The government plans to reorganize the National Health Insurance (JKN), including the Health Care and Social Security Agency (BPJS Health). President Joko ‘Jokowi’ Widodo mentioned this in front of Parliament members.
“BPJS Health and JKN will be completely improved,” he said in his annual state of the nation address to elaborate the 2020 state budget plan (RAPBN) during the parliamentary plenary session on Friday (8/16) in Jakarta.
Since changing its name from PT Askes, and officially operating on January 1, 2014, BPJS Health has been chronically ill. Many times this public legal entity received intensive care, but instead of getting better, it just gets worse. Its financial condition continues to be in a deficit.
The government often injects funds, but the income earned from fees is always smaller than the claim that must be paid. Thus, BPJS Health is unable to fix its financial performance.
It is now in critical condition. This year’s deficit reached Rp 28 trillion, the largest in the last five years, as shown in the following Databoks chart.
The Finance Ministry was forced to intervene. Finance Minister Sri Mulyani Indrawati raised the JKN budget by 83 percent next year to Rp 48.8 trillion compared to this year.
She admitted the budget increase is very significant. It is intended to anticipate the rising fees of BPJS Health, especially those borne by the government.
The plan to raise fees seems to be in sight. The government is preparing a presidential regulation (Perpres), and all tuition classes will increase, including self-paid participants.
The reduction of BPJS Health deficit is the main objective of the increase in fees. “This is being discussed and will be determined,” Sri Mulyani said last week.
Improvements in various policies will also be part of the efforts to reduce the deficit. BPJS Health is expected to improve participant database management, service system, synergy among social security providers, and operational cost control.
Increase in BPJS Fees
So far, BPJS Health fees had only risen once on April 1, 2016. It was regulated in Presidential Regulation No. 19/2016 on Health Insurance.
It rose to Rp 30,000 from Rp 25,500 for the lowest class or Class III, Rp 51,000 from Rp 42,500 for Class II, and Rp 80,000 from Rp 59,500 for Class I.
The fees were supposedly reviewed or adjusted at least once every two years as regulated in Presidential Regulation No. 111/2013 on Health Insurance and the amended Presidential Regulation No. 82/2013.
However, there were no changes in fees in 2018, even though the hospital service costs incurred by the company had reached Rp 41,240 per person in the previous year. Meanwhile, the average charge per person was only Rp 34,766. It means BPJS Health had to pay Rp 6,474 per person at that time.
As quoted by Antara, BPJS Health President Director Fachmi Idris said the company does want to see a membership fee adjustment. From the results of actuarial calculations and the recommendation of the National Social Security Board (DJSN), this year’s fee increase should reach Rp 16,500-Rp 40,000.
Regarding the amount, Fachmi claimed he did not interfere. BPJS Health only provided data about the amount of expenditure they need. “DJSN is the one that proposes. But are we involved? Of course not,” he said last Thursday.
Another factor is that independent participants are mostly in arrears. There were also many incidents of participants registering after being admitted to hospitals. BPJS Health must bear the participants' health care costs, even though they paid the fees only once.
Expenditure-wise, there were also problems with the amount of the bill. The Development Finance Comptroller (BPKP) found this discrepancy during the 2018 BPJS Health audit.