Changes in the name and status of PT Askes Indonesia to become the Social Health Insurance Administration Body or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan in early 2014 initiated the presence of health insurance for all Indonesians. The presence of this institution received a positive response from the entire community. Citizens who used to be afraid when they went to health services, including hospitals, immediately changed. Feelings of anxiety because they did not have money or funds immediately disappeared after the presence of the BPJS Health Card in every citizen’s wallet.
Unfortunately, until now the implementation of the National Health Insurance (JKN) has been impressed only as fulfilling the requirements stipulated by the 1945 Constitution and has not fully provided quality and proper health services to all Indonesian people. Although in number, BPJS Kesehatan participants have jumped significantly.
As of July 2017, the number of BPJS Kesehatan participants has reached 179 million people. With this number of participants, the target to be able to reach the number of participants in the health program as many as all Indonesians by 2019 is very likely to be realized. What should be appreciated next is the high level of satisfaction of BPJS Kesehatan participants. Based on the survey results regarding the satisfaction level of BPJS participants, 81% of participants are satisfied with the services of BPJS health facilities partners.
However, BPJS still faces challenges from stakeholders. From the health service provider sector, there are still many complaints about the payment system imposed by the BPJS which is considered to make hospitals, especially those that are privately owned, difficult to survive. The culmination of this complaint was the interruption of the cooperation between five private hospitals in Mataram and the BPJS at the end of 2016, due to policies regarding health service rates which were considered burdensome for hospitals.
In addition, the Regent of Gowa at the beginning of 2017 rejected BPJS and challenged the local government’s obligation to participate in the JKN implementation. This is because regional spending on free medical treatment has increased after being integrated with the BPJS, compared to the free medical treatment program run by the district government itself.
Another thing that needs to be considered is the difference in services obtained by BPJS card users and those obtained by regular patients. The results of the Perkumpulan Prakarsa (2017) research show that BPJS patients feel that health workers serving BPJS patients seem to be partial to non-BPJS patients. In fact, in some cases doctors have found the application of quota per day to the number of BPJS patients treated.
The need for a needs assessment
At present, it is clear that there is a competition between the big goals of National Health Insurance and the readiness of BPJS and all parties involved in the provision of the National Health Insurance. The tariff classification of Indonesia Case Base Groups (INA-CBGs) which is applied in the implementation of JKN is still often inviting complaints from hospitals that work with BPJS Kesehatan. This is understandable because the hospitals are also a business actor in the business of providing health services. So that in addition to providing health services to the community, the hospital also cannot deny its status as a business actor who must maintain the continuity of its business.
The prospective application of the INA-CBGs tariff, which demands efficiency from health workers, can indeed avoid overtreatment practices, but also opens room for reducing the quantity and quality of services to patients. This step was taken to obtain a profit margin. This makes us unable to fully blame the hospital in some cases where the hospital prioritizes patients who do not use BPJS Health facilities.
The regionalization system into the five regions that applies in determining the INA-CBGs tariff also creates difficulties in establishing an agreement between BPJS and the association of provincial health facilities (faskes). This is not in line with what is mandated in Article 24 paragraph (1) of the Law on the National Social Security System (SJSN). The difference in tariffs based on the type and area of the hospital will also have an impact on hospital services. In fact, all hospitals, both in remote areas and big cities, should provide the same health services.
At this point, BPJS needs to carry out a needs assessment and gap analysis that focuses on the needs of health services and also the capacity of health facilities in each province. Roger Kaufman (1999) explains that needs assessment is an analysis process that is used to find out the gap between the objectives and the results obtained today and transcribed it into a priority scale.
Based on the results of the needs assessment and gap analysis, BPJS can formulate strategic plans related to programs that can be implemented in the future along with the allocation of resources to get the full support and involvement of all stakeholders. In this case, the central and local governments, various health facilities, and of course all Indonesian people. A strategic plan can be the basis for BPJS Kesehatan and the government in determining policies related to the implementation of national health insurance which should pay more attention to the quality of health facilities that work with BPJS rather than impose an increase in the number of program participants.
This is important, because the establishment of the BPJS is clearly a major step in the history of the Indonesian nation. However, without a strategic planning as well as the full involvement and support of existing stakeholders, BPJS Kesehatan will only cause new problems in the implementation of national health insurance itself. For this reason, BPJS Kesehatan needs to revisit the main objectives of the organization. Is it just providing access to health services, or providing assurance of proper and quality health services for all Indonesian people.
Aldy Anggriawan was Consultant at Kiroyan Partners.
Source: Kontan, November 8, 2017, page 23.