The BPJS Imbroglio
    Category: Column By : Taufik Darusman Read : 672 Date : Thursday, January 04, 2018 - 14:44:53

    The 1945 Constitution stipulates that the state shall provide social security to all citizens, but it took legislators almost six decades to figure out what that meant in practical terms. So it was only in 2004 that Law No. 40/2004 on National Social Security System (SJSN) came into force, and it took another seven years, in 2011, before the government established the state body BPJS to manage both health care and pension funds.

    The way the healthcare scheme works, a person seeking medical assistance would first go to a public health unit (puskesmas) which, unless it can handle the case, will send the patient to a hospital for further treatment, free of charge. BPJS will then reimburse the hospital for any charge incurred in curing the patient—a good and simple system that especially benefitted low-income people.

    BPJS was designed to be self-sufficient, with its operational costs covered by dues from both unemployed and employed individuals, as well as employers. But no sooner had the scheme become operational than BPJS began to face financial problems. Three years in the running, in 2014, BPJS had already suffered a Rp 3.3 trillion deficit, which rose to Rp 5.7 trillion in 2015. In the first half of 2017, its deficit had reached Rp 5.8 trillion, and is estimated to hit a whopping Rp 11 trillion by year-end.

    Besides the usual government inefficiency and poor transparency, one reason for the BPJS’s deficit is said to be late payment of members’ dues. Also, according to a financial service authority OJK study, many became members and paid dues only after they needed medical treatment. Yet what was essentially a financial issue took a turn for the worst when the BPJS management came up with a dubious solution. It publicly proposed that the high treatment costs of eight chronic diseases, including cancer, be shared with the patients. Not surprisingly, the idea received heavy criticism as it smacked of a management team in search of a quick fix.

    Government officials also said the idea defeats the purpose of having the scheme in the first place—to alleviate the cost of health care. Though BPJS backtracked by saying it was just an idea, the damage was done—they had created an image of incompetency. Credit is due to the health and finance ministries, which seemed aligned with President Joko Widodo’s pro-people policies. The Health Ministry officials made clear that they saw no merit in the BPJS’s desperate measure, while the Finance Ministry immediately pledged to inject Rp 9 trillion into the BPJS.  Clearly, the government cannot be expected to cough up trillions of rupiah just to stop the bleeding at BPJS. The latest proposal is to divert some of the tobacco tax raised to reduce the deficit, though that is like diverting funds from one pocket to another. Others have suggested, and perhaps correctly so, that the whole BPJS management be replaced.