BPJS good or bad?

Since 2014, Indonesians were shocked by the new healthcare system, that is BPJS. The impact was not only affect the society, but also the healthcare provider. Before BPJS came in, many people got uninsured, and if they were sick, most of them just held it until they recovered by themselves or when they couldn’t bear it, they’ll  went to a doctor or hospital. But after BPJS has emerged, the trend changed. So many people, even the poor one, got a health coverage, that is BPJS. It makes people behave differently for their health. Even when they got a little problem with their health, they would visit a doctor. Off course they will do it because they won’t be charged anymore at the primary care. But how’s this trend affect the healthcare provider? In the era before BPJS, the utilization of healthcare fasilities is not so many. The amount of patients is still fair. Then after the BPJS era, boom! Suddenly the healthcare facilities get so crowded. At the primary care level, most of them has limited human resources and facilities. So the primary care provider must give an extra effort to get along with BPJS era. But for the secondary and tertiary care provider, they can get more patients than usual. So, what are the bad and good things from BPJS? Let’s talk about it.

The Government of Indonesia (GOI) issued Law No. 40 of 2004 regarding the implementation of the National Social Security System based on the humanity principle, the benefit principle, and social justice principle for all citizens. Then GOI has established the Social Security Provider (BPJS) to determine the basic needs for living of participant and/ or their families. It is also expected to improve healthcare quality received by the poor and near-poor. After a study carried out, it found out that a leak occurred in BPJS scheme for the poor and near-poor (PBI). But BPJS is still largely enjoyed by poor and near poor. [1]

Another study found that the BPJS program makes the whole community can access health services without any differences in the healthcare quality .  The amountof people that can use healthcare facilities is increasing too. Furthermore, the type of services to BPJS  participants already fit the community needs, especially the basic healthcare services. [2]

But behind the benefit, there still lies many obstacles. Implementation of BPJS led to increased utilization of services in health facilities, especially hospitals. It make the health facilities become limited (compared to the amount of BPJS participant), so some people often can’t enjoy the healthcare facilities though they have an active BPJS card. Another problems is sometimes the BPJS participants can’t get the package benefit as they should be, because of poor management of hospital. The patient should paying extra money for fulfill the health care. One of the basic huge problems is an unequally amount between total revenue that is coming through participant subscription received with total expenditure both for claimed payment (hospital) and capitation (health center) that called mismatch. It should be acknowledge that mismatch is hardly to avoid as caused by subscription structure that set by the government was below from real actuarial accounting. In fact, actuarial accounting has been calculating and set the cut-off point as ideally subscription for BPJS anyway. However, it decided, always, by considering the political and economics policy.[3]

Indeed, Indonesia’s journey towards universal health coverage has been determined largely by political concerns. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC (Universal Health Coverage) became an electoral asset, moving up the political agenda.[4]

Despite the fact that there are many obstacles and lack in the implementation of BPJS program, it still have bigger benefit for Indonesian people, especially for the poor. So i think that BPJS is good. I really hope in the future, the GOI will put extra effort to make the BPJS program running wel for the participants, the healthcare provider, and of course for the country itself.

 

 

Reference:

Asyary, Al. “INDONESIAN PRIMARY CARE THROUGH UNIVERSAL HEALTH COVERAGE SYSTEMS: A FEELING IN BONES” 4, no. 3 (2018): 8.

Pisani, Elizabeth, Maarten Olivier Kok, dan Kharisma Nugroho. “Indonesia’s Road to Universal Health Coverage: A Political Journey.” Health Policy and Planning, 6 September 2016, czw120. https://doi.org/10.1093/heapol/czw120.

Rahman, Fauzie, Nita Pujianti, Vina Yulia Anhar, dan Ayu Riana Sari. “The Implementation of BPJS Health Program At Public Health Center Martapura in Banjar Regency,” t.t., 3.

Rolindrawan, Djoni. “The Impact of BPJS Health Implementation for the Poor and Near Poor on the Use of Health Facility.” Procedia – Social and Behavioral Sciences 211 (November 2015): 550–59. https://doi.org/10.1016/j.sbspro.2015.11.073.

 

 

 

[1] Rolindrawan, “The Impact of BPJS Health Implementation for the Poor and Near Poor on the Use of Health Facility.”

[2] Rahman dkk., “The Implementation of BPJS Health Program At Public Health Center Martapura in Banjar Regency.”

[3] Asyary, “INDONESIAN PRIMARY CARE THROUGH UNIVERSAL HEALTH COVERAGE SYSTEMS: A FEELING IN BONES.”

[4] Pisani, Olivier Kok, dan Nugroho, “Indonesia’s Road to Universal Health Coverage.”

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