BPJS baik atau buruk???

Definition of BPJS

Following are some legal bases behind the formation of JKN, namely:

The Declaration of Human Rights (HAM) or the Universal Independent of Human Right
was initiated on December 10, 1948 consisting of 30 articles. Article 25 paragraph 1 states that
everyone has the right to an adequate level of living for the health and well-being of himself and
his family, including the right to food, clothing, housing and health care and social services
needed, and has the right to guarantee unemployment, illness disabled, widowed / widowed,
reaching old age or other conditions which resulted in a lack of income, which was beyond his
control.

In 2004, Law No.40 concerning the National Social Security System (SJSN) was issued.
This Law 40/2004 mandates that social security is mandatory for all residents including the
National Health Insurance (JKN) through a Social Security Administering Agency (BPJS).1
The 58th WHA Resolution of 2005 in Geneva: every country needs to develop UHC through a
social health insurance mechanism to ensure sustainable health financing. Achievement of
Universal Health Coverage (UHC) through a social insurance mechanism so that health financing
can be controlled so that health financing guarantees become definite and continuously available,
which in turn social justice for all Indonesian people (according to the 5th Panca Sila Sila) can be
realized.

Law No. 24 of 2011 also stipulates that the National Social Security will be organized by
the BPJS, which consists of Health BPJS and Employment BPJS. Specifically for the National
Health Insurance (JKN) will be held by BPJS Health whose implementation began on January
1, 2014. Operationally, the implementation of JKN was outlined in Government Regulations
and Presidential Regulations, including: Government Regulation No.101 of 2012 concerning
Recipient Beneficiaries ; Presidential Regulation No. 12 of 2013 concerning Health Insurance;
and JKN Roadmap (National Health Insurance Roadmap).

1. UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 40 TAHUN 2004 TENTANG

SISTEM JAMINAN SOSIAL NASIONAL

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 To be able to hold a National Health Insurance in accordance with the conditions set,
various regulations have been issued as follows:

 UU No 40 tahun 2004 tentang SJSN

 UU No.36 Tahun 2009 tentang Kesehatan
 UU No.24 Tahun 2011 tentang BPJS
 PP No.101 Tahun 2012 tentang PBI
 Perpres No 12/2013 tentang Jaminan Kesehatan

Then a practical definition of universal health coverage is that all persons who are
eligible have access to the services they need. To choose the essential health services that
should be monitored, and a set of indicators to track progress towards universal coverage, is a
research task for health programmes in each country. Out of these investigations will emerge a
common set of indicators that can be used to measure and compare progress towards universal
health coverage across all countries. 2

UHC has been defined by the 2005 World Health Assembly as “access to key promotive,
preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby
achieving equity in access”.3 A key response by the Government has been the development of a
compulsory national health insurance scheme designed to pave the way for the achievement of
universal coverage. This scheme, known as Jaminan Kesehatan Nasional (JKN), seeks to make
comprehensive care available to the entire population by 2019. The JKN brings together all
major health insurance schemes (Askes, Jamkesmas, Jamsostek and Jamkesda) under a single
agency - the Social Security Management Corporation for the Health Sector (BPJS
Kesehatan).3 5

High government funding allocations to hospitals (less frequently utilised by poor and
disadvantaged communities) and elevated government spending on pharmaceuticals has also
reduced investment in primary and promotive health services. Indonesia spends only slightly
more than 2% of its GDP on health, approximately half the level of other comparable income

2
Cheng, “Universal Health Coverage: An Overview and Lessons from Asia.”
3
Pisani, Olivier Kok, and Nugroho, “Indonesia’s Road to Universal Health Coverage”; Wiseman
et al., “An Evaluation of Health Systems Equity in Indonesia.”

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 countries . About half of all health spending is public and one-third comes directly from of out
of pocket payments by households.5

THE IMPLEMENTATION SOCIAL SECURITY IN INDONESIA

The involvement of various parties in the Healthcare BPJS programs, such as the
President and Vice President, the Ministry of Health, BPJS, Hospitals, health centers, and the
active participation of the society, shows the importance of managing the JPINT program. The
problem arising in BPJS cannot sufficiently be overcome through coordination and cooperation
measures. More than that, the necessary actions are collaborations, with the active participation
of various interests with the same purpose. Some facts collected lead to the effort of
collaboration, based on the theory of collaborative governance.4

SOCIAL SECURITY IN THE UNITED KINGDOM

Each of the four countries of the United Kingdom has a publicly funded health care
referred to as the National Health Service (NHS). Following devolution in the United Kingdom
from 1998 onward, the control over the non-English services (other than those reserved to the
UK Parliament) was passed to the devolved national governments, with the UK Government
retaining control over the English NHS. The English NHS underwent a major reorganization in
the years after 2010 in the run-up to and passing of the Health and Social Care Act 2012. In
conducting the services for the people, NHS now manages their services through
collaboration. Lawrence et al. (1999:481) define collaboration as: “a cooperative, inter-
organizational relationship that relies on neither market nor hierarchical mechanisms of control
but is instead negotiated in an ongoing communicative process”. 4

This definition highlights the point that collaboration is not mediated through market
mechanisms, so that cooperation depends on an alternative to price structure, and importantly,
whereas hierarchies are associated with a willingness on behalf of members to submit to both
direction and monitoring of their superiors, collaboration involves the negotiation of roles and
responsibilities in a context where no legitimate authority, sufficient to manage the situation, is
recognized. The need to engage in collaborative behavior can be bserved at both individual and

4
Habibie, Hardjosoekarto, and Kasim, “Health Reform in Indonesia towards Sustainable Development Growth
(Case Study on BPJS Kesehatan, Health Insurance in Indonesia).”

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 organizational levels. The numerous driving forces and key motivations are generated from
within individuals and organizations, and as a result of factors and influences in the external
environment. Individual actors seek to promote forms of co-operative behavior for personal,
professional or work-related reasons.

For instance, many professionals are driven by an altruistic motivation believing that the
public interest or individual needs should be at the center of public service organization,
demanding integrated and coordinated frameworks of service planning and delivery. Some
organizations consider exchanging and sharing resources to achieve jointly agreed purposes and
benefits, to be more efficient in the use of resources and to promote learning and innovation.
Other motivations can be traced to external factors. For instance in the UK, central government
is particularly proactive in promoting a collaborative approach through a mixture of statutory
regulation and general exhortation, and in Wales, the notion of ‘partnership’ is enshrined in the
dominant policy paradigm underlying Welsh Assembly Government’s approach to the design
and delivery of public services.2 4

In the end the health BPJS in Indonesia has good intentions for the community but must
be paid attention to the direction of policies and political decisions from the government. BPJS
is very helpful with the principle

 Prinsip kegotong royongan.

 Prinsip nirlaba.
 Prinsip keterbukaan, kehati-hatian, akuntabilitas, efisiensi dan efektivitas.
 Prinsip portabilitas
 Prinsip kepesertaan bersifat wajib.
 Prinsip dana amanat.
 Prinsip hasil pengelolaan Dana Jaminan Sosial

For the Indonesian people, the health system can be relied on with better management going
forward to UHC 2019.

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 References

1. UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 40 TAHUN 2004 TENTANG

SISTEM JAMINAN SOSIAL NASIONAl
2. Cheng, “Universal Health Coverage: An Overview and Lessons from Asia.” VOLUME 4 –
GLOBAL HEALTH, MAY 2015
3. Pisani, Olivier Kok, and Nugroho, “Indonesia’s Road to Universal Health Coverage”; Health
Policy and Planning, 2017, Vol. 32, No. 2
4. Habibie, Hardjosoekarto, and Kasim, “Health Reform in Indonesia towards Sustainable
Development Growth (Case Study on BPJS Kesehatan, Health Insurance in Indonesia).” Review
of Integrative Business and Economics Research, Vol. 6, Issue 3 2017

5. Wiseman et al. International Journal for Equity in Health (2018) 17:138

https://doi.org/10.1186/s12939-018-0822-0
6. UU No.36 Tahun 2009 tentang Kesehatan
7. UU No.24 Tahun 2011 tentang BPJS
8. PP No.101 Tahun 2012 tentang PBI
9. Perpres No 12/2013 tentang Jaminan Kesehatan
10. BUKU PEGANGAN SOSIALISASI Jaminan Kesehatan Nasional (JKN) dalam Sistem
Jaminan Sosial Nasional
11. The Republic of Indonesia Health System Review. Asia Pacific Observatory on Health
Systems and Policies . Health Systems in Transition Vol. 7 No. 1 2017
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devolution:comparing experiences of decentralisation in Kenya and Indonesia. BMJ Glob Health
2018;3:e000939. doi:10.1136/ bmjgh-2018-000939
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in Indonesia: Private Health Sector Market in the JKN Era. Washington, DC: Palladium, Health
Policy Plus; and Jakarta, Indonesia: TNP2K.
14. 2017 Health SDG Profile: Indonesia
http://www.searo.who.int/entity/health_situation_trends/countryprofile_ino.pdf?ua=1.
15. Budi Hidayat et al. The effects of mandatory health insurance on equity in access to
outpatient care in Indonesia. HEALTH POLICY AND PLANNING; 19(5): 322–335

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Board (BKKBN), Indonesia Ministry of Health (Depkes RI), ICF International. Indonesia
demographic and health survey 2012. Jakarta, 2013.
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