Bali at loss on health integration

The provincial administration has been working hard to properly integrate its Bali Mandara healthcare program (JKBM) into the national health insurance (JKN), which should start early next year.

Ketut Suarjaya, head of Bali Health Agency, said the provincial government was still calculating the allocation for premium subsidies.

Under the JKBM scheme, the provincial government pays Rp 8,500 (72 US cents) per person per month for eligible residents with Bali ID cards. Meanwhile, under JKN, which is managed by the Social Security Management Agency (BPJS), the premium for registered members is set at Rp 23,000 per month. "We have not decided how to integrate JKBM and JKN and what kind of schemes we would like to apply next year, in 2015," Suarjaya said.

JKBM, Suarjaya said, remained valid for residents of Bali who did not possess other health insurance.

A serious consideration and hurdle for the administration is the budget allocation.

The provincial government has allocated Rp 280.6 billion to cover insurance premiums for around 2.75 million people eligible for JKBM in 2013.

"When JKBM and JKN are integrated, we will have to pay more, at least Rp 760 billion per year," said Suarjaya.

Another challenge for the merger of JKN and JKBM is limited hospital space for patients treated in third-class rooms.

"Once we integrate with JKN, we have to provide healthcare services to all Indonesian citizens," he said.

At the same time, the majority of Balinese residents still prefer to use their JKBM facilities.

Previously, the Denpasar Indonesian Doctors Association (IDI) had said JKN would improve healthcare facilities for residents as it could reduce medicine costs. JKN would also shift the present paradigm of healthcare providers.

I Nyoman Mangku Karmaya, professor of medicine at Udayana University and former IDI member, said healthcare services in Indonesia were very confusing, and there was uneven distribution of general practitioners and specialists across Indonesia.

Under the JKN scheme, healthcare services at community health centers (puskesmas) are set at Rp 3,000 to Rp 6,000 per person and Rp 100,000 for in patients. Clinics and hospitals are required to pay the extra medical costs.

Patients can make use of JKN services for every class of health care, depending on the monthly premium paid.

Civil servants and members of the Indonesian Army and Police are required to pay premiums at 2 percent of their salaries, while the government will provide a 3 percent subsidy.

Employees in the private sector have only to pay 1 percent of their salaries, while their employers will pay the remaining 4 percent for the JKN premium.

The JKN system is valid for healthcare services at community health centers, state and regional hospitals, private hospitals, clinics and registered doctors.

source: www.thejakartapost.com