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Expert presented by the Government Hasbullah Thabrany who also a professor of Community Health Faculty of Universitas Indonesia was delivered his expertise at judicial review session on UU BPJS, Monday (7/4) at Plenary Room, the Constitutional Court Building.

 

 

A judicial review session on Act of the Healthcare and Social Security Agency (Undang-Undang BPJS Kesehatan) was again held for the seventh time. It was filed by two companies, two insurance companies, and two Indonesian citizens as workers. On this session, the Government presented an expert and two witnesses that stated the Healthcare and Social Security Agency was helpful to people who needed healthcare services. The session was also attended by President Director of the BPJS Fachmi Idris as Related Parties (Pihak Terkait).

Beginning the session on case No. 138/PUU-XII/2014, a professor of Community Health Faculty of Universitas Indonesia Hasbullah Thabrany delivered his explanation as expert from the Government party. Hasbullah said that the BPJS Kesehatan is a healthcare services agency that is monopsony. According to Hasbullah explanation, monopsony is defined by having great buying power, rather than selling. Therefore, it was reasonable if the BPJS Kesehatan is the only one healthcare service agency for all Indonesian citizens..

According to Hasbullah, the BPJS Kesehatan was established to handle the failure of private healthcare services (private insurance, red). Private insurance providers, according to Hasbullah, cannot guarantee people who had certain diseases. For example, people with heart disease or possessed a family record of heart disease were cannot be served by private insurance providers.

Hasbullah was also said that poor people who cannot afford private insurance and elderly people were also cannot be guaranteed by private insurance providers. “This is a market failure, the failure of guarantee entire citizens. On the other hand, Article 28H (1) the 1945 Constitution is noted that every citizen have healthcare services rights. And on Article 34 (2) stipulated that the state shall develop social security to every citizen. Every citizen, means people with chronic disease, poor people, and or elderly people shall guaranteed. This is impossible to be conducted by market mechanism,” explained Hasbullah. 

Free Medical Cost

Hasbullah statements were justified by two witnesses presented by the Government. First witness was Chandra Ariati Dewi, well-known as Ria Irawan. The actress who suffered with cervical cancer and lymph nodes cancer was explained that her medical treatments is conducted using the BPJS Kesehatan facilities. 

Earlier, Ria Irawan once used private insurance to pay her medical treatments at several domestic and foreign hospitals. However, the private providers stated cannot bear the insurance after they figured out her diseases.          

At last, Ria Irawan registered on the BPJS Kesehatan program on August 2014 as class 1 independent member. After getting the membership, Ria followed every terms and procedures of the BPJS Kesehatan utilization until she conducted uterus removal on September 30 2014. Ria said that until chemotherapy process she had to do, she didn’t spend any money after she used the BPJS Kesehatan.

Similar statement was also delivered by the Government’s witness Yani Hanifah. She said the BPJS Kesehatan had helped her to finance his son treatments who suffered from hemophilia. Before registered the BPJS, Yani said that she used the public health insurance program called the Jamkesmas. To gain the Jamkesmas, Yani should manage and followed complex procedures. However, she felt easier after registered on the BPJS Kesehatan because by paying dues she was able to be served at the hospitals.

Yani was also expressed her disappointment after she previously registered as private insurance members. It was because the private insurance aforementioned only bear the ward cost, while the medication cost of her son was didn’t covered by the insurance. Whereas, her son’s disease could caused hemorrhage at anytime. “I am greatly helped by this program. The number of people with hemophilia is indeed not many, but we –family with hemophilia– is also has equal rights to struggle for health,” said Yani.     

Coordination of Benefits

Fachmi Idris as President Director of the BPJS was also presented at the session to answer questions asked by Constitutional Judge Patrialis Akbar. Earlier, Patrialis asked the information validity about the BPJS cooperation with great insurance companies. “Why only cooperates with great insurance companies? Meanwhile, the Applicant in their petition states that during this time they had focused to help people in the implementation of people’s health services?” asked Patrialis. .

Answering the question, Fachmi Idris confirmed there was a coordination of benefit (COB) between the BPJS Kesehatan with additional private insurance. The provision was stipulated on the Government Regulation (Peraturan Presiden –Perpres) No. 12 Year 2013 of Healthcare Insurances. The COB is an underwriting process (payer) for the same health insurance benefits. By the COB, there were benefit limitation at certain amount that did not exceeded the amount of health services expensed. By the COB, there were two parties who pay the medical claim bills.   

By the COB, the BPJS Kesehatan members who wanted to increase their class could raise their privileges by following additional health insurances and pay the margin of the cost that was not covered by the BPJS. “Other insurances agencies (private insurances agencies, red) can cooperate with the BPJS Kesehatan as long as appropriate with the provision,” said Fachmi answered Patrialis’ question. (Yusti Nurul Agustin/Prasetyo Adi N.)

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