Jakarta, The PRAKARSA - The government officially changed BPJS classes 1, 2 and 3 to Standard Inpatient Health Classes (KRIS). KRIS will come into effect in all hospitals no later than June 2025.
This policy was welcomed by civil society organizations, one of which was the Public Policy Research and Advocacy Institute PRAKARSA. The reason is The PRAKARSA has pushed for a standard class policy in the National Health Insurance since the SJSN was first legalized. Then, in 2020 this idea was conveyed again in the Public Consultation Webinar on the Concept of JKN Inpatient Policy which was organized by the National Social Security Council (DJSN) of the Republic of Indonesia, in September 2020.
After almost five years of the process of realizing the JKN standard class, the Indonesian Government has finally ratified the Standard Inpatient Class (KRIS) policy through Presidential Regulation (Perpres) Number 59 of 2024, Third Amendment to Presidential Regulation Number 82 of 2018 concerning Health Insurance, which came into effect as of May 8, 2024.
The Executive Director PRAKARSA, Ah Maftuchan saw that there were six main problems that were addressed by the KRIS policy.
"KRIS can eliminate the stigmatization of the poor and underprivileged classes of JKN-PBI participants, eliminate discrimination in health services, eliminate disparities in the availability of health facilities (including the number of beds) between classes - "rich class X poor class", equalize the quality of health facilities and health services, as efforts to achieve 100% universal health coverage (UHC), and finally can provide "incentives" for the development of the business world." Maftuch said
The six main issues are also based on research findings PRAKARSA 2017 regarding Health Equity for the Poor and Near-Poor in Indonesia (JKN). This research shows that the implementation of JKN in hospitals/PUSKESMAS/clinics faces obstacles such as inadequate facilities, poor service quality, and incomplete types of services. Apart from that, the issue of access to services such as transportation to health services makes it increasingly difficult for people to get health services.
PRAKARSA Seeing that the implementation of KRIS as regulated in the Presidential Regulation is a step forward towards realizing equitable access to health insurance for the Indonesian people.
PRAKARSA also appreciates the National Social Security Council (DJSN) for opening a space for dialogue with non-government actors in the process of preparing policies and implementing this Inpatient Standard Class.
"The involvement of civil society groups in the process of formulating KRIS policies is a concrete form of multi-sector collaboration that can encourage the realization of evidence-based policies in Indonesia," added Maftuch.
On the other hand, PRAKARSA Seeing the KRIS policy is not the end of efforts to improve JKN justice for society. Maftuch emphasized that the implementation of KRIS with standard class should be equivalent to class 2 service.
"The implementation of KRIS can have two real impacts, namely: the risk of increasing contributions and the risk of losing BPJS Health participants, especially those who have previously joined class 1," emphasized Maftuch.
The risk of increasing fees needs to be considered as an impact of implementing standard classes. The risk of increasing fees will have an impact on vulnerable and poor groups, most of whom are in class 3. Therefore, the determination of class fees that are decided to become the KRIS standard should not be too high, such as for class 1, because this could lead to a significant increase in class 3 fees. especially independent participants.
However, the maximum implementation of the standard class according to class 2 is 5 years, because there is a risk of decreasing membership, especially for JKN Class 1 participants who have paid more. Standardization to class 2 could make this class segment reluctant to continue participating in BPJS Health and the standards taken in KRIS must be raised.
Then, raising class standards after implementing KRIS must also be supported by easy access to health services such as easily accessible health facilities and the availability of supporting transportation.
The government also needs to provide support to civil society organizations that provide health services. This effort needs to be made, because health service providers, especially those not managed by the government, will have difficulty in realizing the mandate of this regulation. This needs to be done before there is an obligation to implement the KRIS system in all health facilities in Indonesia as of June 30 2024.