Health Insurance Scheme Amasses Rp 1.93t Deficit in First Year
Jakarta. A year after its launch on Jan. 1, 2014, the Social Security Organizing Body (BPJS), which provides health care and insurance schemes for Indonesians, has posted a Rp 1.93 trillion ($148.22 million) deficit as claims exceeded premium income.
The health insurance agency generated Rp 40.72 trillion in premium revenue last year from its customers, which include employers, employees, workers of the informal sector and government officials.
Meanwhile, claims from customers — which include spending on curative health care, and rehabilitative in-patient care, preventive services like shots and screening tests — stood at Rp 42.65 trillion.
Of this figure, Rp 8.34 trillion was paid to 18,437 community health clinics, known as Puskesmas and Rp 34.31 trillion was paid to 1,681 hospitals.
The mismatch between claims and premium revenue means the government has to step in.
“We expect the deficit can be plugged with a government [cash] injection,” said Fahmi Idris, chief executive for the BPJS’s unversal health care branch known as BPJS Kesehatan.
This year, the agency expects to receive up to Rp 5 trillion in funds from the government, of which Rp 3.46 trillion is expected to be disbursed sometime in the first half of this year, while the remainder will be allocated at the end of 2015.
Through the BPJS, the government subsidizes health premiums for all Indonesians, including citizens working in the informal sector.
The government is still working to get as many health institutions as possible to participate in the program.
The agency had already estimated a potential deficit of up to Rp 1 trillion for the first quarter of 2015, said Riduan, its finance and investment director. Claims from January to March are expected to reach Rp 13 trillion, while the agency receives an average of Rp 4 trillion from premium income per month, he added.
This means premium revenue for the first three months stood at Rp 12 trillion, yielding to a shortfall of Rp 1 trillion.
In addition to seeking financial support from the government, the agency is working to make improvements in its operation that would allow it to generate more revenue and optimize claims.
Its efforts include revising the activation date of insurance cards and raising the amount of premiums.
Starting June this year, new participants will only be able to use the health insurance card two weeks after they register — only slightly longer than the current seven days.
This is done to avoid “free riders” — people who only register when they are sick, or know they would need to pay for health care services in the immediate future.
With regard to the premium, Riduan said the health agency is still reviewing the current figure, although he signaled the possibility of an increase.
The current premium for clients of BPJS Kesehatan’s health insurance schemes ranges from Rp 25,500 to Rp 59,500 per month, per person.
“The increase plan will start in 2016, not this year,” Riduan said.
He added that the agency still has Rp 400 billion in unpaid premium bills from regional governments who registered their officials last year.
These local administrations first need approval from their legislators to settle budget spending, delaying their premium payments.
Also, more than 2 million registrants from the workers category have yet to pay their premiums.
Riduan said BPJS Kesehatan also plans to cooperate with state lenders to help participants in making their payments, including Bank Rakyat Indonesia, Bank Mandiri and Bank Negara Indonesia.
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