The regulation of asking every citizen to have a BPJS

A few years ago the Indonesian Government launched a health insurance program for those citizens who were interested to benefit from it. Recently, a regulation has been passed by the parliament that requires the BPJS for every citizen. Therefore, this health insurance is compulsory now for every citizen. Its implementation started in the beginning of 2014, and by January 1, 2015 every employer is expected to register all his employees in the BPJS. Then, by beginning of 2019 every Indonesian citizen is expected to be part of this health insurance program required by the government. This new regulation brings both advantages and disadvantages for the peoples of Indonesia. Although the new regulation of asking every citizen to have a BPJS helps the poor, it is not a good regulation because it does not provide good salaries for the doctors and nurses, it forces employers to register their employees, and it offers a health service to the poor that is not enough.

It is a fact that the new regulation facilitates the access to health services for people who cannot afford it. In Indonesia there are still many people who have this problem. It is a very sad reality the one of many people who suffer illnesses and cannot receive treatment in the hospitals. Therefore, the BPJS is indeed a noble attempt from the government to solve the problem of the lack of health service for the poor. However, this measure to help the poor to have access to medical services does not overcome its weaknesses. The BPJS unfortunately is not effective yet, and this regulation of asking every citizen to subscribe to it is making bad things worse.

To begin with, this new regulation provides unfair salaries for both doctors and nurses. The budget for the BPJS is determined by the INA-CBG (Indonesia Case Base Groups). This system allocates fixed funds for every specific medical treatment. For example, the budget for every type of CT scan is Rp 250,000. However, there are some types of CT scan that are more expensive than the allotted budget. For example, a heart CT scan is more expensive than a kidney one. Therefore, hospitals will have to pay the difference between the available fund and the real cost. Since the money received by the hospitals is less, then hospitals have to cut the salaries of doctors and nurses. However, that is not fair because doctors and nurses offer a professional work that entails a big deal of pressure and that should be rewarded properly. Beside, doctors spend many years studying, so they need higher incomes to balance the time they have not been getting any income.

Secondly, it is not fair to demand all the employers to register their employees to the BPJS. It is a lack of respect for freedom to force companies to subscribe to the BPJS program because they are free to choose the health insurance that is most suitable for them. If an employer thinks that the health service provided by the BPJS is not good enough, s/he has the right to register his/ her employees in another health insurance that is more suitable for the type of risk the employees are exposed to. For example, if somebody owns a construction company, s/he knows that employees may suffer injuries at a construction site like falling from scaffolding. Therefore, the employer would prefer to register his/her employees in an insurance company like Allianz because this insurance company is specialized in that type of injuries. Now, if the government forces the construction company to also register the employees in the BPJS, the company will have to pay a greater amount of expenses that may reduce the net income of the business and render the business less profitable. Besides, the employer and employees are already contributing to the BPJS by paying their taxes. So, it cannot be said that they do not want to help the poor.

Thirdly, it is not completely fair with the poor people because it does not really take good care of their health. Patients suffering major illnesses will be received in the hospitals and stay in intensive care units if necessary. However, once they recover and can leave the hospital, they will still need to take some medicines that will not be provided by the BPJS anymore. The problem is that those medicines are very expensive, and thus poor people cannot afford them. This is why the BPJS is not truly effective. It does not think in the long run. For example, if a patient is admitted to a hospital because of kidney malfunctioning, s/he will receive treatment in the hospital until the condition improves, but s/he will be left alone afterwards. Besides, it is not possible to get a really good medical service by paying so little. The facilities used cannot be as good because the financial resources are not high. As a result, the poor will get access to a rather low quality health service. Furthermore, the poor people still have to pay. Even though it costs Rp 25,000 per person per month, in the long run it does matter for big families. Since the income of these poor people is too low, they may end up sparing money needed for food in order to get the BPJS. For example, a family was interviewed about the BPJS in a clinic, and the mother said that only the husband and one of the two children have BPJS. The reason why is that they cannot afford the BPJS for four of them. That is why the Government should offer this service for free.

To wrap it up, although the new regulation of asking every Indonesian citizen to have a BPJS has a good aim, to provide health services for the poor, it is not a really effective means to achieve it. This new regulation causes the following problems for the peoples of Indonesia: it does not provide good salaries for the doctors and nurses, it forces employers to register their employees, and it offers an incomplete service to the poor. With the coming of President Joko Widodo, society hopes that this health insurance may become truly effective in serving the poor.