Suara Pembaruan, Sept 7, 2009
By Ghufron Mukti, Professor of Public Health Gadjah Mada University
National Social Security Scheme (SJSN) is one form of social protection to ensure all the people in order to meet the basic needs of a decent life. This system is expected to address the fundamental problems in meeting the needs of the community health service, accident, pension, old age, and death compensation. At the end of her administration, President Megawati Sukarnoputri has signed the Law 40/2004 on SJSN, but until now the fate of this Act is not clear.
This is because of government regulations that will further regulate the idealist program is not published, although the second period Susilo Bambang Yudhoyono Government was in the doorway. What is the fundamental problem?
In my opinion, this program is too ambitious, not seeing the reality on the ground. Even at the beginning have been proposed unemployment guarantees.
It’s a good program, however, not operational. Where the funds to ensure the absolute and hidden unemployment which are so many in this country. Fortunately that time the unemployment insurance are not included in the program SJSN. If included, of the Act will remain a law, but not operational in the field.
How does the unemployment insurance program is not included in the SJSN Act? Are there guarantee that the programs can be operational? It should be and we see Askeskin program which is now become the Community Health Insurance Program (Jamkesmas), already includes insurance for 76.4 million poor and nearly poor in Indonesia. A breakthrough that many developing countries meet difficulties to fulfill.
However, some people questioned whether the program Jamksmas as implementation and as closer SJSN, or just away from the SJSN? This question would require further study. It is clear, through Jamkesmas, about 52 percent of Indonesia get the different forms of health insurance.
Many authorities and decision makers associated with the SJSN forget that in order to implement this idealistic program requires road map and the consensus and a clear phasing. Strangely, the place and the priority is a matter of who the organizer, not other issues more strategically. So that’s understandable some people insist that the House of Representatives which had almost finished the devotion, immediately discuss the Bill Organizer Social Security Agency (BPJS).
I think this would burden the House of Representatives, not only because of their homework a lot, but also the consequences. If forced, very risky, the time available was not sufficient, so the quality of the resulting law could not comprehensive and less able to solve the main problem. Please note that the BPJS arrangement would involve and affects many stakeholders, and potential to create unnecessary tension.
The question is, why should be forced on BPJS, and why more busy thinking about who the organizer agency than thinking about how our society is guaranteed and immediate universal coverage (comprehensive coverage) can be achieved? So, in my opinion is to emphasize how the poor and nearly poor to get insurance, and gradually the middle and upper society to participate in this program.
Thus, another way that should be done is coordination and communication among different parties that has a potential as BPJS, including PT Jamsostek, PT Askes, PT Taspen, Asabri, Jamkesda, MOH, and related technical departments. The existing agency providers can play a role as the agency established goals.
To make SJSN idealistic program became operational, also requires that requirements must be met, such as aspects of political, economic, and technical.
First, the political problem. Does political commitment and political interests and political consensus among different stakeholders has been achieved? The answer, obviously not.
Second, if economically possible? In many countries, social security programs can be initiated and established with income per capita more than U.S. $ 2,000. Germany began a program of social health insurance as income per capita of U.S. $ 2237, Austria U.S. $ 2420, and Japan U.S. $ 2140. The per capita income today began stepping on U.S. $ 2,000. However, the economic structure of the formal sector in particular, should be strengthened.
Korea, two years before compulsory health insurance program, the distribution of population in urban areas about 50 percent. Our society is more than 60 percent of agriculture and rural areas, how to attract tuition assurance system? If it is implemented and its impact on industrial growth has been calculated? It could be siphoned off funds for the security system are too much, so that other sectors become lack of funds.
Third, the problem of technical requirements. To my knowledge, until now there has never been a counting that can be acceptable to all parties, how much actual costs required for implementation of SJSN. Even the cost for a health insurance program have no official count could be a reference.
The next question, how much is the premium per person and how the collection of premiums, and premiums are collected at any level and where? Does the amount of human resources who understand and have technical capabilities are sufficient? Does if this program operational the number of beds in the hospital enough? The answer, obviously not.
The issue does not stop there. How the fate of people who have paid premiums and fell ill while in the area has no hospital that can perform the required operation? Is it compensated or referenced? If referred who has to paid, whether they do not really want to be referred?
Thus it can be concluded that we should not force the House of Representatives who is running out of devotion to knock the hammer on BPJS Act. In opposite, priorities and decision-makers attention instead focused on the agreement and consensus road map and a clear phasing. Perspective and the community must take priority rather than agency providers.
Finally, how eligibility political, economic, and technical, including public awareness should also be considered and fulfilled, so that the idealistic program is not poor operational.