June 18, 2024
JAKARTA – Indonesia may lose thousands of hospital beds once standardized inpatient care for National Health Insurance (JKN) policyholders goes into full effect starting next year, raising concerns over longer hospital admission waiting times for millions of patients.
President Joko “Jokowi” Widodo issued a decree last month mandating all hospitals affiliated with the state insurance to provide standardized wards for all policyholders by June 30 of next year.
JKN policyholders are currently entitled to three different classes of inpatient care based on their monthly premium. But under the new system, called Standard Inpatient Class (KRIS), there will only be a single inpatient class, which can house up to four patients and be supported with a certain set of facilities.
The decree, aimed at ensuring equitable and high-quality medical services for JKN policyholders, requires all government-affiliated hospitals to implement the single-class ward in at least 60 percent of their total rooms. Meanwhile, private hospitals will only be obliged to ensure 40 percent of their rooms meet the standards.
But the new system may reduce the number of hospital beds by 23,227 as healthcare facilities are required to scale down their inpatient wards from the capacity of up to eight to four, said Deputy Health Minister Dante Saksono.
This figure accounts for roughly 9 percent of the current total hospital beds under the JKN system of around 253,100 beds.
[President signs order on equitable healthcare services::/indonesia/2024/05/13/president-signs-order-on-equitable-healthcare-services.html]
But Dante gave an assurance that the reduced number would not affect policyholders’ access to treatment or admissions.
“Based on our data, the average bed occupancy rates in the government-owned hospitals only range between 50 and 60 percent,” the deputy minister said on June 6 during a meeting with House of Representatives Commission IX overseeing health and manpower.
He further reassured that the hospital bed to population ratio would stand at 1.3 per 1,000 people after the implementation of KRIS, still meeting the recommended threshold set by the World Health Organization (WHO) of 1 bed per 1,000 population.
Capacity concerns
Commission IX lawmaker Irma Chaniago of the NasDem Party was skeptical about Dante’s claim, saying that she heard complaints from her electoral district in South Sumatra that patients struggled to get admitted to hospitals due to a lack of capacity, even if some hospitals have a ward that can house up to 12 patients.
“Imagine how much more difficult it would be for patients to get treatment if the hospitals were forced to scale down their wards from having 12 beds to four,” she said.
Lawmaker Edy Wuryanto of the Indonesian Democratic Party of Struggle (PDI-P) shared a similar concern, citing as an example a constituent in his electoral district in Central Java who had to wait a prolonged period to undergo an operation for his brain tumor.
For years, Indonesia has been struggling with hospital under-capacity, particularly in remote areas, which hinder treatments during health emergencies.
During the recent outbreaks of dengue fever across the archipelago, hospitals in several regions struggled to cope with the influx of patients, forcing doctors to treat patients in hallways or in wheelchairs.
Health Ministry spokesperson Siti Nadia Tarmizi stressed that there would not be significant loss of hospital beds after the KRIS implementation.
“We’ll add more rooms in the government-owned hospitals to treat more patients,” Siti said on June 11. “Besides, we’ll also have a lot of additional beds in private hospitals as they turn their single- or double-bed hospital rooms to the standard inpatient wards.”
Aside from the reduced hospital beds, observers were also concerned that the new system would inevitably lead to an increase in JKN premiums.
Currently, the JKN premiums for formal workers are 5 percent of their monthly paycheck, co-paid by the workers and their employers. Meanwhile, informal workers pay between Rp 35,000 (US$2.12) and Rp 150,000 per month depending on the service class they choose.
The government also fully subsidizes the third-class policy for unemployed policyholders and people from low-income families under a contribution assistance scheme (PBI).
Some 272 million Indonesians, 97 percent of the total population of 280 million, are enrolled in the JKN program, according to data from the National Social Security Council (DJSN).