TEMPO.CO, Jakarta - The rumor that the Social Security Agency (BPJS) will no longer cover eight catastrophic illnesses spread very fast. The issue arose during discussions about the agency’s finances with the House of Representatives’ (DPR) health commission two weeks ago. The BPJS reportedly incurred Rp7 trillion in losses and was poised to revoke coverage for the series of high-cost illnesses.
BPJS Chief Fachmi Idris dismissed the speculation, saying the government had never reviewed, let alone canceled, coverage for those diseases. "They are still covered 100 percent," he countered.
Fachmi, 49, has long been involved in the social health sector. The Palembang-born doctor sat on the board of commissioners in 2008 when the BPJS was still Askes (Asuransi Kesehatan = Health Insurance). He guaranteed that services to the public will not be interrupted amid the financial crisis. "Be rest assured that BPJS Healthcare is still on the right track," he insisted.
Last Wednesday, this former chair of the Indonesian medical association met with Tempo reporters Nur Alfiyah and Raymundus Rikang at the BPJS Healthcare headquarters in Cempaka Putih, Jakarta. In the interview, Fachmi denied accusations that the board members’ huge paychecks were one of the culprits behind the agency’s financial deficit. He mentioned a number of strategies to overcome the shortfall, from the stringent control of bill payments to hospitals using cigarette tax to fund health programs.
Is it true that the BPJS will no longer cover chronic illnesses?
That’s a hoax. We still pay 100 percent for the treatment of that eight catastrophic illness: heart disease, kidney failure, cancer, leukemia, thalassemia, cirrhosis, hepatitis, and hemophilia.
Who decides what illnesses are covered by the government?
The health ministry invites all stakeholders to make a review, and the decision from this forum is forwarded to the President. The benefit packages are then stipulated in the presidential regulation. The issue that coverage of the eight diseases was revoked was far-fetched, as the government had never even discussed it. In this era of information explosion, people tend to read only the title but not the rest of the story.
Where did the issue originate?
From the parliament meeting in November. The members of the DPR commission on health inquired about the funding for these illnesses. I informed them that the catastrophic illnesses consumed around Rp20 trillion, or 20 percent of BPJS’s total hospital payments. I don’t know how the information developed and went viral on social media, causing a public uproar.
Why is the cost so high?
Treatments for catastrophic illnesses are usually sophisticated and expensive. For example, installing a coronary stent costs Rp82 million, while an open-heart surgery costs Rp175 million. Medical interventions for these diseases need a lot of resources and the patient numbers (for these treatments) are increasing as the aging population grows. There is also the factor of euphoria surrounding the BPJS program.
What kind of euphoria?
Many patients have long suffered these diseases but never sought treatment because of the high costs. When the BPJS became available, patients came in droves to take advantage. It was like opening a floodgate. But, stay rest assured, we are still on the right track.
How will the BPJS overcome these high costs?
Interventions. At the primary level, we have prevention and health screening and detection of potential type II diabetes, dubbed the mother of diseases. Then at the secondary level, we have a referral program where we get the puskesmas (community health centers) to monitor patients suffering from these diseases to keep their condition stable. With regards to financing, we are seeking references to health insurance systems offered in other countries for chronic diseases.
What can we learn from other countries?
Japan, South Korea, Italy, Germany and France have a cost-sharing system for catastrophic diseases. In the Philippines they have a system that imposes limits on patients, based on cost, age and medical characteristics-much like a commercial insurance system.
Read the full interview in this week's edition of Tempo English Magazine.
