Discourse: While on the brink of overclaim, more hospitals join JKN program

Indonesia marked on Jan. 1, 2014 a historical milestone by launching the national health insurance (JKN) program, a platform for universal health care for citizens, targeted to be fully operational by 2019. A single institution called the Healthcare and Social Security Agency (BPJS Kesehatan) has been tasked with managing the JKN. The program is also pivotal because the government fully covers those deemed unable to afford a minimum standard of health care. However, problems like lack of health infrastructure and mounting hospital bills remain. The Jakarta Post's Hans Nicholas Jong talked recently to BPJS Kesehatan president director Fachmi Idris about the agency's first-year performance.

Question: It has been almost a year since the JKN program started. How has the performance of the BPJS Kesehatan been so far?

Answer: We just did research recently to measure the performance of the BPJS and public satisfaction. We surveyed 2,000 people from all provinces.

The government set a target of the public-satisfaction level to be 75 percent now and 85 percent by 2019. But now we already achieved 81 percent in our first year.

The survey measured satisfaction levels in all four service points: our office, our counters in hospitals, the hospitals themselves and primary health facilities, such as community health centers (Puskesmas).

What's the current status of claims from hospitals and pharmaceutical companies?

We don't pay claims to pharmaceutical companies. The ones who pay them are hospitals. The government has stipulated that we have to pay claims at least one month after patients receive medical treatment.

So if a patient gets medical treatment in November, then we have to pay for the claim by December. If not, then we will have a bad rapport. Then, the law on the BPJS also stipulates that we have to pay for claims within 15 days after hospitals submit all necessary documents.

If not, then we will be penalized. Therefore, we always pay all claims asked by hospitals 100 percent. As a matter of fact, we pay claims in an average of 2.8 days, much shorter than the deadline of 15 days.

If there are rumors of the BPJS Kesehatan not paying claims, then it must be debts from last year [that have not been paid by the previous organizations tasked with handling national health insurance]. [As of December], we have paid Rp 32.5 trillion for hospital claims.

In the past, there were some hospitals in Jakarta that did not accept JKN patients because the payment scheme, called the Indonesia Case-Based Groups (INA-CBG) system, had unfavorable rates. Has there been any revision on that?

In terms of rates, there is indeed a variation. The Health Ministry has decided that the payment scheme was divided into four regions — A, B, C and D. The ministry decided on the rates from the National Casemix Center.

After the rates were calculated, it was found that some tariffs indeed had to be increased, while others had to be decreased. Therefore, the ministry adjusted some of the rates in September.

There were 39 diagnoses for which rates had to be revised, such as orthopedics which was increased. While there are some issues with hospitals in Jakarta [that complain about the unfavorable rates], the majority of hospitals in several provinces are happy with the current system.

But if we look at the number of hospitals joining the JKN program, the number has been increasing, with 1,592 government hospitals and 617 private hospitals.

These private hospitals play a big role. So we have to really inform them [about the payment scheme]. This JKN program is a new system, so not all hospitals' management understand it.

Doctors also need to be informed that the payment from the BPJS is not to individual doctors. After that, the hospitals' management have to manage [their finances], and maybe in some places the management is not transparent. Some government hospitals say that they are not losing money [due to the JKN program].

So if there are hospitals that lose money, it is because of the management. Even a private hospital like Siloam does not lose money. If all hospitals are efficient [in their financial management], then there should not be a deficit.

What's your strategy to provide enough doctors to serve all people in Indonesia by 2019?

I have already done the math. Each year we have 6,000 to 10,000 graduates from 72 medical faculties in the country, considering that each faculty only produces 100 graduates. We will have enough additional doctors [by 2019]. We only have to work on the supply [of medical facilities] and that's not only the responsibility of the Health Ministry, but also local governance.

Is the money from premiums, both paid by the government and JKN members themselves, used purely for the provision of medical services or is some of it also invested?

The government stipulates that 90 percent of the funds that we receive have to be used for medical services. If we have more, then we will keep it for next year's medical-service purposes. But if there is still money left, then we could invest it in something liquid, such as deposits, SUN [government bonds], bonds and so on. Any results from the investment will go to the benefit of JKN members. The remaining 10 percent is for technical backup funds and our operational funds, such as to print cards, letters for members who have not paid their premiums and so on. However, it is hard to measure how much we invest because our cash flow is really fast.

What is your strategy on pushing workers from non-formal sectors to apply for the JKN program in 2015?

Actually we already have many workers applying. Our target this year is only 600,000 non-formal workers. The number that has applied is 7 million. It means people have high awareness and this trend will continue. Some of them applied even before they were sick while some of them only applied once they got ill. But we always urge people to apply for the program even before they are sick. 

source: http://www.thejakartapost.com/l