62.22% of Indonesia's Population Has National Health Insurance (BPJS Kesehatan); Here's a List of 21 Untreated Illnesses

The Central Statistics Agency (BPS) reported that 69.62% of Indonesia's population had health insurance in 2021, a 1.26 percentage point increase from 2020. Of this number, 62.22% of the domestic population had health insurance from BPJS Kesehatan.

Health insurance is a guarantee provided to ensure participants receive health maintenance benefits. Furthermore, the community receives protection in fulfilling basic health needs in accordance with Law No. 40 of 2004 concerning the National Social Security System.

Meanwhile, the government will increase the payment rates for the National Health Insurance Agency (BPJS Kesehatan) to hospitals. These rates cover the BPJS Kesehatan payment method to hospitals through a per-episode healthcare package system or Indonesian Case Based Group (INA CBGs).

The government has decided to increase the compensation rate to BPJS partner hospitals by 30% as of December 2022. The rate increase will also be accompanied by increased benefits with the addition of several covered illnesses. The added benefits include screening for several diseases.

"We are adding preventive benefits for 14 diseases," said the Head of the Communication and Public Service Bureau of the Ministry of Health, Siti Nadia Tarmizi, as reported by *Katadata.co.id* on Wednesday (30/11).

The 14 diseases that will be covered are colon cancer, cervical cancer, breast cancer, childhood cancer, lung cancer, stroke, heart attack, diabetes mellitus, and hypertension. Other covered diseases include anemia screening, thalassemia, congenital hyperthyroidism, non-infectious lung disease, and tuberculosis.

BPJS Watch Advocacy Coordinator Timboel Siregar stated that many hospitals still charge additional fees to BPJS participants. Timboel noted that 12% of BPJS Kesehatan participants had to pay additional fees when receiving services at hospitals.

Another case involved a hospital in DKI Jakarta that downgraded Class I patients to Class III services but claimed Class I service fees to BPJS Kesehatan. Timboel believes that adjusting the Indonesian Case Based Group or INA CBGs rates is important because the last adjustment was in 2016.

Presidential Regulation Number 18 of 2018 stipulates that INA CBGs must be adjusted every two years. For information, INA CBGs is the system used by hospitals to claim the costs of treatment and care incurred for BPJS Kesehatan patients to BPJS.

The following are the healthcare services and illnesses not covered by BPJS Kesehatan:

1. Healthcare services that do not comply with the provisions of applicable regulations;
2. Healthcare services provided at healthcare facilities that do not cooperate with BPJS Kesehatan, except in emergencies;
3. Healthcare services for illnesses or injuries resulting from workplace accidents or work-related incidents already covered by the work accident insurance program or the responsibility of the employer;
4. Healthcare services covered by mandatory traffic accident insurance programs up to the value covered by the traffic accident insurance program according to the participant's class of care;
5. Healthcare services performed abroad;
6. Healthcare services for aesthetic purposes;
7. Services to address infertility;
8. Teeth straightening or orthodontic services;
9. Health disorders/diseases resulting from drug and/or alcohol dependence;
10. Health disorders resulting from self-inflicted injury or from engaging in dangerous hobbies;
11. Complementary, alternative, and traditional medicine that has not been declared effective based on health technology assessment;
12. Medical treatment and procedures categorized as experimental; contraceptives, cosmetics;
13. Household health supplies;
14. Healthcare services due to disasters during emergency response, extraordinary events/epidemics;
15. Healthcare services for preventable unexpected events;
16. Healthcare services provided as part of social service;
17. Complementary medicine;
18. Healthcare services resulting from criminal acts of assault, sexual violence, victims of terrorism, and human trafficking, in accordance with applicable regulations;
19. Certain healthcare services related to the Ministry of Defence, the Indonesian National Armed Forces, and the Indonesian National Police;
20. Other services unrelated to the provided Health Insurance Benefits;
21. Services already covered by other programs.