Indonesia's healthcare agency BPJS Kesehatan under pressure to ease financial burden from delayed premium payments
More than 2 million participants have fallen behind on National Health Insurance (JKN) premium payments, contributing to the programme's financial difficulties last year.
The Healthcare and Social Security Agency (BPJS Kesehatan), the insurance operator, reported that 2,158,584 people had been late in their premium payments for three to six months.
Those who are late in their payments are mostly workers who do not receive fixed salaries," BPJS spokesperson Irfan Humaidi told The Jakarta Post recently. "They are people who register when they fall ill, but stop paying once they recover."
There are 1,915,424 participants in this category, while 242,653 long-time members have failed to keep up with premium payments, including those covered by the Jamsostek insurance programme. A further 175 members have become late-payers after retiring from their jobs.
Irfan said that the rate of non-compliant participants had not harmed the agency's finances, since their number accounted for less than two per cent of the current 140 million JKN participants.
Each JKN participant is required to pay premiums of differing sums, starting from Rp 25,500 (US$1.96) per month.
BPJS Kesehatan expects to remain in the red throughout this year, with its claim ratio expected to hover around 100 per cent. The claim ratio is the difference between the hospitals' bills for health services provided and the premiums collected by the agency from participants registered in the programme.
Separately, the National Social Security Board (DJSN), which is tasked with monitoring the programme, said that while the number of late-payers might be relatively small now, BPJS Kesehatan should not ignore these groups of people.
"If non-compliant participants are ignored and there's no punishment, their numbers will swell," DJSN head Chazali Husni Situmorang told the Post.
BPJS Kesehatan should hunt these late-payers, he argued, a simple process since the agency already had their addresses and phone numbers.
"The agency has to have a strategy. For example, the marketing division should call all those who are late in their payments. The agency could also utilize a system to send automated SMS," said Chazali.
Irfan said that the agency had already sent bills via text message.
"Moreover, late-payers receiving treatment at hospitals will receive notification that they haven't paid," he said.
After six months without payment, they are no longer eligible for health treatments, according to Irfan.
The late-payers also have to pay a fine of two per cent of the total premiums before they can resume their membership in the JKN programme.
"The fine is too small. It should be increased incrementally," Chazali said. "If the fine is too small, then its deterrent effect is negligible."
He also suggested that the BPJS Kesehatan require its participants pay premiums once every six months, instead of monthly.
"It would counter late payments. And it doesn't violate the law because the law doesn't stipulate that BPJS Kesehatan must collect premiums every month," said Chazali.
He also suggested that BPJS Kesehatan publish the names of late-payers in local media or government offices to shame them.
Lastly, Chazali said, BPJS Kesehatan could team up with state-owned electricity company PLN and state-owned telecommunications company Telkom to target late-payers.
"When they pay their electricity bills or phone bills, they could be reminded to pay their JKN premiums," he said