Medical Journal of Indonesia Vol. 31 No. 2 2022 FKUI
Commentary Current Condition of Social Security Administrator for Health (BPJS Kesehatan) in Indonesia: Contextual Factors that Affected the National Health Insurance
Dublin Core
Title
Medical Journal of Indonesia Vol. 31 No. 2 2022 FKUI
Commentary Current Condition of Social Security Administrator for Health (BPJS Kesehatan) in Indonesia: Contextual Factors that Affected the National Health Insurance
Commentary Current Condition of Social Security Administrator for Health (BPJS Kesehatan) in Indonesia: Contextual Factors that Affected the National Health Insurance
Subject
The pandemic,The new focus
Description
The pandemic
In early 2020, the historical 6-year financial
deficit faced by Indonesia’s universal health
coverage (Jaminan Kesehatan Nasional [JKN]) ended
when the government adjusted JKN contribution to
its healthcare spending.1
On average, the amount of
contribution was raised by 83%. This also marked the
end of the ‘structural deficit’ caused by purposively
setting JKN contribution lower than the actuarial
requirement to match the population’s ability to
pay.2
In the same period, countries are affected by the
coronavirus disease 2019 (COVID-19) pandemic, and
Indonesia is not an exception. The rapid spread of
the disease has also changed people’s health-seeking
behavior. Unless considered an emergency, patients
forego treatment and avoid visiting health facilities
to prevent infection.3
The non-COVID-19 utilization
rate dropped by almost 25% during the pandemic.4
Active JKN members (marked by the number of paying
members) also dropped due to economic recession
and contribution evasion.5
On the other hand, COVID-19 healthcare utilization
skyrocketed. COVID-related hospital claims reached
IDR 40 trillion (approximately USD 2.7 billion) in 2020
and doubled to IDR 90 trillion (approximately USD 6.2
billion) in 2021.6
However, this spending is excluded
from JKN as the law mandated that pandemic-related
health spending is covered by the government.7
The overall impact of JKN contribution adjustment
and low healthcare utilization has resulted in a
financial surplus of the JKN fund.8
The national
health insurance administrator (Badan Penyelenggara
Jaminan Sosial [BPJS] Kesehatan) management still
needs to anticipate the period when the government
announced that the COVID-19 pandemic has ended
since that is the start of the COVID-19 financing under
the JKN scheme.9
The new focus
Given the positive financial status of the JKN
fund, the BPJS Kesehatan’s board of directors shifted
their focus from ensuring financial sustainability to
improving the service quality.10 Both healthcare and
administrative services must be efficient, standardized,
and integrated using information technology. An
online queueing system was introduced to inform
patients of the estimated arrival time at health facilities
to shorten the waiting period.11 Teleconsultation was
also piloted to test its impact on healthcare access,
especially in remote areas or areas without certified
health facilities.12
Furthermore, innovative payment systems were
linked to achievements in performance indicators. At
the primary care level, the current performance-based
capitation system, which has been introduced in 2017,
will be subject to reform.13 New indicators will be added
in line with government health priorities. There is also
a plan to introduce incentives and disincentives to the
JKN payment system to encourage health facilities to
improve their performance.
Government policies that impacted JKN
At the end of 2021, the Ministry of Social Affairs
audited its 86.4 million JKN subsidy recipient database
to check for data quality. As many as 9 million were
removed from the list for various reasons.14 Efforts
were focused on replacing the list, but this requires
massive resources to conduct a census at the village
level. This sudden drop in JKN membership affected
the contribution paid by the government to the JKN
fund and automatically impacted the BPJS Kesehatan's
operational costs.
An important milestone of JKN in 2022 is the
issuance of the Presidential Instruction orchestrated
by the Coordinating Ministry for Human Development
and Cultural Affairs.
In early 2020, the historical 6-year financial
deficit faced by Indonesia’s universal health
coverage (Jaminan Kesehatan Nasional [JKN]) ended
when the government adjusted JKN contribution to
its healthcare spending.1
On average, the amount of
contribution was raised by 83%. This also marked the
end of the ‘structural deficit’ caused by purposively
setting JKN contribution lower than the actuarial
requirement to match the population’s ability to
pay.2
In the same period, countries are affected by the
coronavirus disease 2019 (COVID-19) pandemic, and
Indonesia is not an exception. The rapid spread of
the disease has also changed people’s health-seeking
behavior. Unless considered an emergency, patients
forego treatment and avoid visiting health facilities
to prevent infection.3
The non-COVID-19 utilization
rate dropped by almost 25% during the pandemic.4
Active JKN members (marked by the number of paying
members) also dropped due to economic recession
and contribution evasion.5
On the other hand, COVID-19 healthcare utilization
skyrocketed. COVID-related hospital claims reached
IDR 40 trillion (approximately USD 2.7 billion) in 2020
and doubled to IDR 90 trillion (approximately USD 6.2
billion) in 2021.6
However, this spending is excluded
from JKN as the law mandated that pandemic-related
health spending is covered by the government.7
The overall impact of JKN contribution adjustment
and low healthcare utilization has resulted in a
financial surplus of the JKN fund.8
The national
health insurance administrator (Badan Penyelenggara
Jaminan Sosial [BPJS] Kesehatan) management still
needs to anticipate the period when the government
announced that the COVID-19 pandemic has ended
since that is the start of the COVID-19 financing under
the JKN scheme.9
The new focus
Given the positive financial status of the JKN
fund, the BPJS Kesehatan’s board of directors shifted
their focus from ensuring financial sustainability to
improving the service quality.10 Both healthcare and
administrative services must be efficient, standardized,
and integrated using information technology. An
online queueing system was introduced to inform
patients of the estimated arrival time at health facilities
to shorten the waiting period.11 Teleconsultation was
also piloted to test its impact on healthcare access,
especially in remote areas or areas without certified
health facilities.12
Furthermore, innovative payment systems were
linked to achievements in performance indicators. At
the primary care level, the current performance-based
capitation system, which has been introduced in 2017,
will be subject to reform.13 New indicators will be added
in line with government health priorities. There is also
a plan to introduce incentives and disincentives to the
JKN payment system to encourage health facilities to
improve their performance.
Government policies that impacted JKN
At the end of 2021, the Ministry of Social Affairs
audited its 86.4 million JKN subsidy recipient database
to check for data quality. As many as 9 million were
removed from the list for various reasons.14 Efforts
were focused on replacing the list, but this requires
massive resources to conduct a census at the village
level. This sudden drop in JKN membership affected
the contribution paid by the government to the JKN
fund and automatically impacted the BPJS Kesehatan's
operational costs.
An important milestone of JKN in 2022 is the
issuance of the Presidential Instruction orchestrated
by the Coordinating Ministry for Human Development
and Cultural Affairs.
Creator
Ali Ghufron Mukti, Citra Jaya, Rizki Lestari Suhardi
Date
2022;31(2)
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Ali Ghufron Mukti, Citra Jaya, Rizki Lestari Suhardi, “Medical Journal of Indonesia Vol. 31 No. 2 2022 FKUI
Commentary Current Condition of Social Security Administrator for Health (BPJS Kesehatan) in Indonesia: Contextual Factors that Affected the National Health Insurance,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1050.
Commentary Current Condition of Social Security Administrator for Health (BPJS Kesehatan) in Indonesia: Contextual Factors that Affected the National Health Insurance,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1050.