As people began to flock to hospitals and healthcare centers again, National Health Insurance (JKN) claims started to pile up for the non-profit agency, resulting in a deficit of Rp 7.4 trillion (US$473.8 million), or 4.8 percent of the total premium payments by members last year. The deficit is expected to rise to a record high this year as the number of people covered by the insurance amounts to more than 267 million, more than 95 percent of the population.
With the large number of people to cover, the insurer faces greater potential for higher claims and more challenges in regard to premium collection. Indonesia rolled out the JKN insurance under BPJS Kesehatan in 2014 in an attempt to provide universal health coverage for its people.
The large population covered under the scheme made the JKN the largest single-payer health insurance system in the world in 2021, according to medical journal Lancet. The national health scheme is funded by the government at national and regional levels to cover the poor, low-income families and retired government employees, which altogether account for about 54 percent of JKN members.
Social contributions for workers, paid jointly by employees and employers, also play a significant role as they account for 20 percent of the health scheme. Members who work in the informal sector or are self-employed register themselves for the insurance independently, and account for the remaining 26 percent of the JKN coverage.
Prior to the pandemic, BPJS Kesehatan became embroiled in a constant deficit because of mismanagement and an insufficiency of healthcare providers. The lack of implementation of standards of medicines and health services led to poor judgment by hospitals and doctors in allocating the services, leading to soaring claims and medicine scarcity for critical diseases.
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