Know More About BPJS (Indonesian National Health Insurance)

The Mind Map

 

BPJS

What is BPJS?


“BPJS is an institution that organizes the National Health Insurance (JKN) which is a public legal entity state-owned non-profit and accountable to the president. BPJS entered into force on January 1st, 2014.” (Rahman dkk., t.t.)

“Indonesia’s national health insurance scheme (Jaminan Kesehatan Nasional or JKN) is a key element of the Government of Indonesia’s (GOI) commitment to ensuring equitable access to healthcare, especially for the poor and the near-poor. JKN’s contracting with private providers was expected to expand reach faster than simply working through the public sector. The single-payer agency for JKN, Badan Penyelenggara Jaminan Sosial-Kesehatan (BPJS-K), contracts private clinics under capitation and pays hospitals through case-based groups.” (Hp+, t.t.)

What are the goals?


“…the vision of BPJS that held by government ie no later than January 1, 2019 the entire population of Indonesia has a national health insurance to obtain health care benefits and protection to meet basic health needs” (Rahman dkk., t.t.)

How doest it work?


“There were some services that could be used on primary healthcare services including health promotion and prevention services, diagnostic, recovery and health consulting, non-specific surgery, drug and health device, transfusion, laboratory service, inpatient service as well as administration service. Therefore, National Health Insurance contained not only various curative activities, but also health promotion and prevention programs.” (Nurmansyah dan Kilic 2017)

“After National Health Insurance was implemented, BPJS Kesehatan made pre-payment to public health center facilities based on capitation for the number of participants registered at the public health center facility. Capitation fund was used for payment of personnel reward and health service operation. Personnel rewards were paid with a minimum of 60% of total capitation received and was used for medical and non-medical workers that provided services at the public health center facility.”

“Percentage for health service operation funding was addressed to fund drug, health equipments and first-used medical materials as well as other operational activities, such as individual health attempts including promotive, preventive, curative and rehabilitative activities, house visits in order of individual health attempts, operational for mobile public health center, printed material or office stationery. Therefore, after National Health Insurance was implemented, there was a change of fund amount received by public health center. Policy makers said there was a change of funding source during the National Health Insurance era in which the fund source before was from Health Operational Fund, then now there is a capitation fund, so the budget is larger. They also said that the present fund is adequate to fund health promotion and prevention activities.” (Nurmansyah dan Kilic 2017)

How it happen?


What are the differences with other insurances?


How to get it?


Who are the participants?


“BPJS participants are Indonesian citizens and foreigners who lived in Indonesia for at least 6 months and above. This BPJS program covers health insurance, employment injury, old-age insurance, pensions, and death benefits to fulfill minimum standard of ILO convention” (Rolindrawan 2015)

“Participants of BPJS Health program are divided into 2 groups of new participants and the transfer of the previous program, the Health Insurance, Public Health Insurance, the Indonesian Armed Forces, the Police, and the Workers’ Social Security.” (Rahman dkk., t.t.)

The structural of organization?


The characteristics of BPJS


The impact to community


““There is no difference (before and after National Health Insurance implemented), it concerns on curative [service] by any inpatient facility and promotive preventive [activities]” (Doctor of Public Health Center in Urban Area). “Some regulations have been issued regarding National Health Insurance implementation considering the positive impact it could have on the implementation of health promotion programs at public health centers. Furthermore, the existence of additional funding sourced from the capitation fund in the National Health Insurance era can be used to procure materials and equipment for executing additional health promotion programs. Also health promotion programs which are newly implemented during the National Health Insurance era such as Prolanis, house visits and public counseling evidence the notion that National Health Insurance policy has a positive impact on the implementation of health promotion programs at public health centers.” (Nurmansyah dan Kilic 2017)

“Private hospital sector facility capacity increased and offers more services, but contracting with BPJS-K does not significantly affect facility investment decisions. Sampled hospitals reported increasing their installed capacity, including number of outpatient clinics, inpatient beds, and diagnostic testing machines. Hospitals also hired more staff; the average number of clinical and administrative staff at BPJS-K-contracted hospitals increased 23 percent and 15 percent, respectively, between 2013 and 2016. Meanwhile, the average number of administrative staff decreased by 3 percent at non-BPJS-K-contracted hospitals.” (Hp+, t.t.)

REFERENCES:

Hp+, Tnp2K. t.t. “Results of a Survey of Private Hospitals in the Era of Indonesia’s Jaminan Kesehatan Nasional,” 46.

Nurmansyah, Mochamad Iqbal, dan Bulent Kilic. 2017. “The Impact of National Health Insurance Policy to the Implementation of Health Promotion Program on Public Health Center in Indonesia.” Kesmas: National Public Health Journal 11 (3). https://doi.org/10.21109/kesmas.v11i3.1262.

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

Rolindrawan, Djoni. 2015. “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): 550–59. https://doi.org/10.1016/j.sbspro.2015.11.073.

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