Interview: Fachmi Idris
What challenges are posed in terms of customer satisfaction and access to the UHC programme?
FACHMI IDRIS: The satisfaction of our members is very important, but also one of our biggest challenges. The UHC programme is very ambitious, and the government has set the target of covering the entire Indonesian population by January 1, 2019. We began this process in 2014. We recognise that it is not easy to be the biggest single-payer institution in the world for social insurance.
Of course, satisfaction needs to be ensured in all the offices and health facilities managed by BPJS Kesehatan. The first concern is to set up online registration and a customer feedback and complaints system. Another concern relates to strengthening the primary health care system. We need to organise the community and government institutions so that they work together in close collaboration to ensure the Indonesian population understands the importance and benefits of joining the programme. UHC is not only about how to provide the best service for the community, but also changing the mindset of the population. With this system, we implement the managed care concept and follow the correct procedures, ensuring that patients see a family doctor and go to a puskesmas (public health centre).
How can financial sustainability be ensured?
IDRIS: To ensure financial sustainability we have to first prioritise risk prevention, because for social health insurance to be successful we need people to be in a healthy condition. Prevention strategies will relieve financial pressure from the programme. We also need to enhance the collection of contributions and provide an enabling environment for our members to make their contributions and have easy access to do so.
We have also begun to enforce the law, which requires all companies to be members of the programme. We are still in the process of ensuring that individual members comply with the programme, and in terms of law enforcement we need hospitals and care providers to comply with our regulations, especially in order to prevent fraud. Lastly, we have to focus on our core business, which is to control the costs and the quality of health care services.
What kind of synergies can be found between the UHC programme and private insurance providers?
IDRIS: If you talk solely about health insurance, double costs are not an issue. Companies that have two schemes are required to join the social programme, but can still have their own private health insurance scheme. In Indonesia, as we are in a transitioning period, companies always raise the issue of having double costs and downgraded services.
To solve this we propose and provide the coordination of benefits. We need to have private health insurance providers as partners, but we won’t deal with them directly, we will deal with our potential members, which are the private companies that need to register on behalf of their employees. There is a clear benefit for the private insurance providers, because they can share risk with BPJS Kesehatan. If the patients follow our system and go to our provider first, either a family doctor, puskesmas or outpatient clinic, the private insurer won’t spend any money.
Additionally, the implementation of the UHC programme is increasing the general level of awareness and knowledge regarding the benefits of being insured. The mindset of the Indonesian population towards paying in advance to be protected and insured has clearly improved since 2014, and this is not an easy thing in a country with low insurance penetration like Indonesia. When the population is shown that by paying $2 to become a member of BPJS Kesehatan they can have all their health care needs met at one institution, they begin to understand the benefits. Even though there is still a long way to go, awareness has already progressed significantly and has spread to the community, and it will benefit the private insurance providers.
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