Entering 2019, the public was shocked by the news that many participants of the National Health Insurance (JKN) experienced treatment refusal in a number of hospitals. The reason is that those hospitals were no longer working with the Healthcare and Social Security Agency (BPJS Kesehatan). Improving the quality of health services is the reason for BPJS Kesehatan to terminate its contract. As a consequences, those hospitals were no longer accept JKN patients.
Since 1 January 2019, BPJS Kesehatan has terminated its cooperation contracts with 92 hospitals in various regions. For many people, the contract termination is considered related to BPJS Kesehatan’s financial condition. Since its establishment, the healthcare agency does face a cash flow deficit. The deficit reached Rp 3.8 trillion in 2014 and rose to Rp 9.75 trillion in 2017. Last year, it was estimated at Rp 10.9 trillion.
Every year, the government must inject funds to cover the deficit. During the past year alone, the funds that have been spent by the government reached Rp 10 trillion. Most of the funds are used to pay for hospital claims from JKN participants.
However, Director of BPJS Kesehatan Fachmi Idris denied the financial condition as the cause of the cessation of cooperation with a number of hospitals. “The information is not correct. That is not the problem,” he said in Jakarta, Monday (1/7).
According to him, payments by BPJS Kesehatan continued to run until this moment in accordance with applicable regulations. If there are unpaid health facilities, hospitals can use a supply chain financing scheme from third parties, such as banks that work with BPJS Kesehatan.
According to him, the contract termination was done because those hospitals did not meet the requirements in Presidential Regulation No. 82/2018 on Health Insurance. There is credentialing requirement that must be fulfilled to ensure the hospitals can provide good health services for JKN participants.
An accreditation certificate is not enough to fulfil the credentialing requirement. Hospitals must also have an operational permit, hospital class assignment letter, and Practice Permit (SIP) for their health workers. There are also Tax Number (NPWP) for corporation, network cooperation agreement, and a statement of willingness to comply with the provisions related to JKN.
The requirements should have been implemented since 2014 for all cooperation contracts between BPJS Kesehatan and hospitals. However, the government gave a deadline until 1 January 2019 as many hospitals were not ready at the time. Apparently, not all hospitals are complying. The number of hospitals in collaboration with BPJS Kesehatan reached 2,217 hospitals until the end of last year, but only 67.5 percent or 1,497 hospitals were accredited.
According to the Minister of Health Nila Djuwita Faried Anfasa Moeloek, the government had warned the hospitals to take care of the requirements five years ago. “This is one of the requirements for credentialing from BPJS Kesehatan. It is nothing new, but we have reminded the regional governments,” Nila said in Jakarta (1/9).
The government and BPJS Kesehatan implemented strict policy to terminate the contracts of hospitals that did not meet the requirements. The problem is that this strict policy actually has an adverse effect. There were many complaints from people who cannot get health services. They experienced treatment refusal from hospitals that were no longer partnering with BPJS Kesehatan. Time, distance, and other limitations make it difficult for BPJS Kesehatan participants to find other hospitals that can treat them, even though the healthcare agency has only terminated its contracts with 92 hospitals out of 720 troubled hospitals.
According to the BPJS Watch Advocacy Head Timboel Siregar, more than 1 million JKN participants may not get a maximum health services from BPJS Kesehatan. This is a result of the strict policy in fixing the cooperation contracts with health facilities, such as hospitals.
From the 92 hospital contracts, about 65 of them were terminated by BPJS Kesehatan because of failing to get accreditation. Timboel assumes one hospital has 50 treatment rooms, so that the total rooms in the 65 hospitals are 3,250 rooms. If one room are used by three people, it is likely that there will be 9,750 BPJS Kesehatan participants affected.
Assuming the treatment period for one person is three days and 80 percent of the rooms are occupied by patients, then 949 thousand people will be affected by this strict policy within one year. “Based on my rough calculations, one million patients can be affected in one year,” he said, as quoted by BBC News Indonesia, Monday (1/7). The figure does not include hospitals that have not fulfilled other requirements for credentialing apart from the accreditation.
As a result of this problem, the House of Representatives (DPR) Commission IX summoned the Minister of Health and BPJS Kesehatan for a hearing (RDP) on Wednesday (1/9). DPR Commission IX Chairman Dede Yusuf said the health commission basically supports the improvement of service quality through accreditation. However, he demanded its process to be carried out quickly so that the impact on BPJS Health services is not protracted.
Public concerns finally receded. BPJS Kesehatan and the Ministry of Health have agreed to extend their cooperation with hospitals that have not met the credentialing requirement, especially accreditation. Thus, those hospitals can still provide services for JKN-KIS participants.
However, the agreement requires hospitals that have not obtained accreditation to make improvements related to credentialing before June 2019. It is not an easy process and requires a large cost. Hospitals must spend Rp 80 million to get an accreditation certificate.
“We hope those hospitals can take advantage of the tolerance given by the government to immediately complete their accreditation,” Fachmi said.
With the easing of time, Fachmi asked the public not to worry anymore about the health services from BPJS Kesehatan in hospitals. He assured that JKN patients could still come to hospitals and get health services as usual.