KPK deputy for prevention Pahala Nainggolan said BPJS Kesehatan could cut the cost of cataract operations, which in 2018 came to Rp 2 trillion.“Because there is no guideline on how severe the eye blurring must be, people just went to get the cataract treatment, even when their eyes weren’t that blurry,” Pahala said.He said the government should limit claims for diseases caused by “unhealthy lifestyles”, which he said included diabetes, cancer, strokes and kidney failure. The bill for these diseases in 2018 came to Rp 28 trillion, or around 30 percent of the year’s total claims.The government could save Rp 2.8 trillion by limiting these claims, he said.BJPS Kesehatan should fully enforce the requirement that customers pay 10 percent of the bill, especially for the economically able. This would bring savings of Rp 2.2 trillion from the Rp 22 trillion of individual claims in 2018.A further Rp 6.6 trillion in savings could be made by readjusting hospital classes, Pahala said, noting that 898 out the 7,000 hospitals that partnered with BPJS Kesehatan had been put in the wrong class, leading to customers claiming more money than the actual cost of the services the hospitals had provided.As about 4.5 million people have private health insurance, Pahala said, the government should coordinate with the private health insurers regarding the benefits clients are entitled to. He added that BPJS Kesehatan could allocate up to Rp 600 billion worth of claims every year to private insurers.“BPJS Kesehatan can save Rp 12.2 trillion if it implements our recommendations,” he said, adding that the report had been submitted to the Health Ministry late last year after the appointment of minister Terawan Agus Putranto.Launched in 2014, BPJS Kesehatan now covers about 223 million Indonesians, or 83 percent of the population, with more than 30 million individual customers and around 54 million workers covered by state institutions or private companies.Even before the KPK study, many patients were already feeling the pinch as hospitals cut back services where they could. There were reports of patients being discharged 24 hours after surgery because hospitals had come under pressure from BPJS Kesehatan, which is reportedly scrutinizing all the bills they submit.The KPK study notes that many individual customers, as opposed to those whose premiums are paid by their employers, stopped paying the premium after initial use. This caused Rp 5.6 trillion in premium arrears in 2018.“We support the success of this universal healthcare program. Everyone in Indonesia has to be covered,” Pahala said. (mfp)Topics : Before the ruling, the premium for first-class service had been increased to Rp 160,000 from Rp 80,000, the second class to Rp 110,000 from Rp 51,000 and the third class to Rp 42,000 from Rp 25,000. Premiums approximately doubled across all service tiers.The study of BPJS Kesehatan finances is a manifestation of the KPK’s new approach to fighting corruption: working with state institutions on ways to prevent corruption, rather than catching perpetuators of graft in the act. The KPK has regularly conducted such assessments since its establishment in 2003, but the recent study of BPJS was the first following the enactment of the new KPK law, which removed many of its tools to fight corruption, and the introduction of a new set of commissioners in December.“The government assumed that the premiums weren’t enough, so it raised them,” KPK deputy chairman Nurul Ghufron said recently. “We at the KPK see it differently.”The KPK study says the Health Ministry should enforce all essential medical practice guidelines to help hospitals limit unnecessary treatment. It notes that by June of last year, the ministry had only achieved 32 practice guidelines out of the 80 planned. The heavily indebted national healthcare system received a big blow when the Supreme Court rejected a hefty increase in premiums this month, but the Corruption Eradication Commission (KPK) says the government could cover the deficit by going for greater cost efficiency.The KPK says its study of the finances of the Health Care and Social Security Agency (BPJS Kesehatan), which runs the national health insurance system, shows the agency could save as much Rp 12.2 trillion (US$833 million) by enforcing better insurance claim management.BPJS Kesehatan recorded a Rp 13 trillion deficit last year as premium collection fell short while claims soared. It had begun collecting the higher premiums in January and meeting backpays of Rp 4 trillion owed to hospitals, but it must now refund the money and will likely stop paying hospitals following the court ruling.
Alexandra Ting | Daily TrojanHave ball, will travel · Senior libero Taylor Whittingham and the women’s volleyball team begin a road trip on Wednesday against Arizona.After splitting their most recent home games before heading out on the road, the women’s volleyball team looks to rest up and put the games behind them. With a long road trip this week, the Trojans hope to continue improving their level of play, despite their difficult schedule ahead. “I think we are only in school eight days in November,” head coach Mick Haley said. “That is two days a week basically.”While it is easy sometimes to forget that these athletes are students, they certainly do not forget. Even with road trips, the student-athletes have to try and keep up with school work and find a way to maintain their academics in order to avoid the looming threat of academic probation that would keep them from playing. “We know that we are going to be on the road for a long period time,” senior captain Taylor Whittingham said. “That might be a struggle with homework, missing classes or stuff like that.” For the next two games against Arizona and ASU, the Women of Troy will have to be able to continue keeping their errors low, but will have to improve in their attack and their defense at the net in order to score points off of more than just kills and aces.“The one thing going forward for the rest of this month that I would really focus on would be serving,” Haley said. “The second thing would be to continue to improve our team blocking. Those two things will help us as much as anything. “However, the team has little time to practice before these games due to their traveling schedule. Traveling takes its toll on both players and coaches alike, but it will have to be overcome for the Trojans to continue to win games. “On Tuesday we travel, Wednesday we play and Thursday we travel to Tempe and will try to get a practice in there,” Haley said. “Then we play early Friday at 6 p.m., but we can’t get out that night, which is terrible because we have to get up early to get them back by 9 the next morning on Saturday.”The key thing for this road trip will be rest. Without proper rest, the Trojans will be in a position for potential injuries and mental lapses during the games. Also, it is important that they get the rest they need this week, because they have another road trip the following week.“I am trying to get them as much rest before we go to Stanford and Cal, which is the next hard trip,” Haley said. “I am really worried about those two back-to-back trips, because it has a tendency to really take its toll on their physical and mental prep.”The women’s volleyball team will take on Arizona at 7 p.m. on Wednesday and ASU at 6 p.m. on Friday.