Every Indonesian citizen is required to have national healthcare insurance (JKN) by the beginning of 2019. This insurance is operated by an authorized body, the Healthcare and Social Security Agency (BPJS Kesehatan). According to BPJS, by October 2018, 203 million people or about 80% of the population had signed up.
However, as reported by The Jakarta Post, the BPJS Kesehatan faced a deficit of almost $737.9 million in September 2018. This deficit is caused by many problems. However, one of them is due to the participants themselves.
It is important to note that many Indonesians do not really understand how insurance works. They only pay their premiums when they are in need of healthcare. As a general practitioner, I found many patients who had a National Health Indonesia Card (KIS) but had not paid the premiums for a long time.
It is only after they are sick and need high cost healthcare like an operation that they would pay the premium in hopes that they could get the benefit right away.
BPJS has created many regulations to minimize this issue, such as fining those who are late to pay and only enable access two weeks after the latest payment is made. However, this leads to patients and their families complaining to the health workers when they are denied access.
Second, most of them don’t pay attention to the BPJS regulations. All they know is that every healthcare facility is free as long as they have KIS.
In reality, there are many terms and conditions that apply in order to get access to a free facility. In addition, in order to prevent further deficits, BPJS changes its regulations regularly. Recently, for example, BPJS published three new regulations, the coverage of healthy newborn babies, cataract operations, and physical rehabilitation.
Unfortunately, citizens seem unaware of these new regulations, especially those who live in a district area. Eventually, health workers have to explain these new regulations and, as expected, the public will complain because of their lack of access to a free facility.
Finally, the participants tend to misuse the insurance. Whenever they get sick, they will immediately go to the doctor. I often met patients who did not have an emergency situation but went to the emergency room to get free medicines for their flu symptoms, low back pain, or chicken pox.
Apparently, they did not know that only emergency situations allow access to an emergency room. As a consequence they had to pay for a non-emergency illness. In many circumstances, they will go back to the doctor not long after they take the first drug just because their fever or stomachache hasn’t been relieved. They don’t know that BPJS only covers one admission per day.
I think we should learn from countries that have similar universal healthcare, such as the UK with its National Health Service (NHS). A friend of mine told me that there wasn’t any premium that the participants had to pay to the NHS. Besides, when the participant gets sick, they have to call first to make appointment before going to the doctor. If the condition isn’t very serious, the staff will ask the patient to get some medicines by themselves.
Most importantly, in order to have a good, reliable healthcare system, the Indonesian government has to educate its citizens first. They also need to place BPJS staff in every district or village to prevent and correct miscommunications or lack of information about this supposedly sustainable universal healthcare system.