Improve the quality of BPJS healthcare services through KRIS

So (the class system) is not abolished, but the standards are simplified and the quality is increased,

Jakarta (MidLand) – Standard hospital classes (KRIS) are starting to be gradually implemented throughout the hospital network in collaboration with the Health Social Security Administering Agency (BPJS).

Presidential Regulation (Perpres) Number 59 of 2024 relating to health insurance dated 8 May 2024 establishes 12 standard criteria for hospital services by 30 June 2025.

Article 46A of the Presidential Decree requires 12 criteria for treatment facilities and hospital services, including sturdy building components without a high level of porosity, air ventilation and good room lighting.

Apart from this, there are also bed equipment that provides at least two sockets and a tool to call a nurse. So the room temperature is between 20 and 26 degrees Celsius.

In addition to this, service facility providers must also divide treatment rooms based on the gender of the patient, child or adult, as well as infectious and non-infectious diseases.

The treatment room must be divided in an optimal way considering the ideal density in a room containing a maximum of four beds and providing curtains between the beds.

In the treatment room there are toilets that comply with accessibility standards also for disabled people Jack oxygen that meets the requirements to ensure patient safety.

The implementation of KRIS is a mandate of law number 40 of 2004 concerning the National Social Security System (SJSN). The goal is to provide equal healthcare facilities and services for BPJS Health participants.

The implementation of KRIS has started from 2022 through a trial phase in several vertical hospitals (RSs) of the Ministry of Health, including Dr. Sardjito in Yogyakarta, Pongtiku Hospital in North Toraja and Reksodiwiryo TNI AD Hospital in Padang, West Sumatra.

Furthermore, in February 2023, the Ministry of Health completed the KRIS trial investigation in 2,531 of the total 3,122 national hospitals.

As a result, respondents from hospital leadership circles agreed with 6-9 of the 12 required KRIS criteria. Most interviewees found it difficult to meet the needs of oxygen supply and provision of special independent rooms for people with disabilities.

Furthermore, for the implementation of the KRIS, the amount of contributions and the rates of hospital services still need to be reformulated.

Article 103B point 2 of the Presidential Decree emphasizes that hospitals can provide some or all KRIS services according to their capabilities by June 30, 2025.

There is no abolition of the class system

In the last few days since the publication of the presidential decree, digital tracks have recorded debates on the narrative “KRIS abolishes the BPJS healthcare class system”.

Some speculations say that the KRIS system in Presidential Decree no. 59 of 2024 directs inpatient services for BPJS Health patients to a treatment room with up to four beds and 12 room criteria.

This means that BPJS health card holders are provided with only one class (unique class) which is called KRIS. Meanwhile, those who wish to switch to non-BPJS classes of healthcare services must cover the difference in the cost of care services through independent portfolios, private insurance or the company where they work.

However, BPJS Health denied this narrative. The reason is that there is not a single clause in the presidential decree that includes the removal of the class system from BPJS health services.

BPJS Health Chief Director Prof. Ghufron Mukti confirmed that class 1, 2 and VIP levels and contribution rates are still valid.

“If participants want treatment in a higher class, this is allowed. Of course these are non-medical treatments. That’s right, there are still standard classes, there are class 2, class 1, there is VIP class. However , Again, this is a non-medical problem,” he said.

The implementation of KRIS occurs in phases. Of course, during this phasing process, class 1, 2, and 3 services continue to function.

Regarding the tariffs and technical implementation of KRIS they will be further regulated by the Regulation of the Ministry of Health (Permenkes).

Health Minister Budi Gunadi Sadikin said that the health regulation that will be issued is aimed at simplifying services and raising the quality of hospital care standards.

“So, it is not removed, but rather the standards are simplified and the quality is increased. So now there is class three, everyone has moved to class two and class one. So now it is simpler and the public service is better ,” he said.

Taking into account the growth of JKN membership

As of May 1, 2024, health insurance based on community mutual cooperation funds has registered the number of participants in the JKN program reaching more than 272 million people, which is approximately 97.27% of the total population of Indonesia.

The current membership composition consists of more than 151.78 million Contribution Assistance Recipient (PBI) participants, 111.03 million more PBI APBN participants, 40.76 million more PBI APBD participants, and 96.97 million non-PBI people.

Universal health coverage (Universal health coverage/UHC) as a guarantee system for access to care and health services for the population has reached 22 provinces and 334 districts/cities in line with the degree of community satisfaction with the services provided.

In response to this, the head of the Communications and Public Services Office of the Ministry of Health, Siti Nadia Tarmizi, confirmed that the technical regulations related to KRIS also take into account the growth of JKN members.

The Regulation of the Minister of Health, which is a derivative regulation of the Presidential Decree on Health Insurance, will certainly regulate the guaranteed access to hospital services for BPJS health card holders, including adjustments to participants’ contributions.

Guaranteeing access to hospital services is achieved by committing private hospital managers in all regions to allocate at least 30% of the number of beds provided to BPJS Health patients.

Meanwhile, at the government hospital level, at least 60% of services are allocated to BPJS Health patients.

Not only that, this year the Ministry of Health completed the construction of four vertical hospital units to increase patient capacity in line with the implementation of KRIS.

The four new hospitals built this year are UPT Vertical Hospital (RS) Surabaya in East Java, UPT Vertical Hospital Makassar in South Sulawesi, Vertical Hospital Capital Archipelago (IKN) in East Kalimantan and Vertical Hospital Jayapura in Papua .

The Ministry of Health regulation currently being drafted will determine the success of the KRIS implementation. Efforts to increase equality in health services need to be studied in a more technical way without sacrificing the rights of patients and service managers.

Publisher: Achmad Zaenal M

Publisher: Achmad Zaenal M
Copyright © MidLand 2024

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