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Abstract

The deficit deserves to be considered a chronic JKN disease. Indications of the deficit are revealed from the claims ratio figures. In 2014 and 2015, the claims ratio was consistently above 100%. This figure results from dividing claim costs (or participant health costs) by contribution income. Thus, the claims ratio describes the absorption of contribution funds for health costs only. However, contribution income must also be allocated for operational expenses and reserves. The JKN deficit will continue to grow if systemic therapy is nil. For 2016, the author's estimation results by referring to the assumed contribution amounts by Presidential Regulation No. 28/2016 (Cabinet Secretariat, 2016) and service rates in Minister of Health Regulation 59/2014 (Minister of Law and Human Rights, 2014) found a claim ratio of 101%. This means that contribution income still needs to be increased, even if only to fund health services. Where do the funds come from to fund operational costs? Does JKN only rely on government funding injections? The label of chronic deficit disease deserves to be carried by JKN. What is the cure?

Bahasa Abstract

Defisit layak disandang sebagai penyakit kronis JKN. Indikasi defisit terungkap dari angka rasio klaim. Pada tahun 2014 dan 2015 angka rasio klaim selalu berada diatas 100%. Angka ini merupakan hasil pembagian biaya klaim (atau biaya kesehatan peserta) dengan pendapatan iuran. Dengan demikian rasio klaim menggambarkan penyerapan dana iuran untuk biaya kesehatan saja. Padahal pendapatan iuran juga harus dialokasikan untuk biaya operasional dan cadangan. Defisit JKN akan terus bergulir jika terapi sistemik nihil. Untuk tahun 2016, hasil estimasi penulis dengan merujuk pada asumsi besaran iuran sesuai Peraturan Presiden No 28/2016 (Sekretariat Kabinet, 2016) dan tarif pelayanan Permenkes 59/2014 (Menteri Hukum dan Hak Asasi Manusia, 2014) menemukan angka rasio klaim 101%. Artinya, pendapatan iuran masih kurang meski hanya untuk mendanai pelayanan kesehatan. Dari mana sumber dana untuk mendanai biaya operasional? Apakah JKN hanya mengandalkan suntikan dana pemerintah? Label penyakit kronis defisit layak disandang oleh JKN. Apa obatnya?

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