Making the grade: People check a list of recipients of premium state health assistance at the office of the Talise subdistrict head in Palu, Central Sulawesi, on Tuesday. The PBI is health insurance aimed at the poor, and part of the National Health Insurance (JKN) program. (Antara/Basri MMarzuki)

Two years since the implementation of the National Health Insurance (JKN) program, the program  continues to face financial difficulties and has recorded a deficit as a result of the high number of claims made by insurance beneficiaries in comparison with amounts of the premiums it has received.

As part of efforts to address the deficit, the government plans to increase the JKN monthly premium starting next year.

In 2014, the Social Security Management Agency (BPJS), the agency that manages the JKN, reported a deficit of Rp 1.54 trillion (US$ 111.84 million), with Rp 42.6 trillion paid out in claims and Rp 41.06 trillion received in premiums.

Health Minister Nila F. Moeloek cited the example of treatment for heart disease. “First-class premium beneficiaries, for example, are only obliged to pay a monthly fee of Rp 59,500. Meanwhile heart surgery can cost up to Rp 200 million,” she told reporters during a JKN seminar in Jakarta recently.

Nila confirmed that the premium assistance (PBI) rate would be raised from the current Rp 19,225 to Rp 23,000 in 2016.

According to data received from BPJS, that minister said, although heart disease made up 8 percent of the total illnesses treated in 2014, it accounted for 30 percent of the total budget. Hospitalizations in relation to heart diseases sat at number four on a list of most commonly treated illness, yet cost the government the most at Rp 3.5 trillion, she added.

“The premiums are simply not enough to finance the health services provided,” said BPJS planning and development director Tono Rustiano.

An injection of additional funds was needed, he continued.

While non-PBI fees are still under negotiation, Tono said the premiums were likely to be raised in the near future. A third-class premium, he said, which presently costs Rp 25,500, was projected to be raised to Rp 30,000 per month. Meanwhile, the second-class fees were expected to rise from Rp 42,500 to Rp 51,000 and first-class to Rp 80,000 from the current Rp 59,500, he added.

As of 2015, there are currently 155.4 million subscribers of JKN, up from last year’s 133.4 million.

However, current data show that claims still outweigh premium fees received by the government.

Deputy Finance Ministry director general Didik Kusnaini confirmed that in the past two years the program had experienced problems in covering claims, adding that the ministry was usually used as a last resort to make up the deficiency.

Didik said problems in the execution of the JKN program should be identified from their root source, as it was important to know whether the problems were structural or temporary.

Despite the challenges, Tono said that evidently the JKN has positively contributed to the national economy. Citing a recent study conducted by the Indonesian Business Data Center (PDBI), which found that the program contributed Rp 18.6 trillion in 2014, he explained that the JKN has boosted the health industry by Rp 4.4 trillion,  including medicine sales, jobs and hospital construction. (bbn)(+) - See more at: http://www.thejakartapost.com