Indonesia's National Health Insurance Program: Rising Financial Mismatch
There is a growing mismatch between claims paid and premiums received by Indonesia's Healthcare and Social Security Agency (Badan Penyelenggara Jaminan Sosial, or BPJS Kesehatan). This year the deficit could reach IDR 9.8 trillion (approx. USD $731 million), leading to concern about the financial sustainability of the program and the need to search for additional and innovative ways to fund Indonesia's National Health Insurance (Jaminan Kesehatan Nasional, or JKN) program.
Last year the deficit was recorded at IDR 4 trillion (approx. USD $299 million), as claims paid reached a value of IDR 58 trillion, while premiums received stood at IDR 54 trillion. This year the deficit is estimated to grow sharply to IDR 9 trillion based on the following calculation: premiums collected are estimated at IDR 23,000 per client per month (up from IDR 19,225 last year), while the program's operational costs are estimated at IDR 36,000 per client, per month.
The central government of Indonesia plans to raise this year's premium from IDR 19,225 per client, per month to IDR 23,000. However, this plan is still being processed by Indonesia's Ministry of Law and Human Rights. However, the late implementation of the new tariff will not cause a rising mismatch according to M. Ikhsan, spokesman for BPJS Kesehatan because the agency will receive the difference between both tariffs (per 1 January 2016) in subsidy from the central government's 2016 State Budget.
Indonesia's National Health Insurance Program encounters a few basic problems. Firstly, the number of Indonesians making use of healthcare services provided under this program exceeds the number of people paying their monthly premiums (hence causing a claims ratio over 100 percent). Secondly, there is still a large number of healthy Indonesian workers in the private sector who do not participate in the program. Lastly, healthcare services in Indonesia - both quantitatively and qualitatively - are still not optimal (and this could make part of the program's participants reluctant to pay a higher monthly premium).
The Indonesian government targets to provide universal health care to all Indonesians by the year 2019. However, a study conducted by the University of Indonesia predicts that BPJS Kesehatan will have an accumulated deficit of IDR 173 trillion (approx. USD $1.9 billion) by that same year provided no changes are made to the existing payment scheme.
Indonesia's National Health Insurance Program:
| 2014 | 2015 | 2016 | |
| Total Clients (in millions) |
152 | 162¹ | 186² |
| Deficit (in IDR trillion) |
1.54 | 4.00 | 9.79² |
¹ per 26 February 2016
² forecast