, liquid petroleum gas (LPG) subsidy and fuel subsidy to cover the deficit," Rahmad said.
The government must also start punishing hospitals that, according to Rahmad, intentionally persuade patients to undergo unnecessary treatments to inflate the amount of claims to the national health insurance.
"These fraudulent hospitals should be audited to prove their crimes," Rahmad said.
According to him, cigarette companies must also take some of the responsibility for BPJS Kesehatan's deficit. Expensive treatment for diseases related to smoking, such as cancer and heart disease, put a great strain on BPJS Kesehatan and is a major contributor to its deficit.
"The cigarette companies should provide insurance, managed by private institutions or state-owned companies, for people who suffer from these serious illnesses," Rahmad said.
In terms of regulation, Saleh said the House of Representatives and the government need to work together to review the law on social security.
"There must be something wrong with the law because no matter how much money the government spends [on health insurance], it's never enough," Saleh said.
Faulty grand design
Hery Susanto, the national coordinator of Social Security Agency Watch, said low premium is not the cause of BPJS Kesehatan's years of deficit. According to him, the real problem lies with a faulty "grand design."
Hery pointed out that the agency had already suffered from deficits even before the presidential regulation was signed.
Hery said the case-based group payment system implemented by BPJS Kesehatan resulted in many underpayment – the real reason for the high number of fictitious claims.
"It also doesn't help that the government only imposes administrative penalties that don't have any deterrent effect on these fictitious claims," he said.
Hery also criticized BPJS Kesehatan executives for being profit-oriented instead of focusing on providing excellent public service.
"The government has to be more selective when recruiting the new board of directors this year. BPJS Kesehatan needs a leader who understands it is no longer a profit-oriented establishment," he said.
If BPJS Kesehatan cannot improve its performance, Hery said, the government should consider trasferring the management of the national health insurance to the more financially stable Social Security Administration for Employment (BP Jamsostek).