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JAMSOSTEK

08 Jun

Organisation

Jamsostek (Jaminan sosial tenaga kerja) is the social insurance fund for private sector employers and their employees. It provides four programs: Employment Injury, Death, Health Insurance, and a provident fund type Old Age Benefit.[1]

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Figure 1. Jamsostek organizational structure

Source: [2]


Membership (number, structure)

Table 1. Jamsostek Membership 2007-August 2011

Helath insurance structure

2011

2010

2009

2008

2007

Single

945,668

916,050

695,309

823,285

659,211

Married

1,504,447

1,470,408

1,176,113

1,089,759

948,503

Family

3,173,603

3,011,519

2,531,103

2,279,417

3,597,177

Total

5,623,718

5,397,977

4,402,525

4,192,461

5,204,891

Sources: [3]

Premiums (how much, how often are they paid)

Jamsostek premium is determined by percentage of wages, while membership of health insurance program includes employee and their families by the number of children up to 3 people and less than 21 years old and unmarried. Health insurance program is mandatory with conditional, meaning that companies cannot included in the work force throughout the Jamsostek health insurance program if they has provided health care benefits or better benefits. In addition, the premium for single employee is 3% and 6% for married employee family from their wages monthly by employer, but is limited to a maximum salary (ceiling) of Rp. 1,000,000 per month[4]

Services (e.g. basic benefits, catastrophic expenditures)

Generally, Jamsostek cover four programs: health benefits, occupational injury, death benefit, and provident funds. In this paper, I will only describe the health benefit package. There are:[4]

  1. Outpatient care in primary health care. The health services performed by a general practitioner or dentist at the health center, clinic, or private practice. Their role is the gate keeper of service to the secondary level. Services in primary health care includes examination and treatment by a physician / dentist, providing medicine, medical treatment by a physician / dental, diagnostic support a simple, normal delivery at the government maternity hospital, basic immunization services, family planning, consultation and referral services
  2. Outpatient care in secondary health facilities level (Hospital). The examination and treatment perform by a specialist upon referral from a physician in primary health care according to medical indications. It is includes advanced diagnostic support (laboratory, radiology, electro medical examination, anatomic pathology), emergency services and physiotherapy services
  3. Inpatient care at the Hospital. The health services provide in class 3 at private hospitals and to class 2 at Government hospitals, including visit by the doctor at least 1x a day, consulting other specialists, provision of specialist drugs, surgery services (small medium and large), room service ICU / ICCU / PICU, service delivery with complications, advanced diagnostic support (laboratory, radiology, electro medical examination, anatomic pathology), medical treatment by a specialist, and physiotherapy services. The length of stay is limited to 60 inpatient days per year per case includes service in the ICU / ICCU / PICU for 20 days when necessary
  4. Delivery care. Delivery assistance is given to married women workers or employee’s wives for up to 3 (three) children.
  5. Special Services. The rehabilitation services or benefits that provided to restore the body’s functions. It is includes providing the tools consist of the provision of eyeglasses, dentures, mobility aids, hearing aids and eye with a certain ceiling.
  6. Emergency services. The services for Jamsostek member who needs medical services immediately due to life threatening.
  7. Additional services that can be provided if needed –by request-:
    1. Medical Check Up
    2. Hemodialysis
    3. Heart surgery
    4. Cancer
    5. HIV/AIDS Treatment.

Limitation:

  1. Limitation of length of stay for inpatient services.
  2. Close panel health facilities
  3. Limitation of drugs
  4. Cancer, hemodialysis and heart surgery
  5. Congenital

Table 2. Number of cases and reimbursment rate for Health benefit by PT. Jamsostek. Periode: 2006-June 2011

Year

Total Cases

Total reimbursment (in million)

2006

11,798,831

429,897

2007

12,242,960

479,829

2008

15,076,955

588,713

2009

14,745,849

662,193

2010

18,604,383

776,592

2011

10,784,906

433,560

Sources: [3]

Government involvement/subsidies

Obviously, as one of the state owned enterprise (SOE), JAMSOSTEK is fully regulated by Government. In addition, in 2012 the central government – Minister of Manpower and Transmigration- will subsidize JAMSOSTEK premium about 2.8 billion IDR. This contribution will be distributed to the 8100 informal sector such as builder, tailors, fishermen, barbers, farmers, drivers, etc. across nine regions in Indonesia. Those are: Banda Aceh, Bengkulu, Bogor, Cirebon, Jambi, Medan, Palu, Pontianak and Surabaya.[5]

Relation to other health financing schemes, e.g. community based health insurance

There is no relation between Jamsostek with other community based health insurance. But, since there is opt out regulation, Jamsostek need to compete with them. In 2014, Health benefit of Jamsostek will be part of BPJS 1 (national health insurance) by ASKES. Therefore, it is need to be prepared well for successful transfer program. On the other hand, Jamsostek will fully responsible on Employment Injury, Death and a provident fund type Old Age Benefit as BPJS 2. It means that Jamsostek need to merge with other insurance company such as ASABRI (military insurance) and TASPEN (pension insurance).

Is it a successful system or not

If we look the Jamsostek performance in Table 3, even the profit increase every years, the total of employee which non-active also getting higher than the active ones. This situation is the big challanges for Jamsostek and BPJS 1 in 2014. Jamsostek need more effort campaign to promote Jamsostek programs as a real need, instead of an obligation among employee and employers and also for informal sector which can increase the active membership. [6] On the othe hand, Jamsostek as a private company is not suitable for the development of health social insurance scheme in the future due to profit oriented and impact to lack of benefit.

Table 3. Jamsostek performance 2003-2006

No

Description

2003

2004

2005

2006

1.

Membership

1) Employer

ü Active

ü Non-Active

Total

1) Employee

ü Active

ü Non-Active

Total

 

67.093

42.174

109.267

 

 

8.380.126

10.215.372

18.595.498

 

70.378

48.228

118.606

 

 

7.812.409

11.820.129

19.632.538

 

75.616

55.344

130.960

 

 

7.843.742

13.100.169

20.943.911

 

82.352

60.872

143.224

 

 

7.719.695

15.361.672

23.081.367

2.

Contribution (Rp. Million)

1) Non-Old Age

2) Old Age

Total

4.916.520

 

 

1.200.198

4.327.298

5.527.496

 

 

1.390.986

4.988.958

6.379.944

 

 

1.656.858

6.057.509

7.714.367

3.

Claim (Rp. Million)

1) Non-Old Age

2) Old Age

Total

2.070.090

 

547.683

2.082.802

2.630.485

 

658.155

1.915.556

2.573.711

 

773.490

2.619.793

3.393.283

4.

Total Asset (Rp. Million)

26.900.923

33.031.076

38.811.399

49.623.628

5.

Invesment (Rp. Million)

1) Acumulated Investment Fund

2) Increase in Investment Fund

3) Bruto Investment Return

 

 

26.070.330

 

4.196.520

 

3.480.112

 

 

32.530.265

 

6.452.398

 

3.372.992

 

 

37.864.949

 

5.334.684

 

3.627.841

 

 

48.596.346

 

10.731.396

 

6.045.941

6.

Profit (Rp. Million)

535.236

421.064

629.623

722.917

Source: [7]

References:

1 ILO. Indonesia: Providing Health Insurance for The Poor. In: Asia-Pacific Regional High-Level Meeting on Socially-Inclusive Strategies to Extend Social SEcurity Coverage. New Delhi: ILO 2008. http://www.ilo.org/public/english/region/asro/bangkok/events/sis/papers/index.htm

2 Jamsostek. Struktur Organisasi. 2012.http://www.jamsostek.co.id/content/i.php?mid=2&id=10

3 Jamsostek. Laporan Tahunan. Jamsostek. 2012.http://www.jamsostek.co.id/content/i.php?mid=5 (accessed 31 May2012).

4 Jamsostek. Program Jaminan Pemeliharaan Kesehatan. Jamsostek. 2012.http://www.jamsostek.co.id/content/i.php?mid=3&id=16

5 Agustiyanti, Mandiri A. Kemenakertrans Kucurkan Subsidi Iuran Jamsostek LHK Rp2,8 Miliar. Berita Satu. 2012.http://www.beritasatu.com/bisnis/47944-kemenakertrans-kucurkan-subsidi-iuran-jamsostek-lhk-rp2-8-miliar.html (accessed 31 May2012).

6 Ahmad S, Thabrany H. A Decade of JPK Jamsostek: Trend in Membership and Utilization. In: Asia-Pacific Summit on Health Insurance and Managed Care. Indonesia: WHO 2002. http://www.searo.who.int/LinkFiles/National_Health_Accounts_(NHA)_CS_24_Sylvia_1.doc

7 Jamsostek. GOOD CORPORATE GOVERNANCE IN SOCIAL SECURITY ORGANIZATION. 2007;:16.

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