Healing health care for all
2 September 2019
The government has planned to double the premiums for its universal healthcare scheme to address a ballooning deficit incurred during the first five years of its operation that taxpayers now have to pay. It will be an unpopular decision, but bold measures are needed to sustain healthcare services for all.
The Health Care and Social Security Agency (BPJS Kesehatan) argues that the premiums have been “underpriced” for too many risks and benefits, starting at Rp 25,500 (US$1.80) per month for Class III policyholders, and they have not changed since the program began in 2014. The government is proposing to increase the premiums for the lowest class category to Rp 42,000 per month. Class II and Class III premiums, meanwhile, will jump to Rp 110,000 and Rp 160,000 per month, respectively, from Rp 51,000 and Rp 80,000.
Indonesia’s universal healthcare scheme is one of the most generous and biggest in many ways, covering dental care, medicine, physiotherapy and chronic care. It has covered more than 223 million people and has the goal of serving 90 percent of the country’s population of 270 million. While the scheme has successfully provided more people with healthcare services, the facilities and funding to support it are deteriorating.
BPJS Kesehatan is expected to book a deficit of Rp 28.5 trillion this year, up from Rp 19.4 trillion in 2018, Rp 13.8 trillion in 2017, Rp 6.7 trillion in 2016, Rp 9.4 trillion in 2015 and Rp 1.9 trillion in 2014, its first year of its operations. Taxpayers’ money was used to support BPJS Kesehatan with a bailout of Rp 10.3 trillion last year. This practice has sickened BPJS Kesehatan and the state budget, which already has to subsidize for healthcare coverage for the poor.
Presidential Regulation No. 82/2018 allows for the premiums for the insurance scheme to be adjusted every two years. Still, the plan to increase them, which has been agreed by various government players ranging from the Finance Ministry to Vice President Jusuf Kalla, has sparked criticism, particularly from politicians who insist that premium hikes must run in parallel with improved quality of healthcare services.
Quality is one thing, but the management of the insurance scheme is another pressing issue to be addressed to ensure more effective and sustainable universal health care. According to a comprehensive audit by the Development Finance Comptroller, hospitals have been overstating their class category so they can charge higher premiums, while companies are under-reporting the numbers and salaries of their employees so they can pay lower premiums.
Addressing these two issues alone would dramatically improve BPJS Kesehatan’s finances, as would raising awareness of nonwage participants who have laid a heavy burden on the agency by only registering when they are ill and do not pay premiums when they are healthy.
Nothing is ever easy when it comes to price increases, but the accountability is clear. BPJS Kesehatan needs more income to provide Indonesian citizens with the healthcare services they very much deserve. Having said that, BPJS Kesehatan needs to strengthen surveillance and enforcement to make its operations more effective and efficient for a healthier and more productive Indonesia.