Health insurance to cover all Indonesians

National scheme will give citizens free outpatient, Class III treatment

By Wahyudi Soeriaatmadja, The Straits Times, 13 Jan 2014

CHICKEN noodle pushcart hawker Paimin is 52, but has never seen a doctor. When he gets a fever or a stomach bug, he takes herbal medicines, fearful that doctors' fees would put a strain on his family's finances as he earns only about two million rupiah (S$200) a month.

But now that age is catching up with him, the father of three plans to sign up for Indonesia's national health insurance scheme. "My family advised me to get on the plan," he said.

The landmark programme launched on Dec 31 could prove to be a key legacy of President Susilo Bambang Yudhoyono's administration in his final year in office.

It currently covers 121.6 million poor and unemployed Indonesians and public servants, and will be compulsory for all 250 million Indonesians by January 2019.

In an election year, the insurance scheme could prove to be a game changer for Dr Yudhoyono's Democrat Party, but it has also found support across party lines.

In fact, as Indonesian Democratic Party-Struggle (PDI-P) MP Aria Bima pointed out, the scheme was first mooted when Ms Megawati Sukarnoputri was president from 2001 to 2004.

"The Democrat Party may benefit from this," he said. "But we support anything that first and foremost benefits the people."

The scheme will assure lower-income Indonesians such as Mr Paimin of free outpatient and Class III treatment - the lowest category of care in Singapore and other countries - at hospitals and clinics for a mere 25,500 rupiah a month.

The bottom third of citizens - some 86.4 million who fall below or close to the poverty line - are exempt from the premiums.

Another 35.2 million, including civil servants, soldiers and policemen, will also be included in the scheme, bringing the number of insured to 121.6 million.

Coverage is meant to be comprehensive. It covers birth and maternity cases, as well as those who are already ill or getting treatment. But, it is basic.

A number of middle-class private employees are already insured by plans offered through the companies they work for.

Eventually, they will have to contribute to the new scheme, and officials say their existing plans will top up treatment beyond what the state-run scheme offers.

Individuals who do not sign up when it becomes compulsory could lose the right to get a passport or driver's licence, or to own land or vehicles, and pay a fine.

When he launched the scheme, Dr Yudhoyono said it was part of his administration's commitment to meet the basic needs of all Indonesians.

"Now, the poor get health protection, the poor can get free medical treatment. This is guaranteed by BPJS," he said, using the acronym of the Social Security Management Agency, which administers the scheme.

However, the bill for the scheme is big. The government has earmarked 19.9 trillion rupiah to fund the programme this year, mainly to cover the premiums of the poorest 86.4 million. An additional 8 trillion rupiah has been allocated to buy more medical equipment and build more Class III hospital wards.

But challenges remain. Many lower-income citizens still do not know about the scheme.

Health Minister Nafsiah Mboi said last Wednesday that many Indonesians lack an understanding of how insurance works.

Motorcycle taxi driver Mohammad Jabardi is among them. "How can one pay only 25,500 rupiah a month, and when after a few months he gets in an accident, gets his hospital bill of two million rupiah paid in full?" he wondered.

Mr Mohammad was also worried that his hospital bill may not be covered even after he pays the premium every month.

Dr Nafsiah said officials can use easy-to-understand approaches to get the message out: "Last time when we fell very ill, our whole family donated money. But with BPJS, everyone across Indonesia becomes family. They will pay your medical expenses when you are ill. This is the way we explain how insurance works."

Landmark scheme

Benefits: Comprehensive treatment ranging from outpatient to maternity care and surgery, subject to a cap.

Target: The entire population by Jan 1, 2019. About half of Indonesia's 250 million people are on the scheme now.

Allocated funds: 19.9 trillion rupiah (S$2 billion) to subsidise the poorest who cannot afford premiums and 8 trillion rupiah to beef up hospital facilities.

Options: 25,500 rupiah a month for Class III treatment, 42,500 rupiah a month for Class II, 59,500 rupiah a month Class I.