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Abstract
Abstract: The purpose of this study is to conduct measurements of the of Indonesians in the National Health Insurance (JKN) in 2020-2021. Indonesia, as of now, implements a national health insurance service since 2014. It is expected that JKN will expand its coverage to achieve universal health coverage (UHC) in Indonesia. BPJS Kesehatan (BPJS-K) was appointed as the administrator of JKN and had experienced deficit until 2019. One of the weaknesses of JKN in revenue collection is the absence of cross subsidy and pegged contribution in certain level of income that makes the contribution very low for the rich and vice versa for the poor. this, the current study is to increase public awareness that JKN is a cross-subsidy between the rich and the poor in order to produce a more sustainable JKN, better healthcare coverage, and better quality. The methods used in the study are quantitative and qualitative analyses using expenditure data from SUSENAS (National Socio-Economic Survey) data in March 2021 and income analysis from SAKERNAS (National Labor Survey) data in March 2021 to measure the ability to contribute to JKN proportional to their spending and income. In this study several simulations were used to calculate potential contributions based on the percentile distribution of accumulated income levels and expenditure levels of the poorest (0%) and richest (100%). The result of this study shows that 75% of the population had the ability to contribute JKN above the class 3 (informal workers) percapita per month premium (Rp. 42,000,-), 40% of the population has the ability to contribute more than Rp. 100,000, - percapita per month (class 2 informal workers contribution), and the richest 10% of the population has the ability to contribute above Rp. 215,000, - percapita per month. The results of this study demonstrate that some people have the ability to contribute more to JKN, thus making JKN to have a better sustainable financial capacity.
Keywords: ability-to-contribute; JKN; income level; spending; increasing rate
Abstrak: Tujuan kajian ini adalah menghitung kemampuan mengiur (ability-to-contribute) penduduk Indonesia untuk Jaminan Kesehatan Nasional (JKN) pada tahun 2020-2021. Indonesia mengimplementasikan sistem jaminan sosial sejak 2014 yang diharapkan ke depannya JKN tersebut akan lebih luas cakupannya untuk mencapai cakupan kesehatan semesta (Universal Health Coverage/UHC). Namun BPJS Kesehatan (BPJS-K) yang ditunjuk sebagai penyelenggara JKN masih mengalami defisit hingga pada tahun 2019. Salah satu kelemahan JKN dalam pengumpulan iuran adalah masih kurangnya subsidi silang dan kontribusi dipatok pada pendapatan tertentu membuat kontribusi sangat rendah bagi si kaya dan sebaliknya bagi si miskin. Maka kajian ini untuk meningkatkan kesadaran penduduk untuk meningkatkan kontribusinya ke JKN dengan subsisi silang antara si kaya dan si miskin agar dapat menciptakan JKN yang lebih berkesinambungan, cakupan kepesertaan yang lebih luas, dan perbaikan mutu layanan. Metode yang digunakan dalam kajian ini adalah metode kuantitatif dan kualitatif dengan analisis pengeluaran menggunakan data SUSENAS (Survei Sosial-Ekonomi Nasional) Maret 2021 dan analisis pendapatan menggunakan data SAKERNAS (Survei Tenaga Kerja Nasional) Maret 2021 untuk mengukur kemampuan individu dalam membayar iuran JKN sebagai proporsi dari pengeluaran pendapatan mereka. Dalam kajian ini beberapa simulasi digunakan untuk menghitung kontribusi potensial berdasarkan persentil distribusi akumulasi tingkat pendapatan dan tingkat pengeluaran penduduk dari termiskin (0%) dan terkaya (100%). Hasil dari kajian ini adalah sebanyak 75% penduduk mempunyai lebih besar dari iuran peserta bukan penerima upah (PBPU) kelas 3 per orang per bulan (Rp. 42.000,-), 40% penduduk mempunyai kemampuan mengiur lebih besar dari Rp. 100.000,- per orang per bulan (setara iuran PBPU kelas 2 per orang per bulan), dan 10% penduduk terkaya mempunyai kemampuan mengiur lebih besar dari Rp. 215.000,- per orang per bulan. Dari hasil kajian ini ditemukan bahwa sebagian orang mempunyai kemampuan mengiur untuk berkontribusi lebih untuk JKN, sehingga JKN dapat mempunyai kapasitas keuangan berkelanjutan yang lebih baik.
Kata kunci: kemampuan mengiur; iuran JKN; tingkat pendapatan; pengeluaran; kenaikan iuran
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References
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References
BPS (2022) Beberapa Laporan BPS.
Bredenkamp, C. and Buisman, L. (2015) ‘Universal Health Coverage in the Philippines: Progress on Financial Protection Goals’, World Bank Policy Research Working Paper [Preprint], (7258). doi:10.1596/1813-9450-7258.
Busse, R. et al. (2017) ‘Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition’, The Lancet, 390(10097), pp. 882–897. doi:10.1016/S0140-6736(17)31280-1.
Culyer, A.J. and Newhouse, J.P. (2000) Handbook of Health Economics 1A. Volume 1A. Elsevier B.V.
Dutta, A. (2013) Scaling Up National Health Insurance in Nigeria Learning from Case Studies of India, Colombia, and Thailand. doi:10.13140/RG.2.1.4994.4566.
Hidayat, B. (2021) ‘Translate JKN Policies into JKN Financial Modeling (JFM) and Investigate Their Impact’, in USAID-Health Financing Activity, p. 32.
Jakubowski, E. and Richard, S.B. (2013) ‘The Changing National 29 Role in Health System Governance’, The European Observatory on Health Systems and Policies, 29, pp. 1–74. Available at: http://www.euro.who.int/__data/assets/pdf_file/0006/187206/e96845.pdf.
Lind, D.A., Marchal, Wi.G. and Wathen, S.A. (2019) Basic Statistics for Business & Economics. Ninth Edit. McGraw-Hill.
Ministry of Health and Welfare Taiwan (2022) Taiwan National Health Insurance Administration. Available at: https://www.nhi.gov.tw/English/ (Accessed: 24 February 2022).
Muttaqien, M. et al. (2021) ‘Why did informal sector workers stop paying for health insurance in Indonesia? Exploring enrollees’ ability and willingness to pay’, Plos One, 16(6), p. e0252708. doi:10.1371/journal.pone.0252708.
NHIS (2021) Korea NHIS Contribution. Available at: https://www.nhis.or.kr/english/wbheaa02500m01.do (Accessed: 25 June 2021).
Permenkes No. 28 (2014) ‘Tentang Pedoman Pelaksanaan Program JKN’, p. 48.
Perpres No. 64 (2020) Tentang Jaminan Kesehatan.
Perpres No. 75 (2019) Perpres No. 75 Tahun 2019 Tentang Perubahan Atas Perpres No. 82/2018 Tentang Jaminan Kesehatan. Available at: https://bpjs-kesehatan.go.id/bpjs/dmdocuments/e277a92bde56b8d855c9d8cc9cefa2ab.pdf.
Pratama, W.P. (2021) BPJS Kesehatan Surplus untuk Pertama Kali, Ini Sebabnya, 8 February. Available at: https://finansial.bisnis.com/read/20210208/215/1353812/bpjs-kesehatan-surplus-untuk-pertama-kali-ini-sebabnya (Accessed: 23 February 2022).
Putusan MA 7 (2020) ‘Putusan MA No. 7 P/HUM’.
UU No. 24 (2011) ‘Tentang BPJS’, p. 20.
UU No. 40 (2004) Tentang SJSN.
Wu, T.-Y., Majeed, A. and Kuo, K.N. (2010) ‘An overview of the healthcare system in Taiwan’, London Journal ofPrimary Care 2010, p. 5