JAKARTA — Indonesia’s national health insurance scheme (JKN), which covers 219 million active policy holders, is projected to record a 20 trillion rupiah (S$1.69 billion) deficit in 2024, raising the prospect that patients could face higher premiums.
Given the shortfall from insurance premiums collected and claims paid out, JKN may find itself unable to pay out medical claims as early as 2026, the national insurer’s chief has warned.
“Failure to pay (claims) will potentially occur in 2026. That’s why the premiums may be adjusted,” Mr Ali Ghufron Mukti, president director of the Healthcare and Social Security Agency (BPJS Kesehatan), which manages JKN, told local media recently.
If the national insurer cannot honour these medical claims, that will be detrimental to the sustainability of quality healthcare for Indonesians, said Ms Diah Satyani Saminarsih, founder and chief executive of health rights advocacy group, Centre for Indonesia’s Strategic Development Initiatives (CISDI).
“Hospitals that are not paid will not be able to continue their services and may need to be bailed out by the government,” she told The Straits Times, raising the prospect of a decline in healthcare services.
A short-term measure would be to raise premiums, experts say. These currently range from 35,000 rupiah to 150,000 rupiah a month, with the government partly subsidising those paying the lowest rate. Under the scheme, patients can receive treatment for severe and prolonged illnesses such as stroke and cancer, which cost millions of rupiah a month.
“I know the gap between what I pay and what I receive is too big,” said housewife Hotmaida Junita Sibuea, 58, who pays a monthly premium of 150,000 rupiah.
She suffers from hypertension, diabetes and kidney failure, and has undergone surgery. She has eight dialysis sessions every month, and regular consultations with doctors at half a dozen hospitals in Medan, North Sumatra.
By Ms Hotmaida’s estimates, her monthly bills for doctors’ fees, medication and treatments exceed 5 million rupiah, and are covered under JKN. Her family’s sole source of income is her husband’s monthly pension of 3 million rupiah a month.
“I can accept a premium hike, but it should be reasonable. Hopefully, it will not be double the current rate,” she said.
JKN paid out 158.8 trillion rupiah in claims for 2023, covering over 600 million medical cases. About one-fifth of these claims were for severe or prolonged illnesses such as cancer or stroke, which have surged in the past few years, according to the agency. The claims amount for this segment grew from 20.3 trillion rupiah in 2019 to 34.8 trillion rupiah in 2023.
Daily hospital visits covered by JKN also rose, from 252,000 in 2014 to 1.7 million in 2023, as more people joined the scheme.
Indonesia introduced its national health insurance scheme in 2014.
