Materi Pertemua ke 5 Perencanaan Keuangan_Asuransi Kesehatan

Summary

This video focuses on health insurance, explaining its meaning, history, and evolution in Indonesia. It introduces the concept of insurance, highlighting its role in providing financial protection against losses such as accidents, death, or health issues. The script traces the history of health insurance from ancient times to its current form in Indonesia, detailing government efforts to regulate health insurance for public servants, the introduction of BPJS, and the development of various insurance models. It also compares different types of insurance and discusses the challenges in health insurance management in Indonesia.

Takeaways

• 😀 Health insurance is a system designed to protect individuals from financial loss by providing compensation in case of certain events such as accidents, death, or damage.
• 😀 According to legal definitions, insurance is an agreement where the insurer pays a sum of money to the insured in the event of a loss, with the insured paying premiums in return.
• 😀 Health insurance has historical roots dating back to ancient societies, where basic principles like shared contributions for the common good were established.
• 😀 In ancient Chinese society, insurance concepts involved communities paying a sum to a healer for health services, regardless of whether the individuals were sick or not.
• 😀 In Indonesia, the public initially had low awareness about health insurance, with many viewing health issues and death as 'God's destiny' rather than something to be mitigated with insurance.
• 😀 The development of health insurance in Indonesia began with civil servants and military families in 1968 and has gradually expanded, including poor people through programs like BPJS.
• 😀 Health insurance in Indonesia follows a flow: participants pay premiums to insurance providers, who then cover claims to healthcare providers, who in turn deliver health services.
• 😀 Key components of health insurance include participants, service providers, and the claims process, all aimed at improving public access to health services.
• 😀 Health insurance types can be classified based on components such as the relationship of insurers and insured (tripartite vs. bipartite), number of participants (individual, group, family), and type of coverage (mandatory or voluntary).
• 😀 Social health insurance is mandatory and non-profit, with the government playing a significant role, whereas commercial health insurance is voluntary and profit-driven, often offering higher premiums based on individual characteristics like age and health.
• 😀 The difference between conventional insurance and managed care lies in their focus—conventional insurance aims to mitigate losses for the insurer, while managed care focuses on improving overall health and education through community-rated risk sharing.

Q & A

What is the primary definition of insurance according to Webster Dictionary?

Insurance, as per Webster Dictionary, is a system that protects someone from loss by having them pay a certain amount of money (a fee) to an insurance organizer. When a loss occurs, the insurance organizer compensates the individual with a specified sum of money.

How does the law in Indonesia define insurance?

According to Indonesian law (Article 246 KUHD), insurance is an agreement where the insurer, in exchange for a premium, binds themselves to compensate the insured for losses or damage resulting from an uncertain event, including the loss of expected profits.

What are some common types of losses covered by insurance?

Insurance generally covers losses such as fire, traffic accidents, death, and other unexpected incidents that cause harm to the insured.

What is the historical origin of insurance, especially health insurance?

The concept of insurance dates back to 1007 BC, where ancient societies followed the basic principle of the 'law of the sea', which required everyone to contribute towards the common good. In ancient China, communities paid healers regularly, and in the event of illness, the sick person would receive treatment without additional payment.

Why was health insurance initially slow to develop in Indonesia?

In Indonesia, the development of health insurance was slow due to cultural beliefs that life and death were considered God's destiny, which led to a low awareness of the importance of health insurance. Additionally, the government was relatively slow in introducing insurance concepts to the public.

What is the general flow of the health insurance process in Indonesia?

In Indonesia, the process involves participants paying premiums to an insurance agency. The insurance agency then pays claims made by health service providers (PPK), who in turn deliver health services to the insured participants.

What are the two key benefits of health insurance?

Health insurance provides general benefits, such as improving public access to health services, and specific benefits, such as reducing uncertainty by ensuring coverage in the event of an accident or illness.

What are the key components of health insurance?

The key components of health insurance include the input component (participants and caregivers), the process component (registration, monitoring, evaluation), and the output component (providing health improvements to the community).

What are the main differences between social health insurance and commercial health insurance?

Social health insurance is mandatory, based on a group rating, and aims for comprehensive coverage, with fixed costs. In contrast, commercial health insurance is voluntary, based on individual risk factors (like age and gender), and seeks to generate profit, often with higher costs.

What are the two types of health insurance commonly known in Indonesia?

The two common types of health insurance in Indonesia are conventional insurance, which is based on community rating, and managed care, which is a system where financing is based on the number of registered members with managed health services.