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No More Deficit
Director of Healthcare and Social Security Agency (BPJS Kesehatan) Fahmi Idris. Tempo/ Fakhri Hermansyah
Friday, 08 December, 2017 | 06:36 WIB
No More Deficit

TEMPO.CO, Jakarta - The Healthcare and Social Security Agency`s (BPJS Kesehatan) Rp9 trillion financial deficit this year shows that it is not being properly managed. If there are no changes to the paradigm of the government or the House of Representatives (DPR), this new social security system may face bankruptcy.

Since the nationwide social security system was passed into law, there has been a misconception about it. Many officials and politicians speak of it as if it were a generous facility from the state. There is the impression that the BPJS Kesehatan must cover all the costs of medicine and treatment for every Indonesian, without exception.

That is, of course, a misperception. The government should make people realize that the social security system is basically an insurance scheme. As well as having the right to have costs covered, citizens have an obligation to pay sensible premiums. If not, the income of the BPJS Kesehatan will never be enough to pay for all the costs of the medical staff, medicine and hospital treatment of all its participants.

Therefore, the latest arguments over cost-sharing schemes in which eight serious conditions-heart disease, kidney failure, cancer, stroke, thalassemia, leukemia, cirrhosis hepatitis and hemophilia-is paid together by BPJS and the patient themselves, should not have happened. If the DPR and the Ministry of Health understand the essence of a social security system, a cost-sharing approach is the logical solution to the financial problems of BPJS Kesehatan.

Currently, the costs of treatment for patients with those eight conditions account for 20 percent of BPJS spending, which in total amounts to almost Rp70 trillion. Most of the patients with these health issues live in urban areas, where incomes are higher than for those living in rural areas. In many nations, social security only covers basic healthcare. Therefore, the cost-sharing scheme, or subsidies for these eight conditions, is financially far more logical.

Moreover, fundamental reforms must be made to BPJS Kesehatan’s management. Every component of the national social security system needs to be recalculated accurately. The number of health facilities needs to be increased drastically so there are no more complaints from BPJS participants about long waiting times for treatment. There are currently only approximately 2,000 participating hospitals, which is nowhere near enough for the almost 172 million BPJS participants. And the charges for doctors and medical facilities in hospitals also need to be reexamined so they are proportionate.

Meanwhile, attention needs to be paid to the private companies and regional governors to ensure they are paying employees’ BPJS contributions. Thousands of private companies have yet to join the scheme even though their staff are receiving the benefits. Many regional governments also owe tens of billions of rupiah in contributions even though millions of people in their areas are BPJS participants.

If reforms take place too slowly, the BPJS Kesehatan deficit will worsen. The social security system will become a burden on state spending.

Read the full article in this week's edition of Tempo English Magazine


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