BPJS Nears Major Test in Joint Coverage Scheme

FEBRUARY 06, 2015

Jakarta. The national health insurance scheme known as JKN faces a major challenge this month in its ongoing effort to scale toward universal coverage, as the fledgling state-owned firm that administers the scheme, BPJS Kesehatan, will absorb three million new subscribers — along with responsibility for coordinating benefits with their existing  private sector insurance providers.

Firdaus Djaelani, a commissioner at the Financial Services Authority (OJK), which regulates insurers, said on Thursday that by the end of February, BPJS planned to pick up part of the tab for three million people who currently hold private insurance.

The government has tasked BPJS with the ambitious goal of achieving universal coverage by 2019.

While adding private insurers’ policyholders to JKN’s roster nominally expands coverage to more people, skeptics say shortcomings in the depth of JKN’s benefits effectively create a two-tier, inequitable system that reinforces existing disparities in access to health care. The “coordination-of-benefits-mechanism” effectively subsidizes private insurers: BPJS expands its subscriber pool and acts as the main guarantor; private firms pay costs not covered by JKN, which are many.

“For example, for an appendectomy, the [JKN] only covers Rp 3 million [$240], while the total cost could reach up to Rp 10 million,” Firdaus said.

“The remaining fees will be paid by the private insurers.”

Under the so-called coordination-of-benefits mechanism (COB), BPJS Kesehatan will act as the main guarantor, while the private insurers will pay extra costs not covered by BPJS Kesehatan, he said.

Indonesian Employers Association (Apindo) chief Hariyadi Sukamdani warned the scheme forced firms to pay workers’ premiums twice, for an inferior product.


BPJS Kesehatan