How sustainable is the JKN?

The country is now in its second year of universal health coverage — as is the US. As expected, there are problems galore, from technical glitches, limited hospital referrals leading to long waits everywhere and little motivation for private employers to register their employees.

The last factor contributed to plans earlier this year to increase premiums, the highest option being a monthly
Rp 60,000 (US$4.57). But despite all its shortcomings, for the poorest, the national health insurance (JKN) program is the only option compared to those who can afford private coverage. In a country of 250 million people government insurance plans covered over 120 million Indonesians at the mid-point of last year.

But as the JKN’s appeal increases, the question remains — how can it be sustainable, however much the premium is increased? No one can be discriminated against so taxpayers will likely be covering those who show little regard to their own health.

This will include those regularly snacking on oily or sweet culinary delights, on top of three meals a day of steamy white rice and hearty side-dishes. A recent survey of 1,000 Jakarta professionals revealed that less than half had healthy lifestyles.

Addiction to smoking still affects a third of Indonesians — despite increased tobacco excise, pictorial warnings, bans on smoking indoors and the reported closure of hundreds of cigarette factories. Public health experts say higher tobacco excise and increased cigarette prices remain the only deterrents at least reducing cigarette consumption — along with campaigns on healthy lifestyles.

Smoking contributes to Indonesia’s major non-communicable diseases. Kompas last week cited 2013 Health Ministry data that showed how even regencies were heavily burdened by cardiovascular ailments, hypertension, cancer and diabetes.

Local leaders could make a real difference. People are encouraged to exercise when nearby parks are much cleaner and accessible as in cities such as Surabaya and Bandung.

However, ensuring sustainable health coverage for future generations means investing heavily in prevention on a national scale. In a declining economy, the government would not prioritize higher tobacco excise for fear of losing revenue, unless it factors in the health costs, which are estimated to be triple that of the revenue from our tobacco industry.

This year, the government has targeted Rp 145.7 trillion from excise tax and health advocates are calling for at least 10 percent of revenue from the industry to be spent on health campaigns, facilities and treatment.

The experts also say today’s “demographic dividend” — an unprecedented 60 percent of the population under 30 years old — will mean little if youngsters ape unhealthy habits.

Our middle-income nation also faces obesity and stunting, both feared to undermine productivity and the overall health of the population. Enabling many more families to access nutrition and increasing awareness of healthy lifestyles are therefore part of inevitable investments to ensure health for current and future generations.

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