Thursday, June 25, 2020

BPJS-Kesehatan - Raising Premium Is Not The Solution

Cara Cek Kelebihan Iuran BPJS Kesehatan yang Terlanjur Dibayar ...Since July last year, the agency managing Indonesia's national health insurance – known as BPJS-Kesehatan – has been suffering an estimated deficit totalling Rp 28 trillion or around US$1,998 million. That's more than triple the deficit at the end of 2018 .

The COVID-19 pandemic is expected to worsen this. At least 1.9 million Indonesian workers are unemployed as a result. This economic hardship will likely reduce the number of enrolled members and cause a significant revenue loss for BPJS Kesehatan.

To support the agency, the government plans to increase national health insurance premiums from July 1 2020.

Under the plan, the government will raise the premium for first-class health service by 87.5% to Rp 150,000 per month per person, for second-class service by 96% to Rp 110,000, and for third-class service by 65% to Rp 35,000.

However, this move only addresses short-term problems. It does not tackle the structural issues the BPJS faces, ranging from its revenue-generation strategies to its health service priorities.

We will first show you why the premium rises are not the best solution. We have also identified four other effective strategies to achieve sustainable and inclusive national health insurance to ensure all Indonesians get equal access to health care.

Why raising premiums is not the best solution - Under BPJS-Kesehatan, Indonesia is running the world's largest universal health insurance scheme . It has about 224 million members, covering more than 80% of the population, including 96 million poor individuals.

The scheme is Indonesia's attempt to provide universal health coverage. This means all Indonesians should have access to health services regardless of their economic status.

The raised premiums will only hurt that attempt, as access to health services will be limited to people who can afford it. Those who can't afford the premiums may end up being excluded from the health-care system or may have to downgrade their memberships.

Only one-third of the 74 million informal workers in Indonesia are receiving government subsidies for insurance premiums. The remaining two-thirds are required to join the national health insurance independently.

As of 2019, only half of the independent members paid the premiums. Assuming this is a reflection of the group's ability to pay, raising the premiums will further reduce the ability of these vulnerable groups to buy health insurance. Informal workers who are relatively healthy and fit will likely opt out of the insurance membership.

Motivation to pay is another important factor. Many existing members who maintain their membership are motivated by a high need for health care due to existing illness . One of the most telling signs is that the independent members group consistently has a very high claim ratio .

The increase in premiums does little if anything to address this selection bias in membership. Instead, it might further discourage some people from continuing to pay their premium if they cannot foresee that they will use their health insurance. The healthy will be more likely to drop out. Those who stay are the ones who are 'sick'.

Ideally, a national health insurance scheme should support services to keep the population healthy by delivering basic curative and preventive services, to curb the need for more expensive hospitalisation costs. In reality, a high proportion of BPJS-Kesehatan's budget is still used to pay hospital bills associated with chronic diseases, which should be prevented at primary care level . From 2014-2016, nearly 80% of BPJS Kesehatan's annual spending was on secondary and tertiary health-care facilities.

Thus, it is fair to say the national health insurance program is still at its core a 'sickness insurance'. Raising premiums will not be effective if BPJS still prioritises high-cost health services for the sick.

Alternative solutions - Raising premiums – while everything else in the health system is unchanged – is not the best policy option. We suggest other pressing strategic, structural approaches need to be adopted.

First, we need to better identify people who can contribute more. The current class system is irrelevant to members' ability to pay and should be evaluated. Standardised, instead of tiered, services arguably can promote fair health service delivery to all insured members.

Premiums could be calculated based on income brackets instead. To do this, BPJS Kesehatan can collaborate with the Ministry of Finance's Tax Directorate General.

Second, mandatory universal health insurance membership for every citizen will ensure a reasonable amount of funds pooled from the public. The government can enforce this with an improvement in data updates and verification of the poor and near-poor population, so the government subsidy is allocated properly.

Third, BPJS Kesehatan can reorient the current health-care delivery towards a preventive model. To promote this approach, the government should strengthen the role of community health centres as the backbone of preventive care and chronic disease management. The government should also strengthen co-operation and integration between public and private sectors at the primary care level .

Lastly, BPJS-Kesehatan itself must promote transparency. Local health officials and the general public have complained about BPJS Kesehatan's lack of transparency, which deters people from enrolling.

Opening critical data to public scrutiny is a powerful tool to support an effective response mechanism within BPJS-Kesehatan. It also prevents administrative frauds such as double claims from happening. Without transparency and accountability, the public will always question the trustworthiness and legitimacy of BPJS-Kesehatan.

Author: Ade W. Prastyani

InDriver - No Insurance Protection

inDriver - Home | FacebookE-hailing drivers have been advised not to register themselves under the illegal InDriver e-hailing app as any mishap would not be covered by insurance. Malaysia e-hailing drivers association (MEHDA) said this purported e-hailing operator had been operating illegally for months in Penang.

Upon checks and confirmation from the Land Public Transport Agency, the said company does not have a Business Mediation License to operate, making it an illegal e-hailing operator. Following more complaints and investigations, we found that InDriver, despite being illegal, allows e-hailing drivers to sign up and go online using the app to ferry passengers without having a valid public service vehicle license.

All e-hailing drivers are encouraged not to use the InDriver app, because in the event of any mishap during rides, the illegal status of InDriver and their drivers would mean both passengers and drivers are not covered by insurance while on the road. This would also lead to further complications should there be accidents along the journey.

GNC Files For Bankruptcy

GNC MalaysiaGNC has filed for bankruptcy, warning it will close up to a quarter of its stores and search for a buyer. The 85-year-old vitamin and dietary supplement company has been saddled with nearly $1 billion of debt and has faced declining sales at its brick-and-mortar locations since before the pandemic. 

However, GNC said that stay-at-home orders during the Covid-19 pandemic prevented the company from accomplishing its refinancing plans because of the abrupt "dramatic negative impact" on its business.

GNC will continue operating, but it will become a smaller company. It plans to close up to 20% of its 5,800 retail stores, which amounts to as many as 1,200 locations across the United States. GNC also sells its products in an additional 1,200 Rite Aid (RAD) stores.

It obtained $130 million in fresh financing from its largest vendor, vitamin supplier IVC, to help it restructure. GNC aims to emerge from bankruptcy in the fall.
GNC explained that bankruptcy will give the company an "opportunity to improve our balance sheet while continuing to advance our business strategy, right-size our corporate store portfolio, and strengthen our brands to protect the long-term sustainability of our company."

Around 30% of its stores in the United States and Canada were forced to temporarily close because of the pandemic. In its first-quarter earnings report released in May, losses accelerated to $200 million — far more than the $15 million it lost during the same time period in 2019 — because of the store closures.

Olympus Camera Exist After 84 Years

Interchangeable Lens Cameras | OlympusOlympus, once one of the world's biggest camera brands, is selling off that part of its business after 84 years. The firm said that despite its best efforts, the "extremely severe digital camera market" was no longer profitable. It had recorded losses for the last three years.

The market for standalone cameras has fallen dramatically - almost 84% between 2010 and 2018. The arrival of smartphones, which had shrunk the market for separate cameras, was one major factor, it said. 

The Japanese company made its first camera in 1936 after years of microscope manufacture. The Semi-Olympus I featured an accordion-like fold-out camera bellows, and cost more than a month's wages in Japan. The company continued to develop the camera business over the decades, becoming one of the top companies by market share.

The 1970s was a high point, with their cameras advertised on television by celebrity photographers. Those cameras were revolutionary - they were very small, very light, they were beautifully designed, had really nice quality lenses.

A cult following stayed with the firm, despite teething issues with new technologies such as autofocus. But the firm had a second wave with digital cameras, where they were early adopters. But they targeted their later range of mirrorless cameras at a middle market - people who weren't serious photographers - they wanted something better than a point-and-shoot camera, but they didn't want a DSLR camera. That market very very quickly got swallowed up by smartphones, and turned out not to exist.

Olympus Corporation, however, will continue. The company never stopped making microscopes, and has turned its optical technology to other scientific and medical equipment such as endoscopes.

Japanese Insurers Shifted to Online Distribution

Malaysia launches first Internet insurance platform | Asia FirstJapan’s life insurance industry is expected to contract by 1% this year compared to the 2 per cent growth registered in 2019. The company has revised Japan’s insurance forecast in the aftermath of the global Covid-19 outbreak. The Japanese life insurance market is forecast to grow by 0.9% during 2019-2023.

The Covid-19 crisis has forced the country’s economy into recession, with GDP falling by 3.4% in the first quarter of 2020 after a 6.4 drop in the last quarter of 2019.

This is expected to adversely impact the growth in new business premiums and insurers could face lower investment returns with interest rates being decreased by the Central Bank. 

Insurers face added pressure from Japan’s dependence on offline sales. Latest data from Japan Life Insurance Institute reveals about 3% of life insurance products are sold through online channels, whereas sales representatives and agents together account for more than 70%.

Restrictions on movement and reduced face-to-face interactions are expected to impact life insurance uptake in the short-term. While insurers are trying to bridge this gap, it is expected to take considerable time to achieve significant digital transformation.

An ageing population, low birth rate and low interest rates are key factors constraining life insurers’ growth prospects in Japan. Mortality updates and premium rate cuts in 2019 are also putting profitability under pressure.

As insurers brace for the looming slowdown, the next steps for recovery will involve a marked shift from the legacy offline-based business processes to technology-driven solutions.

Wednesday, June 24, 2020

Johnson & Johnson US$2.1 Billion Damages

A bottle of Johnson and Johnson Baby Powder. Consumers expressed concern on social media about a talc-based baby powder made by Johnson & Johnson on Wednesday after a Missouri jury ordered the company to pay 72 million in damages to the family of a woman who said her death from cancer was linked to use of the product.Reuters PhotoA US court has upheld a verdict that talcum powder sold by Johnson & Johnson caused ovarian cancer and ordered the pharmaceutical giant to pay $2.1 billion in damages.

The decision by the Missouri Court of Appeals cut by more than half the $4.4 billion a jury had awarded 22 people in 2018. The court agreed that some of the plaintiffs should not have been included in the case as they were from outside the state.

But the Tuesday decision upheld the awarding of damages for the company "knowingly selling products that contained asbestos to consumers."

"Because defendants are large, multi-billion-dollar corporations, we believe a large amount of punitive damages is necessary to have an effect in this case. It is impossible to place monetary value on the physical, mental and emotional anguish plaintiffs suffered because of their injury caused by defendants, " the judgement said.

A spokeswoman for Johnson & Johnson said the company would appeal the decision in the Supreme Court of Missouri.

Johnson & Johnson has faced thousands of lawsuits across the United States alleging it failed to warn consumers of the risk of cancer from asbestos in its talc-based products.

In 2019 a California jury became the latest to award millions in damages to a plaintiff who said the company's baby powder had given her terminal cancer.

Last month the firm announced it was discontinuing production of its talc-based baby powder in the US and Canada, in part due to the "constant barrage of litigation advertising" over the product.

It will continue to sell the product in the rest of the world, it added

USA - Insurers & Hospitals To Disclose Price

How to Bring Real Competition to the Health Care IndustryThe Trump administration won a court ruling Tuesday upholding its plan to require insurers and hospitals to disclose the actual prices for common tests and procedures in a bid to promote competition and push down costs.

Health and Human Services Secretary Alex Azar called the decision in federal court in Washington, D.C., “a resounding victory” for President Donald Trump’s efforts to open up the convoluted world of health care pricing so patients and families can make better-informed decisions about their care.

“This may very well be bigger than healthcare itself,” Trump tweeted Tuesday, on the ruling. “Congratulations America!”

But the American Hospital Association, which sued to block the Trump administration regulation and was on the losing side, announced it would appeal. Industry argues that forcing the disclosure of prices negotiated between hospitals and insurers amounts to coercion.

That means the decision by U.S. District Judge Carl J. Nichols may not be the final word.

“American patients deserve to be in control of their healthcare,” Azar said in a statement. “Especially when patients are seeking needed care during a public health emergency, it is more important than ever that they have ready access to the actual prices of health care services.”

Melinda Hutton, general counsel for the hospital association, said the trade group is disappointed by the ruling upholding what she called a “flawed” policy. Hutton, too, cited the coronavirus pandemic, saying that complying with the rule would impose new costs at the wrong time.

“It also imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care,” Hutton said. “The AHA will appeal this decision and seek expedited review.”

The administration’s disclosure rule is set to take effect in January, but that timetable is now unclear.

Nonetheless, patient advocate Cynthia Fisher said the judge’s decision will help demystify health care costs and is in line with what most people want to see. “Americans want hospitals and insurance companies to reveal their hidden prices and believe that it will lower prices,” said Fisher.

As proposed, the Trump administration rule would require that hospitals:

—publish in a consumer-friendly manner negotiated rates for the 300 most common services that can be scheduled in advance, such as a knee replacement, a Cesarean-section delivery or an MRI scan. Hospitals would have to disclose what they’d be willing to accept if the patient pays cash. The information would be updated every year.

—publish all their charges in a format that can be read on the internet by other computer systems. This would allow web developers and consumer groups to come up with tools that patients and their families can use.

Insurers also oppose the plan, saying it could prompt providers that are accepting a bargain price to try to bid up what they charge if they see that others are getting more.