The government is redefining primary healthcare needs and the standards of service at hospitals eligible for the National Health Insurance (JKN) to ensure the deficit-stricken program’s sustainability.
Health Minister Terawan Agus Putranto said the ministry was working on finishing a benefits package for policyholders that was based on primary health needs, as mandated by a 2004 law on the national social security system (SJSN), and was expecting to realize it by the end of June.
Terawan said the new benefits package would contain a list of what the JKN could and could not cover, as well as what it could cover with restrictions.
The ministry will further discuss the package with the Healthcare and Social Security Agency (BPJS Kesehatan), which manages the JKN, to take into account the social security fund managed by the agency and to avoid “aggravating” its deficit further.
As deficits continue to batter the agency, totaling Rp 13 trillion (US$920 million) last year alone, the government issued in early May a presidential regulation to almost double JKN premiums roughly two months after the Supreme Court annulled an earlier regulation on similar premium increases.
BPJS Kesehatan president director Fahmi Idris said that with the premium hikes, the agency would still see a deficit of Rp 185 million by the end of 2020 — but this was better than the Rp 3.9 trillion deficit projected if it maintained the old premiums.
Achmad Choesni, the head of the National Social Security Council (DJSN) overseeing the BPJS, said the council was still mulling over the criteria for JKN hospitalization classes, which was expected to be gradually implemented starting at the end of this year before coming into full force by 2022.
It remained to be seen whether there would be only one service class for all policyholders or two, such as by separating the recipients of contribution assistance (PBI) — low-income patients whose premiums are fully paid by the state — from non-PBI participants.
Currently, there are three types of JKN plans, with the third-class service also covering a large number of PBI recipients.
If the prevailing third-class JKN service was to be used as the baseline for the new categorization, then the number of hospital beds for the third-class service should also be increased to accommodate 270 million Indonesians, said National Mandate Party (PAN) lawmaker Saleh Daulay.
JKN now covers some 220 million participants, but the government is aiming for all its citizens to join the program to help close the gap between claims and benefits.
The Health Ministry’s director-general for health services, Bambang Wibowo, said his office had requested that hospitals add third-class beds even before the pandemic struck to anticipate policyholders downgrading their insurance plans following the previous premium hikes.
(source news :https://www.thejakartapost.com/news/2020/06/14)
Indonesian Government Policy
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