Gemawan Association conducted a research on the implementation of national health insurance execution for the people in Pontianak City.
The findings of Gemawan’s research published directly by the researcher, Sri Haryanti, found that the implementation of health insurance in Pontianak City still has very complex problems.
Sri stated that health is the basic thing for every citizen guaranteed by the constitution and a country has an obligation to ensure the fulfilment of the right to health insurance for the society.
“We researched this with the aim of identifying problems with the JKN service program in the city of Pontianak. We also mapped the potential for fraud or corruption in the program implementation.” she said during a media briefing at Kanopy Cafe which was also attended by Ombudsman and BPJS Pontianak, Monday (11/9/2017).
Currently Sri mentioned that in Pontianak City, 65.63 percent of the population is JKN participants, both the beneficiary dues from APBN and none beneficiary dues.
There were still many issues found, from membership, human resources in providing services to frequent shortages of drug stocks, requiring patients to buy the medicines by themselves.
In fact, the worst thing was that there were still hospitals and health workers negligent to serve BPJS patients compared to general patients.
The results of Gemawan’s research on the users’ satisfaction of the National Health Insurance (JKN)/Social Security Agency (BPJS) in Pontianak City, found that three out of four patients they assisted in the Government Hospital owned by West Kalimantan province were dissatisfied with the services provided by the provincial hospital.
In addition, it was also explained by Sri Haryanti, from the side of Gemawan, that this dissatisfaction was because when using BPJS the service took longer compared to other general patients. The explanation was conveyed by her during the media briefing regarding the research findings on the implementation of health insurance in Pontianak City.
In fact, one out of four assisted patients felt less satisfied with the services provided because they still had to redeem medicines outside with quite high price.
In contrast to services in hospitals owned by the provincial government, the results of Gemawan’s research show that two of the two patients they assisted at the Puskesmas were satisfied with the services provided because they were in line with expectations.
“Out of the two patients assisted at Puskesmas were satisfied with the services provided.” she said.
She also added that two of all assisted patients felt lucky to be the participants of BPJS Kesehatan participants because if they were not the participants, they probably would not be able to pay for quite expensive treatment.
Sri Haryanti also conveyed that there are still government hospitals in West Kalimantan which provide discriminatory services to patients referred from Private Hospitals of Pontianak City.
She also explained that this was indicated by the slow treatment knowing that the patients were referred from a certain private hospital.
In addition, Gemawan’s research findings show the differences in treatment between general patients and BPJS Kesehatan patients. Even though she also conveyed that not all doctors and health workers had the same treatment to the patients of BPJS.
Besides conducting a research on the patients of JKN users, Gemawan also collected data from healthcare workers. Sri said that three out of three doctors and 2 nurses who became their respondents revealed that the tariff charged in INA CBGs system carried out by BPJS were so low. In fact, it frequently did not match with the treatment given to the patients.
Therefore, the hospital had to outsmart in various ways to cover the shortage of tariffs included in the package. Because if it was not done, the hospital will suffer a loss.