Prev-Prom as a starting point for revamping the National Health Insurance (JKN) ecosystem

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Timboel Siregar Advocacy Coordinator of BPJS Watch and General Secretary of All Indonesian Workers’ Organization-Indonesian Workers’ Society Confederation (Organisasi Pekerja Seluruh Indonesia-Konfederasi Rakyat Pekerja Indonesia – “OPSI-KRPI”)

IO – COVID-19 has hit all aspects of global life and especially the Indonesian people. The economy and business were so badly-affected; world economic growth continued to slow down and showed negative values, including that of Indonesia, whose economic growth rate in the second quarter was minus. 

Certainly, the number of COVID-19 infected in Indonesia continues to show an increasing trend, while the slowing condition of the Indonesian economy has resulted in layoffs for workers and workers who have been discharged without payment. Overcoming COVID-19 problems and economic problems simultaneously and continuously becomes a necessity for the Government of Indonesia. The transition to life in the new normal has only become an option to revive the economy by promoting health protocols. 

Prioritizing health protocols means that the main core of this transition period is living healthily by promoting prevention and promoting healthy living, commonly referred to as health preventive and promotive (Prev-Prom). The entire community, including business people and workers must be able to live healthily to avoid COVID-19 so that the production wheel continues to spin and the community’s economy can recover quickly. 

With the momentum o f COVID-19, this is indeed the time for the Government to focus more on Prev-Prom health. The public is invited and re-taught to be able to live healthily by prioritizing prevention. In terms of National Health Insurance (JKN) implementation, this will be the starting point for its ecosystem’s improvement. So far, the chaotic JKN is only seen from the curative side without ever looking upstream, namely Prev-Prom. 

When looking at data on visits to health facilities for JKN participants from year to year, there is an increasing trend. In 2018 the number of visits to health facilities was 233.9 million visits or 640,821 uses per calendar day. This number jumped significantly in 2019 to 433.44 million visits or 1,187,506 uses per calendar day. This figure shows two things, first, JKN has opened access to health insurance to the people very well, secondly, the increasing amount of utilization proves that the Prev-Prom program is not going well so that our society is increasingly being treated for being ill (curative). 

Of course, with the increasing number of people being treated because of the failure of Prev-Prom, the problems in the JKN ecosystem will be increasingly difficult to correct. The main problems of the JKN ecosystem are in three areas, namely, Membership, Services and Health Facilities, and Financing will be more complex if Prev-Prom is not taken seriously by the Government. With the number of hospitals collaborating not significantly increasing, while the uses of JKN are increasing, this will affect the service issues that JKN participants have complained about so far. Services that do not improve have an impact on future JKN financing. 

The low perception and awareness of the Government and the National Health Insurance (BPJS) in seeing Prev-Prom can be measured from the budget allocated. Budgets are shrunken only because perspectives and perceptions of Prev-Prom are low. The JKN program so far has only been seen as merely curative. Of the total realized costs in the JKN 2019 of IDR 108 trillion, the realization of the Prev-Prom budget was only IDR 499 billion, or less than 0.5%. In 2020, from the Annual Activity and Budget Plan, the National Health Insurance has IDR 111.24 trillion in its budget, while for health preventive and promotion is only budgeted at IDR 584 billion, or still around 0.5%. 

The Government and the National Health Insurance (Health BPJS) should have a breakthrough and creativity to support the improvement of the Prev-Prom program in the JKN program, which synergizes with the Prev-Prom program organized by the Ministry of Health. After being appointed Minister of Health, Dr. Terawan promised to return the essence of the existence of the Community Health Center (Puskesmas), which is more on health Prev-Prom. But until now the promise has not been realized. It is time for the Puskesmas to be returned to carry out Prev-Prom tasks. Doctors may have to go around to see the health conditions of the people, including their homes, to see sanitation and other environmental conditions, or other actions so that public health is even better. 

Prev-Prom together with curative and rehabilitative programs are mandated by Article 22, paragraph (1) of the National Social Security Act, but the Board of Directors of the National Health Insurance (Health BPJS) is not qualified to interpret Pre-Prom in terms of its budget and program. Therefore, it needs significant improvement from within the Health BPJS itself. 

Soon, in February 2021, the Board of Directors and the Board of Trustees of the health BPJS for the period of 2016 – 2021 will finish their term of service. The selection process for the new Board of Directors for the period 2021 – 2026 will begin rolling in August 2020. Hopefully, the Selection Committee will be able to explore the knowledge, vision, and mission of the candidates for Directors and Supervisory Board of the Health BPJS for this Prev-Prom problem, so that the new Directors will be able to better articulate Prev-Prom in their programs and budgets. 

With a quality Pre-Prom, the three areas of JKN ecosystem problems will be easier to fix. A qualified JKN ecosystem will support the implementation of better JKN for all Indonesian people.