Jakarta. Costly treatments for heart disease, kidney failure and cancer, health problems that could be prevented with healthier lifestyle or curable with early detection, have bogged down Indonesia's universal health insurance scheme in the past few years and amplified health insurance agency BPJS Kesehatan's deficit problem. 

BPJS spokesman Iqbal Anas Ma'ruf said the agency spent Rp 78 trillion ($5.5 billion) throughout 2014-2018, around 17 percent of the agency's spending over the period, to pay for treatment for the three serious illnesses.  

Over the same time, the agency accumulated Rp 9 trillion in deficit with outstanding debt to hospitals and pharmaceutical companies.  

"These are the two sides of a coin. On the one hand, more people are receiving help because they could access cancer treatment. But on the other hand, expenses are increasing each year. This is where the problem lies, how to control the catastrophic number of patients, including cancer patients," Iqbal said in Jakarta on Thursday.

Ira Soelistyo, the head of the Indonesian Association of Children With Cancer (YKAKI) said state insurance helps a lot of families because cancer treatment for children is very expensive. Ira said from time to time there are unexpected expenses that need to be covered, and YKAKI would often have to lend a hand to pay for medical treatment children with cancer might need.

Iqbal said the agency is actively educating the public to lead a healthier lifestyle to prevent these diseases. He also regrets the fact that many BPJS members neglect to pay their insurance premium. When they do, they pay just when they are about to be admitted to the hospital for a serious illness and then stopped paying the monthly premium after they recover.

Major Deficit

BPJS Kesehatan is currently carrying a major deficit due to unpaid medical bills that have piled up since its establishment in 2014. The insurance is projected to accumulate Rp 28 trillion in deficit this year, Rp 9 trillion of which was carried over from last year.

Finance Minister Sri Mulyani Indrawati said the government intends to set aside Rp 48.8 trillion for healthcare in the 2020 state budget, a much larger provision than this year's Rp 26.7 trillion.

The House of Representatives (DPR) is still debating a plan to bump up BPJS Kesehatan's premium. It has so far refused to increase the insurance's lowest premium from Rp 25,500 to Rp 42,000 a month.

The National Social Security Council (DJSN), who has the mandate to formulate the fee, said the premium increase plan has been well thought out.

"Our calculation is already very balanced, based on fee comparisons according to every segment, service trend and available data," council member Angger Yuwono said on Thursday.

Nevertheless, he said, the DJSN is aware the increase in premium is likely to be met with disagreement from the public and the government.

The council recommends that subsidized customers of BPJS Kesehatan – those who come from poor families – should now pay the same premium as the insurance's third-tier members of Rp 42,000 per month, a 65 percent increase from the current Rp 25,500 per month.

Second-tier members should pay a premium of Rp 80,000 per month (Rp 51,000 previously) and first-tier members should pay Rp 120,000 per month (Rp 80,000 previously).

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