Jakarta. The national health insurance scheme agency BPJS Kesehatan recently hosted a visit by a Malaysian university hospital, namely the Hospital Canselor Tuanku Muhriz (HCTM). 

According to BPJS Kesehatan president director Ghufron Mukti, the national health insurance (JKN) program has recorded 271.4 million participants or 97.24 percent of the total population. This makes BPJS Kesehatan as one of the health insurance providers with the largest number of participants in the world.

"BPJS Kesehatan has collaborated with 23,274 of the so-called ‘first level healthcare facilities [FKTP] and 3,099 advanced level referral health facilities [FKRTL]. In its payment system, BPJS Kesehatan uses a performance-based capitation approach in FKTP, based on a number of performance indicators, including visit rates, non-specialist referral ratios, as well as chronic disease control through the Chronic Disease Management Program [Prolanis]," Ghufron said. 

The performance-based approach also takes into account other factors such as the availability of medical personnel, and the ratio of doctors to JKN participants. 

Apart from capitation funding, BPJS Kesehatan provides non-capitation funding for emergency services in various health facilities, including those that do not collaborate with the health insurance agency. This approach has spurred an increase in the utilization of health services by more than 20 percent from 2022 to 2023. This has also had an impact on improving the quality of medical services for JKN participants.

"At FKRTL, there are two financing mechanisms, namely package rates which cover all components of hospital resources used, both in medical and non-medical services or known as Indonesian Case Base Groups [INA-CBG], and Non-INA financing CBG for specific services outside the INA-CBG tariff, such as medical aids and special medicines," Ghufron said. 

BPJS Kesehatan also continues to promote the Chronic Disease Management Program (Prolanis). This program aims to provide optimal services for participants with chronic diseases such as diabetes mellitus and hypertension, at a more effective and efficient cost. There is also the Referral Back Program (PRB) that makes it easier for participants with chronic illnesses to access the services they need. Once the patient's condition is stable, they can return to FKTP with ongoing doctor monitoring.

BPJS Kesehatan also launched innovations such as a historic screening which provides an opportunity for JKN participants to identify potential risks of 14 diseases. They are diabetes mellitus, hypertension, heart ischemia, stroke, cervical cancer, breast cancer, anemia in young women, tuberculosis, hepatitis, chronic obstructive pulmonary disease. , thalassemia, colon cancer, lung cancer, and congenital hypothyroidism.

"Participants can carry out screening independently via the JKN Mobile app, the official BPJS Kesehatan website, or when accessing health services at FKTP. They can do the screening once a year. The results of this screening are grouped into low, medium and high risk. High-risk participants will be directed to a health facility for further examination and treatment," Ghufron said. 

It is now easier for JKN participants to be served at healthcare facilities without having to queue. Thanks to the online queue system on the Mobile JKN app, participants can wait for their turns anywhere and anytime.

HCTM’s representative Zairul Azwan Mohd Azman said Malaysia could learn a lot from BPJS Kesehatan. 

"The various innovations and achievements of BPJS Kesehatan should be a model for other countries in providing comprehensive health insurance. There are many things that we can learn from BPJS Kesehatan in implementing the JKN Program in Indonesia which has very complex geographical conditions," said Zairul.

The HCTM delegates also visited the BPJS Health Command Center, of which its real-time monitoring capabilities earned praise from Zairul. HCTM also hopes the visit can strengthen bilateral cooperation in the health sector.