Hike in premiums for Indonesia's public health insurance a worry for the poor, but experts say this is necessary
JAKARTA: It was almost noon, and Mdm Fadilah Ardiana has been waiting for several hours for her third-trimester checkup at a Jakarta public health centre.
The 24-year-old housewife has been relying on the national healthcare insurance known as JKN for health screenings throughout her pregnancy.
She does not need to fork out extra money for her visits, although long queues are to be expected at the health centre.
“We don’t mind waiting,” said Mdm Ardiana, who was accompanied by her husband Mr Noval Ferdianysah, 28.
Rolled out in 2014, the JKN is one of the world’s largest healthcare system by the number of subscribers, with more than 200 million people.
It is compulsory for all Indonesians, even though they might already have private medical insurance. The same applies to foreigners working in Indonesia.
Following a first adjustment in 2016, the premium for the first tier is 80,000 rupiah (US$5.70) a month, second tier 51,000 rupiah and third tier 25,500 rupiah. The tier decides the ward class if a patient is hospitalised.
On Oct 24, the government announced that the JKN premium would be increased up to 100 per cent to make up for its billion-dollar deficit.
Effective January next year, the new premium will be 160,000 rupiah, 110,000 rupiah and 42,000 rupiah respectively.
The hike worried Mr Ferdiansyah, who subscribes to the third tier coverage. “I am against it because for ordinary people like me, it is a burden,” he said.
A rider for an e-hailing app, his monthly income is unstable. He earns between 3 million rupiah and 7 million rupiah depends on the amount of rides he makes, and has to set aside 2 million rupiah for housing rent.
Stories similar to that of Mr Ferdiansyah and Mdm Ardiana are common in Indonesia, where many live off less than US$10 a day.
However, experts said a premium hike is long overdue in order for the scheme to function effectively.
MIXED REACTION TO PREMIUM HIKE
Administered by the Social Security Administrator for Health (BPJS), the national insurance scheme's objective is to make healthcare accessible to Indonesian citizens.
Under the scheme, the hardcore poor are exempted from paying the premium.
However, it has raked up a huge debt since its inception, owing hospitals 21.16 trillion rupiah as its medical claims far exceed the premium it collects.
The presidential regulation on the premium hike was inked by President Joko Widodo, which angered some Indonesians. Hashtags such as #boikotBPJS (boycott BPJS) were trending on Twitter last week.
Mdm Fika, who was seeking treatment at a public health centre in South Jakarta, is among those who disagreed with the raise.
The 31-year-old said she was disappointed with the scheme because she was once ordered to pay a fine of 500,000 rupiah for late premium payment.
She ignored the fine and intends to disregard the premium hike as well.
“I have stopped paying,” she told CNA.
On the other hand, there are JKN subscribers who felt that the premium increase is acceptable as long as the medical services are improved.
Mdm Penny Handayani, a 37-year-old lecturer told CNA she hoped the referral process would be simplified, with more hospitals taking part in the insurance programme.
The mother of two said she was generally satisfied with the scheme when she used it during both of her pregnancies.
“With JKN, we have to go to a local public health centre first for checkup and referral, before we can visit a hospital that partners with BPJS.
“All you need to do is manage your expectations. When it comes to using the scheme, comfort is not a priority,” she said.
Mdm Handayani said she does not agree with people who want to boycott the system.
“JKN still has to exist. If not, private insurance will reign and poor people cannot afford to get sick,” she said.
Mdm Dita Kurniawan, 35, is also in favour of a premium hike because she has witnessed firsthand the consequences of late disbursal of BPJS fund.
She said when her late daughter was hospitalised for brain tumour, the hospital was not equipped with the necessary medical devices because the BPJS fund had not been disbursed.
“I had to run out in the middle of the night to find medicine and feeding tubes at pharmacies.
“Even for a brain MRI scan, my daughter had to be transported to another hospital in an ambulance,” she said.
Mdm Kurniawan also claimed that her brother-in-law, an anesthesiologist working at a public hospital, was not paid for three months because the hospital had not received the BPJS money.
PREMIUM HIKE NECESSARY: EXPERTS
Judging by the huge deficit, watchdog BPJS Watch’s advocacy coordinator Mr Timboel Siregar said the JKN premium hike is necessary.
Furthermore, there are regulations stating that the premium has to be reviewed every two years.
However, he cautioned that the increase will make JKN unaffordable for the poor, especially those who are currently subscribing to the third tier.
“The premium increase might force many subscribers to become inactive or to downgrade to a lower class,” Mr Siregar told CNA.
“This may actually cause income to fall for JKN.”
Instead of doubling the premium, Mr Siregar proposed to the government to increase the premium by about 10 per cent.
Mr Hasbullah Thabrany, a health expert from the University of Indonesia, said what BPJS should do is to target the rich Indonesians who might be willing to spend more on the programme.
The scheme currently acts as a cross-subsidy programme, where people from the upper economic class pay a monthly premium but tend to use their private insurance when they need medical service.
The premium for the top tier of JKN should be increased, Mr Thabrany suggested.
“It will work when every Indonesian feel obliged to make it successful.”
BPJS PROMISES BETTER SERVICES
Low cost and better healthcare facilities in neighbouring countries have attracted some Indonesians to go abroad for medical treatment.
One of them, who only wanted to be known as Mr Ivan, chose to visit Malaysia when his son was sick.
He said quality service aside, the cost is also generally 20 per cent lower than Jakarta.
“People should view the healthcare scheme as a risk transfer when they are sick. Unfortunately, the facilities here are sad and troublesome.
“That's why people are reluctant to use it, and when the premium increases, people get angry,” he said.
Although the premium increase will not immediately solve BPJS’s financial woes, the agency assured subscribers that services will be improved.
“We will manage the queues, ensure that the doctors work according to medical service standards and that there are adequate medicine,” BPJS Health head of public relation Mr M. Iqbal Anas Ma’ruf told CNA.