HATI-HATI! SAKIT AKIBAT MER0K0K TIDAK DITANGGUNG BPJS? - [Metro Pagi Primetime]

Summary

In this interview, Ali Gufron, the Director of BPJS Health, discusses the financial impact of smoking-related diseases on the national health system, especially the costs associated with catastrophic diseases like cancer and heart disease. He highlights ongoing discussions around policies that might exclude smoking-related illnesses from BPJS coverage, though the specifics are still in development. Gufron emphasizes the importance of preventive measures, such as screening and lifestyle changes, while assuring that medical conditions deemed necessary by doctors will continue to be covered. The conversation also touches on the accessibility and effectiveness of BPJS services, urging citizens to stay informed about their health coverage.

Takeaways

• 😀 BPJS Kesehatan faces a significant burden from health conditions caused by smoking, with major diseases such as heart disease, cancer, and kidney failure costing the system billions annually.
• 😀 In 2024, BPJS Kesehatan is expected to spend around Rp 4 trillion on catastrophic diseases, and the total expenditure for the year could reach 160 trillion rupiahs.
• 😀 BPJS Kesehatan coverage includes medical conditions based on medical indications, and so far, no policy has been set regarding whether smoking-related diseases should be excluded from coverage.
• 😀 The implementation of any new policy regarding smoking-related diseases will require further discussion, as the details and legislative framework are still under consideration.
• 😀 Despite concerns about smoking-related illnesses, BPJS Kesehatan will continue to cover all diseases as long as they meet the medical indications and procedural requirements.
• 😀 BPJS Kesehatan is working with various stakeholders, including the Ministry of Health, to address the impact of smoking on public health, though detailed policies are still in the development phase.
• 😀 There is a large number of smokers in Indonesia, with approximately 70 million active smokers, which could affect the future participation in BPJS Kesehatan if smoking-related illnesses are excluded from coverage.
• 😀 BPJS Kesehatan’s role is not only about treatment but also about prevention and health promotion, encouraging individuals to be more responsible for their own health, including quitting smoking and limiting alcohol consumption.
• 😀 Certain diseases, like tumors, can be treated through BPJS Kesehatan depending on the severity, with outpatient treatments available until they require inpatient care.
• 😀 There is a clinical guideline for conditions like tumors, which outlines whether they should be treated as outpatient or inpatient cases. Medical professionals must ensure treatments are in line with these guidelines and medical indications.
• 😀 BPJS Kesehatan uses the mobile JKN platform to make it easier for participants to check their health status, schedule screenings, and consult with doctors, making healthcare more accessible for everyone in Indonesia.

Q & A

What is the primary concern regarding the burden of smoking-related diseases on the healthcare system?

The concern is the significant financial burden smoking-related diseases impose on the healthcare system, particularly on BPJS Kesehatan, which spends substantial amounts each year on catastrophic diseases such as cancer, heart disease, and kidney failure.

How much does BPJS Kesehatan spend annually on catastrophic diseases?

BPJS Kesehatan spends approximately IDR 4 trillion annually on catastrophic diseases, with the total healthcare expenditure reaching around IDR 160 trillion by the end of 2024.

Does BPJS Kesehatan cover all diseases caused by smoking?

Currently, BPJS Kesehatan does not have any specific regulation that excludes smoking-related diseases from coverage. As long as there is a medical indication and proper procedures are followed, such diseases are covered.

What are the potential implications if smoking-related diseases were excluded from BPJS Kesehatan coverage?

If smoking-related diseases were excluded, it could lead to a loss of coverage for many people, especially since a large proportion of BPJS participants are smokers. This could potentially result in financial hardships for those affected.

What is the stance on excluding smokers from BPJS Kesehatan coverage?

The idea of excluding smokers from BPJS Kesehatan coverage has been discussed, but no such policy has been implemented yet. The focus is on health promotion, prevention, and personal responsibility rather than outright exclusion from the system.

How does BPJS Kesehatan handle claims related to chronic diseases like cancer or heart disease?

BPJS Kesehatan covers chronic diseases such as cancer and heart disease, provided they meet medical indications and are processed according to standard procedures, even if the disease is related to smoking.

What role does the Ministry of Health play in addressing smoking-related diseases?

The Ministry of Health, along with BPJS Kesehatan and other relevant stakeholders, conducts research and collaborates on health policies related to smoking and its impact on public health.

What is the current status of the regulation regarding smoking-related diseases and BPJS Kesehatan coverage?

As of now, there is no specific regulation excluding smoking-related diseases from BPJS Kesehatan coverage. The discussion is ongoing, and any potential policy would need further discussion and clarification.

How does BPJS Kesehatan ensure that the healthcare provided is adequate and efficient for all patients?

BPJS Kesehatan ensures adequate healthcare by following medical indications and standard procedures, allowing doctors to determine whether a treatment, such as a CT scan, is necessary for the patient’s condition.

How does BPJS Kesehatan handle medical referrals and claims for diseases like tumors?

For conditions like tumors, BPJS Kesehatan covers treatments according to clinical guidelines. Tumor patients may be referred to higher-level hospitals if needed, and the treatment will be covered as long as it meets the required medical indications and procedures.