CHAPTER IV RESULTS AND ANALYSISmedia.unpad.ac.id/thesis/120210/2013/120210130107_4_9283.pdf ·...

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CHAPTER IV

RESULTS AND ANALYSIS

This chapter consists of three sections. First, general description of location

and Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) in general. Second, explanation of the management of Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) in Head Office

and Bogor Branch Office. Last, explanation of Islamic finance perspectives towards

the management of Social Security Administrative Body for SJSN Health Program

(BPJS Kesehatan).

4.1 General Information of Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan)

4.1.1 The History of Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan)

It all started on 19th October, 2004 when Megawati Soekarnoputri, 5th

President of the Republic of Indonesia officially legalized National Social Security

System Act No. 40 of 2004 (Sistem Jaminan Sosial, or known as SJSN), many

parties expected accusations that Indonesia as a country without national social

security system will disappear and solve the health problems of Indonesian citizens

immediately.

The emergence of national social security system triggered by The 1945

Constitution of the Republic of Indonesia and the Fourth Amendment (on 11

August, 2002) Article 5 Paragraph (1), Article 20, Article 28H Paragraph (1),

Paragraph (2), Paragraph (3), Article 34 Paragraph (1) and Paragraph (2) mandated

the development of national social security system in Indonesia. National Social

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Security System (Sistem Jaminan Sosial Nasional, or known as SJSN) Act already

went through long process for 4 (four) years (until 19 October, 2004) until it was

authorized and becomes one of the government regulation formally. During the

serious discussion between the government team and the Special Committee

(Panitia Khusus, or known as PANSUS) plan for create and establish national social

security system act made by House of Representatives (Dewan Perwakilan Rakyat,

or known as DPR RI), national social security system act has already undergone

three times in total until it was issued into National Social Security System Act No.

40 of 2004 on 19th October, 2004 has gone improvement for 56 (fifty-six) times.

Thus, the process for drafting the national social security system act took 3 (three)

years, 7 (seven) months and 17 (seventeen) days since Kepseswapres No. 7 on 21st

March, 2001.

It is not easy, but Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial, or known BPJS) does exist as an implementation

of National Social Security System Act No. 40 of 2004 in which should have been

operated since 9th October, 2009. Changes from 4 (four) Persero which have been

organized national social security programs into Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) and Social Security

Administrative Body for SJSN Employment Program (BPJS Ketenagakerjaan) has

become an order that must be done. This multi-dimensional change must be

prepared so those are operating based on National Social Security (BPJS) Act No.

24 of 2011 Article 60 Paragraph (1) where Social Security Administrative Body for

Health Program (BPJS Kesehatan) officially operates in organizing a national

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health insurance program on 1st January, 2014. Then, National Social Security

(Badan Penyelenggara Jaminan Sosial, or known as BPJS) Act No. 24 of 2011

Article 6 Paragraph (1) decided that PT. JAMSOSTEK (Persero) was permanently

changed to Social Security Administrative Body for SJSN Employment Program

(BPJS Ketenagakerjaan) on 1st January, 2014. Finally, according to National Social

Security (Badan Penyelenggara Jaminan Sosial, or known as BPJS) Act No. 24 of

2011 Article 64 Social Security Administrative Body for SJSN Employment

Program (BPJS Ketenagakerjaan) officially began operating no later than 1st July,

2015.

Social Security Administrative Bodies (BPJS) is a non-profit institution

formed in order to organize the national social security system in Indonesia based

on National Social Security System Act No. 40 of 2004. According to National

Social Security (BPJS) Act No. 24 of 2011, BPJS will replace two main national

social security system in Indonesia, namely: PT. ASKES (a health care insurance)

and PT. JAMSOSTEK (an employment insurance). The transformation of PT.

ASKES and PT. JAMSOSTEK to Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial, or known as BPJS) will be carried out gradually.

In the beginning of 2014, PT. ASKES will change to Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) and followed by PT.

JAMSOSTEK changed to Social Security Administrative Body for SJSN

Employment Program (BPJS Ketenagakerjaan) in 2015 and both institutions will

be responsible directly to the President of Indonesia.

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4.1.2 The Definition of Social Security Adminisrative Body for SJSN Health


The Social Security Administrative Bodies (Badan Penyelenggara Jaminan

Sosial or known as, BPJS) is public legal entity formed with the purpose to organize

the national social security system. Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial, or known as BPJS) were divided into 2 parts

namely: Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) and Social Security Administrative Body for SJSN Employment

Program (BPJS Ketenagakerjaan). Health insurance is a guarantee of health

protection so each participant can get health maintenance and protection in fulfilling

basic needs benefits given to everyone, both to those who have paid their monthly

contribution or paid directly by the Government of Indonesia. As for Social Security

Administrative Body for SJSN Employment Program (BPJS Ketenagakerjaan) is a

public legal entity that directly responsible towards the President of Indonesia it has

a function to organize Old Age Saving Program (JHT), Death Benefit Program

(JKm), Work Accidents Program (JKK), Pension Program (JP) for all workers in

Indonesia, including expatriates who are working in Indonesia for more than 6

months. Social Security Administrative Bodies (Badan Penyelenggara Jaminan

Sosial, or known as BPJS) also depend on National Social Security System Act No.

40 of 2004 Article 5 Paragraph (1) and Article 52 as the basis for its operation.

4.1.3 The Management of Social Security Administrative Body for SJSN


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In its implementation, the management of Social Security Administrative

Bodies (Badan Penyelenggara Jaminan Sosial, or known as BPJS) can be divided

into two types, namely, source of funds in the form of monthly contribution fund

and its allocation managed by Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial, or known as BPJS) as taking care the

responsibilities of each participant as health services and other life guarantees. In

addition, there are other various provisions in the management of Social Security

Administrative Bodies (Badan Penyelenggara Jaminan Sosial, or known as BPJS)

such as the distribution of monthly contribution fund groups that must be paid and

membership rules to become a member of Social Security Administrative Bodies

(Badan Penyelenggara Jaminan Sosial, or known as BPJS) program.

4.1.3.1 Membership of Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial¸ or BPJS)

1. Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan)

All Indonesian citizens must join as participants in Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) including

expatriate employees who are working at least 6 (six) months in Indonesia and have

paid their monthly contribution fund. In general, Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) participants can be divided into

two groups consist of: Contribution Aid Recipients (Penerima Bantuan Iuran, or

known as PBI) and group of Non-Contribution Aid Recipients (Penerima Bantuan

Iuran, or known as PBI). Contribution Aid in health insurance is health care for the

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poor and unpriviledged as mandated by National Social Security System Act No.

40 of 2004 Article 17 Paragraph (4) in which their monthly contribution fund are

paid by the Government of Indonesia as Health Care Insurance Program

participants. The criterias for Contribution Aid Recipients (or known as, PBI)

participants are poor and unpriviledged people with certain criterias set by the

government regulation. They are group of people who are entitled to receive health

insurance that is categorized into permanent disability (physical and/or mental

disability) and resulted in inability of someone to do their work and determination

of permanent disability must be done an authorized doctor. As for group that are

not classified as the Contribution Aid (Penerima Bantuan Iuran, or known as PBI)

participants are:

a. Wage Recipients Worker (Pekerja Penerima Upah, or known as PPU) with

their family members, namely those who work for the employer to get

compensation in the form of wage or salaries. Wage recipient workers

(Pekerja Penerima Upah, or known as PPU) consist of: civil servants

(PNS), member of The Indonesian National Armed Forces (TNI), member

of The Indonesian National Police (POLRI), functioners (pejabat negara),

non-civil servant government employees, private employees, and other

workers who meet certain criterias for wage recipient workers (Pekerja

Penerima Upah, or known as PPU).

b. Non-Wage Recipients Worker (Pekerja Bukan Penerima Upah, or PBPU)

along with their family members are those who work at their own risk. In

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this case, it can be categorized as informal sector workers, or independent

workers.

c. Non-Workers (Bukan Pekerja, or BP) and family members, are people who

do not work but are able to pay monthly contribution fund. They are

investors, employers, pension recipients, veterans, pioneers of

independence and non-other workers who fulfill the requirements of Non-

Workers (Bukan Pekerja, or known as BP).

2. Social Security Administrative Body for SJSN Employment Program (BPJS

Ketenagakerjaan)

The participants of Social Security Administrative Body for SJSN

Employment Program (BPJS Ketenagakerjaan) are divided into two groups. First,

informal sector workers. Second, formal sector workers. There are fundamental

differences exists when it comes to manage the registration requirements.

According to the types, Social Security Administrative Body for SJSN Employment

Program (BPJS Ketenagakerjaan) with Workers Participants in Employment

Relations consists of formal sector workers and non-independent (incorporated in

the company). Those included in this category of BPJS participants are those who

work as civil servants (PNS), The Indonesian National Armed Forces (TNI) / The

Indonesian National Police (POLRI), State-Owned Enterprise (BUMN), retired

Civil Servants / TNI/ POLRI, BUMN, private employees, foundation, Join

Ventures, veteran to Pioneer Independence. Later on, the employer will register

themselves with their employee to Social Security Administrative Body for SJSN

Employment Program (BPJS Ketenagakerjaan). Meanwhile, Social Security

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Administrative Body for SJSN Employment Program (BPJS Ketenagakerjaan)

participants outside the employment relations are those who work in the informal

sector, or classified as independent workers. In order to facilitate management, an

organization can be formed consists at least 10 people which then registered to

Social Security Administrative Body for SJSN Employment Program (BPJS

Ketenagakerjaan).

4.1.3.2 Social Security Administrative Bodies (Badan Penyelenggara Jaminan

Sosial or BPJS) Contribution Fund

1. Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan)

Health insurance contribution is the amount of money that must be paid by

each participant and/or employer which amount decided based on the percentage of

wage (for Wage Recipients Worker, or known as PPU) or any certain nominal

amount (Non-Wage Recipients Worker, or PBPU and Contribution Aid) for

healthcare insurance program (Ministry of Health, 2013). Each employer is obliged

to collect contribution fund from the employees, add compulsory contribution, and

pay contribution fund to the Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) periodically (no later than 10th of every month). If the

15th day falls on a holiday, then contribution fund shall paid on next business day.

The contribution fund payment delay will be imposed by a fine of 2% (two percent)

for every month of delay, calculated based on contribution fund which should be

paid by the Employer. Non-Wage Recipients Worker (Pekerja Bukan Penerima

Upah, or known PBPU) and Non-Worker (Bukan Pekerja, or known as BP) shall

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paid JKN contribution fund no later than the 15th every month regularly to Social

Security Administrative Body for SJSN Health Program (BPJS Kesehatan). The

payment of JKN contribution fund also can be made in the beginning.

Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) calculate the deficiency or excess of the JKN contribution fund in

accordance with participants salaries or wages. If there is an excess or deficiency

of payment, Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) will notify in written to the employers and/or participants no later than

14th business days from the contribution acceptance. The contribution fund payment

excess or deficiency will be include into account by the next month’s contribution

fund payment. The amount of contribution fund shall be paid by Non-Wage

Recipients Worker (Pekerja Bukan Penerima Upah, or known as PBPU) who have

more than five members in the family (including the participants) must be paid by

participants with provisions or IDR 25,500/month for class III (inpatient services),

IDR 51,000/month for class II and IDR 80,000/month for class I (inpatient

services).

2. Social Security Administrative Body for SJSN Employment Program (BPJS

Ketenagakerjaan)

Pension security contribution of 8% (eight percent) shall be charged by 5%

(five percent) by Employers and 3% (three percent) by workers. This regulation is

apply simultaneously since 1st July, 2015. The amount of monthly contribution fund

shall be paid depends on provisions of each program that applies.

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4.1.3.3 The Allocation of Social Security Administrative Bodies (Badan

Penyelenggara Jaminan Sosial or BPJS) Contribution Fund


Kesehatan) has become a public legal entity that organize and manage the health

insurance program for all citizens. While Social Security Administrative Body for

SJSN Employment Program (BPJS Kesehatan) has become a public legal entity

that organize and manage Work Accidents Program (Jaminan Kecelakaan Kerja or

JKK), Old Age Saving Program (Jaminan Hari Tua or JHT), Pension Program

(Jaminan Pensiun or JP) and Death Benefit Program (Jaminan Kematian or Jkm).

Furthermore, Social Security Administrative Bodies (Badan Penyelenggara

Jaminan Sosial or known as BPJS) also has the right to invest national social

security fund in the form of short-term and long-term investment by consider

several aspects, such as liquidity, security of fund itself and final results.

One of Social Security Administrative Body for SJSN Health Program fund

management is make payments to the first-level health facilities (Fasilitas

Kesehatan Tingkat Pertama, or FTKP) such as public health center (Pusat

Kesehatan Masyarakat, or PUSKESMAS) and the clinics.

As for Social Security Administrative Body for SJSN Employment Program

covers Work Accidents Program (Jaminan Kecelakaan Kerja or JKK), Old Age

Saving Program (Jaminan Hari Tua or JHT) and Death Benefit Program (Jaminan

Kematian or Jkm) for all workers and their family.

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4.2 General Description of Social Security Administrative Body for SJSN


4.2.1 Vision and Mission of Social Security Administrative Body for SJSN



Kesehatan) vision is “covering the universe in 2019”. At the latest of 1st January,

2019 Indonesian citizens has joined the Indonesian national health insurance (or

known as, Jaminan Kesehatan Nasional) in order to obtain the benefits health care

maintenance and protection in meeting basic needs in health sector in accordance

with those held and managed by Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan).

The mission of Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) is to build strategic partnership with various institutions

and also encourage communities participation in terms of expanding the

membership of the Indonesian national health insurance (or known as, Jaminan

Kesehatan Nasional). These missions are:

1. Carry out and strengthen an effective, efficient and good quality health services

for the participants through optimal partnership institutions with the

availability of health facilities;

2. Optimizing the fund management of Social Security Administrative Body for

SJSN Health Program (BPJS Kesehatan) that is effective, efficient, transparent

and accountably for the continuity of the existing programs; and

3. Build Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) that is effective and based on various principles of good

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organizational governance and improve employees competencies in order to

achieve superior performance.

Implement and develop a system of planning, evaluation, review, quality-

control management and risk management for all Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) operational activities.

4.2.2 Legal Foundation of Social Security Administrative Body for SJSN


The legal foundation of Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan) are:

1. The 1945 Constitution of the Republic of Indonesia;

2. National Security System Act No. 24 of 2004;

3. National Social Security (BPJS) Act No. 24 of 2011; and

4. President Regulation No. 111 on The Amendment of President Regulation No.

12 of 2013.

4.2.3 The Functions, Duties and Authority of Social Security Administrative

Body for SJSN Health Program


Kesehatan) law determined that Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan) function is to organize national health insurance

program. According to National Social Security System (Sistem Jaminan Sosial

Nasional, known as SJSN) law, national social security is held nationally based on

the principles of social insurance and equity which aims to ensure that each

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participant will obtain the benefits of health maintenance as well as protection in

meeting basic health needs.

In carrying out the functions mentioned above, Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) has the duties to:

1. Conduct and/or accept participants registration;

2. Collect the contributions from participants and the employers;

3. Receive the contribution from the Government of Indonesia;

4. Manage the national social security funds for the benefit of participants;

5. Collect and manage the national social security participation funds;

6. Pay benefits and/or financing health services in accordance with the provisions

of the national social security program; and

7. Provide information about the national social security program to the

participants and communities.

In order to carry out the duties as referred above, Social Security

Administrative Body for SJSN Health Program (or known as BPJS Kesehatan) has

the authorities to:

1. Collect the payment of monthly contribution fund from the participants;

2. Invest the national social security fund in short and long term investments by

considering several aspects such as liquidity, solvability, prudence, data

security, and adequate results first;

3. Conduct supervision and evaluate the participants and employers obedience in

fulfilling their obligations in accordance with the mandates in the national

social security legislation;

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4. Make an agreement with health facilities provider regarding the payment of

health services referring to the standard rates set by the Government of

Indonesia;

5. Make and/or stop the work contract together with health facilities providers;

6. Impose administrative sanctions to the participants or employers who does not

fulfill their obligations;

7. Report the employer to the authority due to an attitude of non-compliance in

paying contributions or in an effort to fulfill other obligations according to the

provisions of the legislation; and

8. Cooperate with other parties in the context of organize a national social security

program.

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4.2.4 Organizational Structure and Position in Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan)

Organizational Structure and Position in Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) can be seen in an Appendix 4.1.

Based on Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) Manual Board, the following below are the division of directors and the

explanations of their main duties in general:

1. President Director: lead and be responsible for all activities carried out by BPJS

Kesehatan, make public policy, take strategic decisions for BPJS Kesehatan

and act as a coordinator for board of directors.

2. Director of Coverage Expansion and Customer Service: set policies related to

the operational activities which includes membership policy, marketing,

customer relations and coordinate, manage and be responsible for the

implementation of related activities based on policies, guidelines and

predetermined plan.

3. Director of Health Care Service Assurance: set policies related to the

operational activities which includes service policy, health care service

assurance, medicine, promotion and the evaluation of health care service

assurance, partnership with health facilities and coordinate, manage and be

responsible for the implementation of related activities based on policies,

guidelines and predetermined plan.

4. Director of Development Planning and Risk Management: preparing short-

term and long-term planning for BPJS Kesehatan, make management report of

BPJS Kesehatan, conduct a performance evaluation of BPJS Kesehatan

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regularly, carry out research and development related to BPJS Kesehatan core

process, conduct actuarial and risk management in an effective and efficient

manner, and coordinate, manage and be responsible for the implementation of

related activities based on policies, guidelines and predetermined plan.

5. Director of Finance and Investment: set policies for BPJS Kesehatan regarding

the accounting, investment, finance and coordinate, manage and be responsible

for the implementation of related activities based on policies, guidelines and

predetermined plan.

6. Director of Human Resources and General Affairs: set policies for BPJS

Kesehatan regarding the human resources, organizations, facility resources and

coordinate, manage and be responsible for the implementation of related

activities based on policies, guidelines and predetermined plan.

7. Director of Information Technology: set policies for BPJS Kesehatan regarding

the technology which includes availability of strategic policies, and

information technology services through planning, design, development,

implementation, network and infrastructures maintenance in all units for the

availability of management information systems for BPJS Kesehatan and

coordinate, manage and be responsible for the implementation of related

activities based on policies, guidelines and predetermined plan.

8. Director of Legal Compliance and Inter-Institutional Relations: set policies for

BPJS Kesehatan related to law and regulation, establishment of a partnership

with state institutions or related organizations through developing concepts,

strategies, communication, coordination and collaboration between the

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institutions in order to support and operationalization of BPJS Kesehatan.

4.3 Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) in Bogor Branch Office

4.3.1 The Location of Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) in Bogor Branch Office


Kesehatan) Bogor Branch Office is a change from PT. ASKES (Persero) Bogor

Branch Office. Change occurred based on National Social Security (BPJS) Act No.

24 of 2011 which officially operated on 1st January, 2014.


Kesehatan) Bogor Branch Office is located at Jln. Ahmad Yani No. 62E Tanah

Sarel, Bogor City 16161 Telp (0251) 8323900 , Faximile (0251) 8323800 with

working area of Bogor City and the physical building bordered by:

1. North Side: Waroeng Steak and Shake.

2. South Side: PT. WLN Indonesia.

3. West Side: Bogor Vape House.

4. East Side: Indonesian Center for Agricultural Socio Economic and Policy

Studies (Kantor Pusat Sosial Ekonomi dan Kebijakan Pertanian).

4.3.2 Work Rules in Social Security Administrative Body for SJSN Health


Work rules are needed for the effectiveness and smooth performance of the

employees. The existence of work rules will shape the sense of discipline for each

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employee. The work rules that are apply at the Social Security Administrative Body

for SJSN Health Program (BPJS Kesehatan) Bogor Branch Office are as follows:

1. Business Hours, Monday – Friday : 08.00 am until 04.00 pm (UTC +7).

2. Rest Hours : 12.00 am until 01.00 pm during business hours.

3. Holidays, Saturday and Sunday.

4.3.3 Organizational Structure and Position in Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) in

Bogor Branch Office

A figure of Organizational Structure and Position in Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) in Bogor Branch

Office can be seen in an Appendix 4.2. As a result, head of branch office is the

highest leader in BPJS Kesehatan Bogor Branch Office. Besides that, the structures

and duties of BPJS Kesehatan Bogor Branch Office can be described as follows

below.

1. Head of Branch Office

a. Prepare a work plan and budget;

b. Planning work activities to achieve branch office performance;

c. Plan and direct the preparation of participant potential maps in order to

achieve marketing targets;

d. Directing and controlling the implementation of services for the

participants; and

e. Coordinate and cooperate with partners in an effort for the expansion of

business, finance, membership and service improvement.

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2. Head of Marketing

Its jobs are to obtain data about market pontential, controlling the activities of

field staff, ensuring the achievement of membership targets, archiving data of

the participants, provide services in the form of BPJS Kesehatan information

and make a report.

In carrying out the duties, Kepala Unit Pemasaran is assisted by:

a. Marketing Administration Staff; and

b. Relationship Officer.

3. Head of Primary Health Care Financing Assurance

Its jobs are to improve partnership with first-level health facilities (Fasilitas

Kesehatan Tingkat Pertama, or FTKP), check the billing documents of first-

level health facilities (Fasilitas Kesehatan Tingkat Pertama, or FTKP) and

control service in first-level health facilities (Fasilitas Kesehatan Tingkat

Pertama, or FTKP).

In carrying out the duties, Head of Primary Health Care Financing Assurance is

assisted by:

a. Verificator;

b. Staff Management of Primary Health Care Facilities; and

c. Staff Utilization of Primary Health Care Services and Anti Fraud.

4. Head of Referral Health Care Financing Assurance

Its jobs are improve partnership with advance referral health care facilities

(Fasilitas Kesehatan Rujukan Tingkat Lanjutan, or FKRTL), check the billing

documents of advance referral health care facilities (Fasilitas Kesehatan

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Rujukan Tingkat Lanjutan, or FKRTL) and control pricing services of advance

referral health care facilities (Fasilitas Kesehatan Rujukan Tingkat Lanjutan, or

FKRTL).

In carrying out the duties, Head of Referral Health Care Financing Assurance

is assisted by:

a. Verificator;

b. Staff Management of Referral Health Care Facilities; and

c. Staf Utilization of Referral Health Care Services and Anti Fraud.

5. Head of Membership, Quality Control and Complaints Handling

Its jobs are receive documents, examine the completeness and validity of

registration documents, contribution fund payment documents and payment

guarantee documents to ensure good service, handle customer and health

facilities complaints to improve service quality and make reports.

In carrying out the duties, Head of Membership, Quality Control and

Complaints Handling is assisted by:

a. Membership Administrator;

b. Customer Service Staff; and

c. Quality Control and Complaints Handling Officer.

6. Head of Legal Compliance and Public Communication

Its jobs are create supervisory and compliance plan, coordinate of actions

needed, issue a confirmation letter and data check or field check for the

participant who are in arreas in payment of contribution fund.

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In carrying out the duties, Head of Legal Compliance and Public

Communication is assisted by:

a. Examiner Staff; and

b. Legal Compliance and Public Communication Staff.

7. Head of General Affairs and Finance

Its jobs are publish the balance sheet of branch office, sign a check and bilyet

giro for the payment of head of branch office salaries and/or wages, budget

control, sign receipt voucher and expenditure, monitoring and evaluate the

contribution fund, verify the evidence of financial transactions, coordinate in

making management reports, control an administrative, distribution, archieve,

report all types of taxes and foster human resources.

In carrying out the duties, Head of General Affairs and Finance is assisted by:

a. Human Resources Staff;

b. General Affairs, Administration and Secretariat Staff;

c. Billing Staff;

d. Accounting and Finance Staff; and

e. Teller.

8. IT Helpdesk

The main jobs are maintain the security of database, transmission of data

membership and contribution to the head office, setting up user and system

authorization, do a back-up plan for the operational (back up, security and

recovery), manage and maintain the computer facilities such as hardware,

software and network to ensure optimal use.

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4.3.4 The Management of Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan) in Bogor Branch Office

In accordance with the applicable provision in Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan), the management

include two outlines, collection of fun and its allocation. Based on National Social

Security (BPJS) Act No. 24 of 2011 Article 42 stated that source of fund for Social

Security Administrative Body for SJSN Health Program (BPJS Kesehatan) comes

from the Government of Indonesia with a nominal maximum of IDR

2,000,000,000,000,- (2 trillion rupiahs) and also from the contribution fund paid by

the participants. But participants contribution fund are the most important source of

funds in the Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) can provide claims and health services to the participants.

“The primary source of funding for health insurance or claims for Social

Security Administrative Body for SJSN Health Program (BPJS Kesehatan)

participants comes from the monthly contribution fund paid by the participants”

(Buan, personal communication, November 27, 2018).

From the following information, it is said that Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) depending on

the monthly contribution fund paid by the articipants to provide health insurance

program. Therefore, Social Security Administrative Body for SJSN Health Program

(BPJS Kesehatan) expects each participant to pay off their monthly contribution

obligations so that health insurance program in the form of payment for the services

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or medicines can be maximal. The sanctions are imposed towards the participants

who are late in contribution fund payment to avoid lack of funds.

In addition, the fine that was applied at 2% of the monthly contribution

multiplied by the number of months in arrears has been changed to 2,5% and it only

applies if a participant is hospitalized. If a participant is delinquent payment of

monthly contribution fund but does not undergo hospitalization, then the percentage

of fines will not be imposed and a participant is only need to paid the amount of

contribution in arrears. This change was made by Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) in order to avoid riba (interest)

that was prohibited in the principles of Islamic finance.

“If a participant delays their contribution fund payment, then that person

must pay off arrears by 2,5% of the total hospitalization cost plus the hospitalization

cost itself as a sanction. And if until 6 months later, that person does not pay their

sanctions, then Social Security Administrative Body for SJSN Health Program

(BPJS Kesehatan) card will remain inactive and can not get any services provided

by Social Security Administrative Body (BPJS Kesehatan)” (Buan, personal

communication November 27, 2018).

Based on National Social Security (Badan Penyelenggara Jaminan

Kesehatan, or known as BPJS) Act No. 24 of 2011 Article 17, sanction can be given

in the form of written remark, fines or unable to obtain services carried out by the

Government of Indonesia. This sanctions are applied with the intention that each

participant awareness to pay monthly contribution fund on time will arise for the

sake of health services to be obtained. However, the change in the amount of fine

75

to 2,5% from the total cost of hospitalization is different from President Regulation

No. 111 of 2013. But one same thing is the time limit for no more than 3 (three)

months and for Non-Wage Recipients Worker (Pekerja Bukan Penerima Upah, or

known as PBPU) and Non-Workers (Bukan Pekerja, or known as BP) are given 6

(six) months deadline.

According to National Social Security (BPJS) Act No. 24 of 2011 Article

14, anyone, foreign citizen who works in Indonesia at least 6 (six) months, being a

participant in Social Security Administrative Body (BPJS Kesehatan) is a

mandatory. In addition, there is no limit time in membership of Social Security

Administrative Body (BPJS Kesehatan).

“For participation in Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) will not be broken, or other words, it will continue and

the participants can not stop” (Buan, personal communication, November 27,

2018).

Because the participation of Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan) is mandatory, that means each participant has

an obligation to pay monthly contribution fund without knowing when to stop

because it applies for the entire life, then the participants will get health care

services. The nominal amount for monthly contributions are divided into certain

categories set by President Regulation No. 111 of 2013 on The Amendment of

President Regulation No. 12 of 2013. The certain nominal monthly contribution

based on the table and figures of the categories below.

76

Figure 4. 1 The Categories of BPJS Kesehatan Participants

Table 4. 1 The Categories of BPJS Kesehatan Participants

No. Category Participant Contribution Fund

1 Contribution Aid recipients

(Penerima Bantuan Iuran, or

PBI)

The monthly contribution fund is

borne by the government every month.

2 Non-Worker (Bukan Pekerja, or

BP) and Non-Wage Recipients

Worker (Pekerja Bukan

Penerima Upah, or PBPU)

a. Rp 25.500,00 (twenty five

thousand five hundred

rupiahs)/person every month with

the benefit of getting Level III

treatment room service in the

hospital.

b. Rp 51.000,00 (fifty-one thousand


the benefit of getting Level II


hospital.

The Categories of BPJS Kesehatan Participants

Non Contribution Aid Recipients (Bukan Penerima

Bantuan Iuran, or PBI)

Non-Worker (Bukan Pekerja, or BP)

a. Investors

b. Employers

c. Pension Recipients

d. Veterans

e. Pioneers of Independence

f. Not the workers who are not include in A up to E who can afford to pay

Non-Wage Recipients Worker (Pekerja

Bukan Penerima Upah, or PBPU)

Informal Sectors

Independent Worker

Wage Recipients Worker (Pekerja

Penerima Upah, or PPU)

a. Civil Servants

b. TNI and POLRI members

c. State Officials

d. Non-Civil Servant Government Employees

e. Private Employees

f. The workers who are not include in A up to E and receives wage

Contribution Aid Recipients (Penerima

Bantuan Iuran, or PBI)

77


c. Rp 80.000,00 (eighty thousand


the benefit of getting Level I


hospital.

3 Wage Recipients Worker

(Pekerja Penerima Upah, or

PPU)

a. For the civil servants (Pegawai

Negeri Sipil), monthly contribution

is determined based on the basic

salary (gaji pokok) and family

allowance (tunjangan keluarga)

except for the non-civil servants

government employees (pegawai

pemerintah non-PNS or PPNPN)

in which are taken at 5% (five

percent) of salary/wages: 3%

(three percent) is paid by the

employer and 2% (two percent) is

paid by the participants.

b. For the private employees,

monthly contribution are taken at

5% (five percent) of salary/wages

with a condition: 4% (four percent)

is paid by the employer and 1%

(one percent) is paid by the

participants.

4 Pension Recipients (Penerima

Pensiun, or Pensiunan)

Monthly contribution are taken at 5%

(five percent) from the pension

benefits where 3% (three percent) is

paid by the government and 2% (two

percent) is paid by the participants by

referring to the benefits chosen based

on the point no.2 described above.

5 Veterans, Pioneers of

Independence (Perintis

Kemerdekaan), widow (janda

and widower (duda), the orphans

(anak yatim piatu) from the

veterans or Pioneers of

Independence.

Monthly contribution are taken at 5%

(five percent) from 45% (forty-five

percent) of the civil servants

salary/wage on echelon IIIa with 14

(fourteen) years working period per

month is paid by the government.

6 Family Members a. For those classified as Wage

Recipients (Penerima Upah), their

monthly contribution is borne by

the participants for 1% (one

78


percent) from the basic

salary/month.

b. For those classified as Non-Wage

Recipients and Non-Worker is

borne by the participants referring

to the benefits chosen based on the

point described in no. 2 above.

For those who are categorized as Contribution Aid Recipients (Penerima

Bantuan Iuran, or known as PBI), the obligation to pay the monthly contribution

fund are paid by the government, which means that there is budget coming from the

Government of Indonesia to cover the health care cost for the poor and

unpriviledged people. Based on President Regulation No. 111 of 2013 on The

Amendment of President Regulation No. 12 of 2013, payment of monthly

contribution fund to Wage Recipients Worker (Pekerja Penerima Upah, or known

as PPU) is carry out by the employer directly in cutting the employees salaries and

remitted to Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) no late than 10th each month. As for Contribution Aid Recipients

(Penerima Bantuan Iuran, or known as PBI), payment of monthly contribution fund

are given directly from the minister of finance to Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) while for Non-Wage Recipients

Worker (Pekerja Bukan Penerima Upah or known as PBPU) with their family

members paid by the participant monthly, no later than the 10th of every month.

The payment procedure made by private companies are through certain

banks or organizations that have collaborated with Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) while the payments made by

79

participants can be through pay it directly to Social Security Administrative Body

for SJSN Health Program (BPJS Kesehatan) Branch Office or through other parties

that have collaborated with Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan).

“For the civil servants, monthly contribution fund can be paid by the

treasury fund managed the Ministry of Finance and directly deposited to Social

Security Administration Body for SJSN Health Program (BPJS Kesehatan). The

way to collect it, we have tried to make the monthly contribution fund payment

easier for the participants by building partnership with many parties such as BNI,

Bank Mandiri, PT. Pos Indonesia, and so on. This also will minimize the possibility

of delinquent payment of monthly contribution fund” (Buan, personal

communication, November 27, 2018).

In terms of monthly contribution fund payments, Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) tries to make it

easier for participants so the funds can be fully collected. For the advantages and

disadvantages of monthly contribution payments, President Regulation No. 111 of

2013 On The Amendment of President Regulation No. 12 of 2013 stated that Social

Security Administrative Body for SJSN Health Program (BPJS Kesehatan) will do

the calculations based on the participants salaries and/or wages and will give written

notification to the employer or participant no later than 14 business days after the

monthly contribution fund is received. The excess or deficiency of monthly

contribution fund payments will be put in into payment bill for the next following

month.

80

After the participants pay their monthly contribution fund and have no

arrears, or after the participants have an active Social Security Administrative Body

for SJSN Health Program (BPJS Kesehatan) membership card, the participants

automatically has their right to receive services either at the first level of the location

decided based on wishes of the participants themselves or in advanced level referral

to the hospital by bring the referral letter from the origin hospital and/or the clinic.

“Participants have their right to obtain transparent information, to choose

first-level service places and the referrals by bringing the participant membership

card along with a referral letter from the origin place” (Buan, personal


Based on President Regulation No. 111 of 2013 On The Amendment of

President Regulation No. 12 of 2013 Article 22 concerning in the health insurance,

first and advanced level of health care facilities included:

1. First level health care services, consist of non-specialist health care services

which include:

a. Administrative Services;

b. Promotive and preventive health care services;

c. Examination, treatment, and medical consultation services;

d. Non-specialist medical actions, both operative and non-operative;

e. Services for the medicines and medical consumables;

f. Blood transfusion according to the medical needs;

g. Laboratory diagnostic support for at the first level; and

h. First-level hospitalization accordance with the medical indications.

81

2. Advanced referral health care services including the heath services:

a. Administrative services;

b. Examination, treatment and consultation by the specialists and

subspecialists;

c. Specialist medical action, both surgical or non-surgical in accordance with

the medical indications;

d. Services for medicines and medical consumables;

e. Advanced diagnostic support services in accordance with the medical

indications;

f. Medical rehabilitation;

g. Blood transfusion services;

h. Clinical forensic medical services;

i. Mortuary services for the patiens who died in the health care facilities

(Fasilitas Kesehatan, or known as FASKES);

j. Non-incentive inpatient care service; and

k. Inpatient care services in the Incentive Care Unit (ICU).

Services obtained by the participants are unlimited, means the participants

can continue to receive health care insurance services until they are no longer need

it anymore (recover or die). In addition, there is no limit on the type of diseases that

will be serve by Social Security Administrative Body for SJSN health Program

(BPJS Kesehatan).

“For non-covered categories of the disease, there is none. During the

procedure, all types of illness, both mild and severe, will be guaranteed by Social

82

Security Administrative Body for SJSN Health Program (BPJS Kesehatan) because

the amount of our services has no limit” (Buan, personal communication,

November 27, 2018).

Besides getting the first-level service and advance level of referrals, based

on President Regulation No. 111 of 2013 On The Amendment of President

Regulation No. 12 of 2013, Article 32 stated that participants have their right to

obtain medical services, medical devices an medical materials referred to the price

list of medicines, medical devices, consumable medical materials in accordance

with what was stipulated by the Minister of Health. This means that the guarantee

of use medicines and medical devices that are covered is only in the list of

dependents (not all are covered and guaranteed by Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan)). For the participants who lived

in the areas where there are no health care facilities available, Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) is obliged to

proved compensation in form of the cash replacement, debased on President

Regulation No. 111 of 2013 On The Amendment of President Regulation No. 12 of

2013 Article 32, Paragraph (2), send the health care workers or in form of the

provision of certain Health Care Facilities (Fasilitas Kesehatan, or known as

FASKES).


Kesehatan) services for the participants may not be guaranteed if it is outside the

provision of President Regulation No. 111 of 2013 On The Amendment of President

Regulation No. 12 of 2013, Article 25 which covering:

83

1. Health care services are carry out without following the procedures as

stipulated in the applicable regulations;

2. Health care services are carry out in health care facilities (fasilitas kesehatan

or known as FASKES) that are not cooperating with Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) except in

the emergencies;

3. Health care services that have been guaranteed by a work accident insurance

program against illness or injuries due to accidents or employment relationship;

4. Health care services that have been guaranteed by a guaranteed traffic

insurance program until the value covered by the traffic accident insurance

program;

5. Health service carried out abroad;

6. Health care services for aesthetic purposes;

7. Services for dealing with infertility;

8. Flatten the teeth services (orthodontic);

9. Health problems and/or disease caused by drug addiction and/or alcohol;

10. Health problems from hurting themselves on purpose, or as a result of a

dangerous hobby;

11. Alternative (complementary) and traditional medicine such as acupuncture,

shin she, chiropractic that have not been declared effective yet based on the

health technology assessment;

12. Medicine and medical measures that are categorized as an experiment;

13. Contraceptives, cosmetics, babies foods and milk;

84

14. Household health supplies;

15. Catastrophic health care services in the emergency relief, extraordinary events

and/or outbreaks;

16. Health care service costs in the event of unexpected avoidable preventable

adverse events; and

17. Cost of the other services that are not related to the heath care insurance

benefits provided.

Both first-level and referral health care services can be enjoy by all

registered participants with same service. The purpose of classification and the

difference amount of monthly contribution fund to be paid so that the participants

can choose for the appropriate category and the ability to obtain the desired service

class by themselves.

“Class category selection was made because the government saw economic

ability to afford are diferent, so it is unlikely that all generalized at level 1 class

monthly contribution (IDR 80,000,-) for all the services themselves, which

distinguishes only beds and the accommodation” (Buan, personal communication,

November 27, 2018).

Form of accommodation obtained by the participants were divided by the

categories set forth in President Regulation No. 111 of 2013 On The Amendment

of President Regulation No. 12 of 2013 Article 23 where health care insurance

grouped into 3 classes of treatments based on the following table:

Table 4. 2 Groups of Health Care Insurance Based on Classes of Treatments

85

3rd Class Medical

Ward

2nd Class Medical Ward 1st Class Medical Ward

a. Contribution Aid

Participants

(Penerima

Bantuan Iuran, or

PBI) and the

residents who are

registered by the

local government;

and

b. Non-Wage

Recipients

Worker (Pekerja

Bukan Penerima

Upah, or PBPU)

and Non-Worker

(Bukan Pekerja)

who pay monthly

contributions with

the benefit of

getting the 3rd

Class Medical

Ward.

a. Civil Servants (Pegawai

Negeri Sipil, or PNS)

and Civil Servants

Pension Recipients

(Penerima Pensiun

Pegawai Negeri Sipil)

Junior Clerk, First Class


Clerk, Rank (golongan

I) and Junior Supervisor,

First Class Junior

Supervisor, Supervisor,

First Class Supervisor

(golongan II) along with

the family members;

b. Members of The

Indonesian National

Armed Forces (Tentara

Nasional Indonesia, or

TNI) and Pension

Recipients of The

Indonesian National

Armed Forces

(Penerima Pensiun

Tentara Nasional

Indonesia, or TNI) who

are equal to Civil

Servants (Pegawai




Clerk, Rank (golongan

I) and Junior Supervisor,

First Class Junior

Supervisor, Supervisor,

First Class Supervisor

(golongan II) along with

the family members;

c. Members of The

Indonesian National

Police (Kepolisian

Republik Indonesia, or

POLRI) and Pension

a. State Officials

(Pejabat Negara)

along with the family

members; and

b. Civil Servants

(Pegawai Negeri

Sipil, or PNS) and

Civil Servants

Pension Recipients

(Penerima Pensiun

Pegawai Negeri Sipil,

or PNS) Junior

Superintendent, First

Class Junior

Superintendent,


Class Junior

Superintendent

(golongan III) and

Administrator, First

Class Administrator,

Junior Administrator,

Middle

Administrator, Senior

Administrator

(golongan IV) along

with the family

members;

c. Members of The

Indonesian National

Armed Forces

(Tentara Nasional

Indonesia, or TNI)

and Pension

Recipients of The

Indonesian National

Armed Forces

(Penerima Pensiun

Tentara Nasional

Indonesia) who are

equal to Civil

Servants (Pegawai


86

3rd Class Medical

Ward


Recipients of The

Indonesian National

Police (Penerima

Pensiun Polisi Republik

Indonesia) who are

equal to Civil Servants

(Pegawai Negei Sipil, or

PNS) Junior Clerk, First

Class Junior Clerk, First

Class Clerk, Rank

(golongan I) and Junior

Supervisor, First Class

Junior Supervisor,

Supervisor, First Class

Supervisor (golongan II)


members;

d. Wage Recipients

Worker (Pekerja

Penerima Upah, or

PPU) and Non-Civil

Servants Government

Employees (Pegawai

Pemerintah Non-PNS)

with salary/wages up to

1,5 (one point five)

times from income is not

taxable with marital

status with 1 (one) child


members; and

e. Non-Wage Recipients

Worker (Pekerja Bukan

Penerima Upah, or

PBPU) and Non-Worker

(Bukan Pekerja, or BP)

who pay monthly

contributions with the

benefit of getting 2nd

Class Medical Ward.

Junior


Class Junior

Superintendent,


Class Junior

Superintendent

(golongan III) and




Middle


Administrator

(golongan IV) along

with the family

members;

d. Members of The

Indonesian National

Police (Kepolisian

Republik Indonesia,

or POLRI) and

Pension Recipients of

The Indonesian

National Police

(Penerima Pensiun

Polisi Republik

Indonesia) who are

equal to Civil

Servants (Pegawai

Negei Sipil, or PNS)

Junior


Class Junior

Superintendent,


Class Junior

Superintendent

(golongan III) and




Middle

87

3rd Class Medical

Ward



Administrator

(golongan IV) along

with the family

members;

e. Veterans (Veteran)

and Pioneers of

Independence

(Perintis

Kemerdekaan) along

with the family

members;

f. Widow (janda),

widower (duda) or

the orphans (anak

yatim piatu) from the

veterans (veteran) or

Pioneers of

Independence

(Perintis

Kemerdekaan);

g. Wage Recipients

Worker (Pekerja

Penerima Upah, or

PPU) and Non-Civil

Servants Government

Employees (Pegawai

Pemerintah Non-

PNS) with

salary/wages above

1,5 (one point five)

times until 2 (two)

times times from

income is not taxable

status with 1 (one)

child along with the

family members; and

h. Non-Wage

Recipients Worker

(Pekerja Bukan

Penerima Upah, or

PBPU) and Non-

Worker (Bukan

88

3rd Class Medical

Ward


Pekerja, or BP) who

pay monthly

contributions with the

benefit of getting 1st

Class Medical Ward.

From the service category described in the Table 4.2, it can be understood

that the agreement between Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) and the participants is a health financing agreement

where the participants pays their monthly contribution fund to Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan), or can be said

that Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) collects monthly contribution fund from the participants and which bear

the participants contribution fund and pay it to the service intermediary who has

cooperated with Social Security Administrative Body for SJSN Health Program

(BPJS Kesehatan). This deal flow can be explained through the Figure 4.2.

“So the monthly contribution fund paid by the participants to Social

Security Administrative Body for SJSN Health Program will be collected, then the

health care facilities that have handled participants make billings, we pay them from

the fund. So the cost that the service charge to Social Security Administrative Body

for SJSN Health Program (BPJS Kesehatan), we do not ask for single fee to the

participants. We did not make the health care facilities because our focus is on the

financing system” (Buan, personal communication, November 27, 2018).

89

Figure 4. 2 Flow of Social Security Administrative Body for SJSN Health Program

Based on National Social Security (Badan Penyelenggara Jaminan Sosial,

or known as BPJS) Act No. 24 if 2011, Article 43 stated that the allocation of funds

were intended to finance contributory health insurance, Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) operational cost,

and investment with goal of funding social development for the society. National

Social Security (BPJS) Act No. 24 of 2011, Article 40 also explained that Social

Security Administrative Body for SJSN Health Program (BPJS Kesehatan)

separates between their assets and social security assets. This aims to ensure that

social security assets and their development are intended for social security (dana

amanah or known as trust fund).

“Based on law, monthly contribution fund is a mandate from the

participants and are purely used for the participants health care services. In terms

of the monthly contribution fund should not used by any party, including paying

the country’s debt” (Buan, personal communication, November 27, 2018).

Social Security Administrative Body

for SJSN Health Program (BPJS

Kesehatan)

Health Care Service Providers (Clinics,

Hospitals, etc)The Participants

90

Monthly contribution fund collected from the participants are managed by

Social Security Administrative Body for SJSN Health Program (BPJS Kesehatan)

based on Social Security (BPJS) Act No. 24 of 2011, Paragraph B through short

and long-term investment by considering the aspects of liquidity, solvability,

prudence, data security and adequate results and aims to increase funding power for

the participants. So basically, financing of health care insurance provided by Social

Security Administrative Body for SJSN Health Program is public funds that are

returned back to the participants in form of the health care insurance.

“Because the principle used in Social Security Administrative Body for

SJSN Health Program (BPJS Kesehatan) is mutual cooperation, that means comes

from the participants and return back to the participants again” (Buan, personal

commuication, November 27, 2018).

The principle of mutual cooperation carry out by Social Security

Administrative Body for SJSN Health Program (BPJS Kesehatan) indicates that

participants pay for themselves for the purpose of health care services and the

government only served to provide help for those who can not afford and also make

the regulations regarding Social Security Administrative Body for SJSN Health

Program (BPJS Kesehatan) for the sake of public interest.

91

4.4 Plan for The Development of Social Security Administrative Body for

SJSN Health Progrm (BPJS Kesehatan) based on Islamic Finance

Principles

The problems that are sticking in various media on 24 May, 2017 at Bogor

Regional General Hospital (Rumah Sakit Umum Daerah, or known as RSUD

Bogor), on 28 May, 2017 at Permata Hospital (Rumah Sakit Permata) Pamulang

and on 20 September, 2017 at Bintan Regional General Hospital (Rumah Sakit

Umum Daerah, or known as RSUD Bintan) regarding the cases that doctors are

refused to handle the patients due to statements that “Social Security Administrative

Body for SJSN Health Program (BPJS Kesehatan) contains usury which is

forbidden in Islam, that is not an authority for local and national level of Social

Security Administrative Body for SJSN Health Program, but it is a matter for the

hospital themselves.

“That is not one of our business, that is an authority of the revelant hospital.

We cooperated with the hospital as a health care service provider, business-to-

business only. For contracts and other matters are up to the hospital. Generally, the

doctors who refuse will be deactivated by the relevant hospital” (Buan, personal


The basic problems that arised and become polemic in the society are

eventually triggered a meeting held with National Social Security Council (Dewan

Jaminan Sosial Nasional, or known as DJSN), OJK, and the Indonesia Ulema

Council (Majelis Ulama Indonesia, or known as MUI) with Social Security

Administrative Body for SJSN Health Program and resulted in several decisions

that,

92

“Social Security Administrative Body for SJSN Health Program (BPJS

Kesehatan) can not be said to be haram and prohibited because there is an element

of mutual cooperation and helping the others. In addition, in the registration form,

it is now written about where the monthly contribution fund will be distributed, so

the information is more transparent. Therefore, a fine of 2% per month which is

said to be usury has been removed and changed to 2.5 % if only the participant is

hospitalized” (Buan, personal communication, November 27, 2018).

Although the bad news about Social Security Administrative Body for SJSN

Health Program (BPJS Kesehatan) spread widely, that does not affect in number of

participants registered every month, so Social Security Administrative Body for

SJSN Health Program is unlikely to be made.

“There is no decrease in number of the participants who registering

themselves to us. Instead, they are being worried about the issue and will result in

the elimination of Social Security Administrative Body for SJSN Health Program

(BPJS Kesehatan) especially for those with economic difficulties” (Buan, personal


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