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Don't get sick, or else

Jakarta Post Editorial - May 22, 2024

Jakarta – President Joko "Jokowi" Widodo on May 8 signed a presidential regulation (Perpres) that aims to revamp the national health security system to promote equality, only to confront tough challenges from those who have paid higher premiums.

Perpres No. 59/2024 on National Health Security (JKN) introduces the Inpatient Care Standard Class (KRIS) that will ensure all citizens who have been registered with the Health Care and Social Security Agency (BPJS Kesehatan) receive equal treatment.

When coming into effect on June 30, 2025, the KRIS will remove the three-tiered system. Class 1 participants of BPJS Kesehatan pay a Rp 150,000 (US$9.35) monthly premium, while the class 2 premium is Rp 100,000 and class III premium is Rp 35,000.

According to Health Minister Budi Gunadi Sadikin, the KRIS is intended to increase the minimal required level for healthcare services, so that everywhere across Indonesia, minimum standards for healthcare services provided under BPJS Kesehatan can be far improved.

The single-class system sounds ideal, especially given the fact that Indonesia is one of the countries that has adopted universal health care. As of March 1, 2023, the number of Indonesian people who are part of the JKN-Indonesia Healthy Card (KIS) program reached 252.1 million, or more than 90 percent of the country's total population.

Under Perpres No. 59/2024, the Health Ministry opens a possibility for partnerships between BPJS Kesehatan and private insurance companies to provide patients with additional medical cover on top of their existing health insurance.

Nevertheless, the worry of many BPJS Kesehatan class 1 and class 2 members about the KRIS is quite understandable because they have been paying more and therefore deserve better facilities than the lower-class members.

According to BPJS Watch advocacy coordinator Timbul Siregar, the single-class hospital care scheme may result in declining revenues especially from the class 1 and 2 policyholders, although revenues from class 3 policyholders may increase.

Indeed, the potential for deficit should be taken into consideration by the government when adopting the single-class system.

Deficit has been a constant challenge facing BPJS Kesehatan since its inception in 2014. The deficit skyrocketed from Rp 1.9 trillion in 2014 to Rp 9.4 trillion in 2015. It declined to Rp 6.4 trillion in 2016, but in the following years the deficit hit between Rp 13 trillion and Rp 19 trillion until the government increased the premiums in 2019.

BPJS Kesehatan president director Ali Ghufron said recently the national health insurance provider would have to brace for yet another deficit this fiscal year as the claims have reached Rp 176 trillion, while revenues from the premiums decline as 53 million participants are reportedly no longer active.

Some hospitals are now transitioning to KRIS, and 3,060 out of 3,176 hospitals have reportedly agreed to implement the program. As of April 30, as many as 2,558 hospitals were ready to implement KRIS, based on the results of a recent survey of 12 KRIS criteria. Under Perpres No. 59, public hospitals are required to prepare 60 percent of inpatient facilities for KRIS, and private hospitals 40 percent.

Unlike public hospitals, private hospitals will likely fall short of funds to renovate their inpatient facilities in line with KRIS criteria because of the decrease in revenues from the class 1 and 2 insurance premiums.

The government has yet to decide on a new single tariff for the insurance premium. BPJS Kesehatan is set to discuss the new tariff with the Health Ministry, the National Social Security Council (DJSN) and the Finance Ministry. During the transition period, the current three-tiered system will remain in place.

With growing challenges in health care post-pandemic, the government must support the right to health through good policymaking, so all people have the chance for a better life.

For the time being, with uncertainty looming, we should maintain a healthy lifestyle that will prevent us from obtaining diseases. As the old saying goes, preventing is always better than curing.

Once we get sick and need hospitalization, we may have to deal with "too complicated to understand" healthcare procedures.

Source: https://www.thejakartapost.com/opinion/2024/05/22/dont-get-sick-or-else.htm