Health Social Security in the Health Bill: Centralization of Social Security Administration on a Single Actor

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The PRAKARSA - The Health Bill has entered the socialization stage by the Ministry of Health as a manifestation of efforts to improve access to health services for the community. This bill will abolish 9 laws related to health and changes to several articles in 13 laws including Law number 40 of 2004 concerning the National Social Security System and Law number 24 of 2011 concerning Social Security Administering Bodies. Adjustments to several articles in the two laws contain several aspects of improving health insurance including social health insurance for workers who are not registered by employers, increasing the treatment time limit indefinitely according to patient medical needs, and the absence of a maximum quota of BPJS patients handled at the hospital. .

The PRAKARSA welcomes changes to 2 of the National Health Insurance Law in the Health Bill as a form of the government's commitment to improving the health situation of the Indonesian people. “However, if you look closely, especially at the changes in the articles in the two laws regarding national social security (No. 40 of 2004 concerning SJSN and 24 of 2011 concerning BPJS), this bill has the potential to centralize the management of national health social security in Indonesia. Ministry of Health”, said Darmawan Prasetya, social policy researcher at The PRAKARSA.

Darmawan explained that this centralization could be seen from several articles of amendment. First, article 425 paragraph 11 regarding changes to article 37 in Law Number 24 of 2011 concerning BPJS which regulates the obligation of BPJS to report annual performance results to the President through the Ministry of Health, is known to DJSN. This situation has led to a longer flow of supervision to BPJS Health because so far BPJS Health has been overseen by the OJK, BPK and DJSN as carrying out the mandate for BPJS supervision. Second, the role of the Ministry of Health is also expanding if we look at the process of terminating the collaboration between BPJS Health and hospitals regulated by the Health Bill in article 424 paragraph 5 concerning changes to article 23 of Law Number 40 of 2004 concerning SJSN. There will be a conflict of interest if hospitals and BPJS Kesehatan are both supervised by the Ministry of Health.

Third, the involvement of the Ministry of Health in managing BPJS Health through the National Health Insurance Program has the potential to disrupt the independence of BPJS Kesehatan in managing trust funds. These funds are collected from premiums paid by each participant. The involvement of the Ministry of Health in managing BPJS for Health has the potential to confuse the management of trust funds at BPJS Kesehatan with the state budget in financing the national health insurance program, which has actually been separated so far. But Darmawan also reminded that on the other hand, this bill needs to encourage increased transparency of trust funds to the public. Article 425 paragraph 11 in the Health Bill regulates public reporting of trust funds managed by BPJS Health, but BPJS Health is only required to submit it in the form of an executive summary. "We propose that the reporting of trust funds be carried out in a more complete manner and not only in the form of an executive summary so that it is more transparent to the public," said Darmawan closing the conversation.

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