Health costs in Indonesia will continue to experience inflation, but unfortunately there are still many citizens who pay for outpatient care with money from their own pockets. Based on data in the 2019 Health Statistics published by the Central Statistics Agency (BPS), the percentage of citizens who have health complaints who do outpatient care and pay costs without health insurance amounts to 18.68% in government hospitals, 29.01% in private hospitals, 31.72% in puskesmas, and 64.1% in doctor’s clinics. Meanwhile, for inpatient care, 18.72% of the community still made their own payments at government hospitals, 27.08% at private hospitals, 39.96% at puskesmas, and 73.88% at doctors’ clinics. The decision to pay out-of-pocket for treatment at a clinic or puskesmas may be due to the lack of cooperation between the clinic or puskesmas in relation to health insurance or private health insurance. However, the facts above show that there are still many people who have to spend their own money to pay for treatment, especially in public or private hospitals. In fact, their financial burden can certainly be much reduced if they have health insurance.
How important is health insurance?
Health insurance is the only solution to overcome financial losses due to rising medical costs. As written in a survey conducted by Willis Towers Watson, the averagegross increase in health costs, from 2017 to 2019, ranged from 10% to 11%. This clearly exceeds Indonesia’s annual average inflation over the same period of 3.15%. When a person does not have health insurance, he or she has the potential to lose a large amount of money when seeking medical treatment. This will certainly interfere with their financial health in the short and long term. Health insurance will actually cover the cost of treatment in the form of hospitalization, outpatient care, and medicines. This does not mean that with health insurance we are free from these financial risks. There are still some services that cannot be covered by health insurance.
Is BPJS Kesehatan enough?
The premiums are cheaper in general, making the benefits of BPJS Kesehatan arguably more complete than private health insurance. Almost all diseases are covered by BPJS Kesehatan. In this health insurance from the Government of Indonesia, there is no term pre-existing condition , which means that BPJS Kesehatan will still cover any diseases that existed before the patient became a participant. However, understand that, in order to undergo further treatment to a more complete health facility, BPJS Kesehatan requires a procedure in the form of a referral letter from a general practitioner at a level I health facility, where your BPJS membership is registered. The hospital referral system in BPJS Kesehatan uses a tiered flow, carried out vertically from the lower level of service to the higher level of service. Sometimes, this referral system is clearly not suitable for patients who need quick medical treatment. In addition, BPJS also has special procedures for those who are sick and need to be treated outside the city. In this emergency condition, the patient must visit the nearest BPJS Health office and request a letter of introduction to visit the First Level Health Facility (FKTP) to receive services, a maximum of three times only.
Is private health insurance better?
Unlike BPJS Health, there is no referral system in private health insurance, patients only need to register at hospitals that are partners of insurance companies and are immediately served for the treatment process. Insurance is also easy to use even outside the city or abroad. However, with a more expensive premium, health insurance benefits are not as much as BPJS Health. The more benefits that are taken, the older the age of the insured, the more expensive the premium that must be paid. In addition, insurance also applies pre-existing conditions. For VIP rooms, patients with private health insurance can access them, while BPJS Kesehatan patients cannot. Class I BPJS Kesehatan participants will get a more comfortable inpatient service treatment room than class II and III participants, namely rooms with four to two patients only. If you want to compare which is better between BPJS Kesehatan and health insurance, then these two health insurance can be said to complement each other. Many benefits are only covered by BPJS Kesehatan and cannot be covered by private health insurance. Meanwhile, the speed in handling that private health insurance has certainly cannot be enjoyed by BPJS Kesehatan patients. However, if someone is indeed less able to have health insurance, at least they must have BPJS Kesehatan in order to mitigate the risk of losing large amounts of money for treatment. That is a review of the importance of health insurance that we must have. Basically, participation in health insurance is different. If BPJS Kesehatan is mandatory, private health insurance is voluntary. But when it comes to the benefits, everyone in all circles certainly needs health insurance. The high cost of health services will certainly force someone to spend a large amount of money for this one need. Without the protection of health insurance or health insurance, it is likely that a person will go into debt for the sake of treatment, or even worse, sell the assets he already has or he has bought with the results of years of sweat.
