The National Health Insurance (JKN) implementation by the Social Security Administration (BPJS) for Health these past six years is still lacking. This is evidenced by research conducted by the UGM Center for Health Management Policy (PKMK) which summarizes the myriad of problems in implementing JKN.
Fraud in the implementation of JKN is still widespread. The Regional Government (Pemda) is not fully responsible for controlling JKN cost claims. This condition is exacerbated by several articles in the BPJS and SJSN Laws that cause poor fraud control and compensation policies.
The results of PKMK UGM research also found problems in the legal product of Inpres No. 8/2017 regarding the responsibilities of regional heads to ensure the continuity and improvement of the quality of services for JKN participants that are not running.
“The local government’s commitment to JKN is only limited to paying the PBI APBD premium. There is no Law-Enforcement of PBPU arrears. The local government only focuses on PBI/the poor,” said JKN PKMK UGM researcher, M. Faozi Kurniawan.
Faozi and the PKMK UGM research team found solutions to the JKN governance problem: it is necessary to increase the responsibility of local governments in controlling the JKN claim costs, institutionalize fraud prevention and enforcement within JKN, and fulfill the compensation policy.
The compensation policy itself is a mandate of the SJSN Law 2004 article 23 paragraph 3, and BPJS Kesehatan should implement it. The JKN policy is a good policy that aims to give the same health services for all participants according to their medical needs.
“In fact, until now, there has been no equal distribution of health services,” he added.
Another JKN PKMK UGM researcher, Puti Aulia Rahma, said the commitment to control fraud is still low, both in terms of the health care team itself and the structures above it, including the Head of the Health Service, the Head of FKTP, and the Director of the Hospital. The reason for this low commitment remains the same, namely legal products that have not met the need for fraud control.
“The direction regarding fraud control in general, and in particular regarding the role of the highest leadership in an organization to control fraud has not been well stated in Law no. 24 of 2014 concerning Social Security Administrative Bodies and Law no. 40 of 2004 concerning the National Social Security System. This situation shows that fraud control has not become a priority in social security programs in Indonesia,” explained Puti.
To overcome the fraud problem in the implementation of JKN, Puti said it is necessary to optimize the role of the health office to provide direction and show examples in efforts to control JKN fraud to the below structures. This is also an effort to optimize the implementation of Permenkes No. 36 of 2015, which has now been changed to PMK No. 16 of 2019.
Source: https://www.ugm.ac.id/id/berita/20927-pkmk-ugm-desak-revisi-uu-bpjs-dan-sjsn
