TEMPO.CO, Jakarta - Juniarti`s bad luck is evidence of poor health care in Indonesia. The HER2 breast cancer patient is suing the managing director of the Healthcare and Social Security Agency (BPJS Kesehatan), the health minister and President Joko Widodo. She feels she has been wronged by the government because the trastuzumab breast cancer medicine prescribed by her doctor is no longer supplied by the BPJS. As a result, her treatment is not working, and she is nearing the end of her life.
The BPJS decision was based on Document No. 2004/III.2/2018 on the Guarantee of Trastuzumab for BPJS Participants-2018 Indonesian Health Card Holders. This document, signed by the BPJS director, refers to the opinion of the Clinical Advisory Council that there was no clinical basis for giving trastuzumab to breast cancer patients. Other reasons given were that the medicine is seen as ineffective in prolonging the lives of patients with advanced breast cancer, it has serious side-effects, and is very expensive. The medicine, which costs Rp24.8 million per vial, contains antibodies that are effective in stopping the breaking of HER2 cancer cells.
Juniarti believes that the BPJS acted hastily because it withdrew the treatment which is a move outside the authority of the body. According to Minister of Health Decree No. HK.01.07/Menkes/659/2017, including or removing medicines from the list covered by the BPJS is a ministerial decision.
It is easy to guess that the decision to remove trastuzumab from the list of medicines covered by the BPJS was because of funding issues. As of last year, the agency suffered a deficit of Rp10 trillion. Finance Minister Sri Mulyani has repeatedly reminded the BPJS to save costs and increase revenues. The removal of trastuzumab is not the only savings the agency has made. For example, it has limited the number of cataract operations, reduced the frequency of physiotherapy to a maximum of eight sessions per month per patient and cut back on the coverage of new-born infants classified as healthy.
The BPJS argues that the new rule is a follow-up of a ministerial meeting results at the start of the year mandating the BPJS to focus on the quality of services and effectiveness of spending. This means being in line with the agency’s financial resources.
Instead of reducing health services, the BPJS should be addressing its financial deficit, meaning increasing its income, by adding to the number of participants from the private sector. It is this relatively wealthy group that will become the financial backbone of the BPJS through the principle of cross-subsidies. As of July 2018, private sector BPJS participants comprised 28.5 million of the total 199 million. This is far less than the Central Statistics Agency (BPS) number of 121 million private sector employees aged 15 and above. Other solutions could be to increase premiums or increase the size of the cash injection from the government.
No less important is clarity from the government on the nature of the healthcare security program: is it a state facility aimed at providing universal healthcare, or will it become a general health insurance scheme? If it is to be a state facility, the government must cover the costs of the BPJS without exception.
