A problem with a healthcare insurance company

These should be provided for all people, regardless of their pay scale. It should not be a for profit subject. It should be a Human right to all.
Move to The Netherlands ... everybody pays te same premium (controlled by the government, now around 150 euros per month) ... young /old/sick ... everybody must be accepted by the insurance companies
 
Yes I do know people who have had cancer but not the big bills as like most people in the western world they were covered by the 'socialist' health care that most americans seem to be so afraid of. Such a mean spirited attitude. Oh, my god my contributions might pay for someone else's treatment even though others would be paying towards your treatment if you got something really serious.
It depends on individual circumstances. If you are talking about BPJS, Indonesia's healthcare system, it is largely funded by working people, as they contribute to it through a percentage of their salaries, plus employer's contributions.

BPJS runs a deficit every single year, and the government has to cover this shortfall, which ultimately comes from the taxpayers. The IDR 150k monthly premium is peanut and is certainly insufficient to cover healthcare costs for many people.
 
Move to The Netherlands ... everybody pays te same premium (controlled by the government, now around 150 euros per month) ... young /old/sick ... everybody must be accepted by the insurance companies
Copy to @Shadrach ..
In France 24% of my gross salary went in contribution to Social Security, Pension, and a few other minor taxes.
The employer contributes also, more than me.
This is before income / revenue taxe !
Means if my gross salary is 1000, I bring home 760. Before income taxe.
And even with that level of contribution, the Social Security system has every year an abyssimal loss...
So what do you expect from BPJS for 10 $ per month ?
 
It depends on individual circumstances. If you are talking about BPJS, Indonesia's healthcare system, it is largely funded by working people, as they contribute to it through a percentage of their salaries, plus employer's contributions.

BPJS runs a deficit every single year, and the government has to cover this shortfall, which ultimately comes from the taxpayers. The IDR 150k monthly premium is peanut and is certainly insufficient to cover healthcare costs for many people.
What depends on individual circumstances?
I was talking about the american paranoia about making contributions that might be used for somebody else's healthcare because they consider it about as close to communism as you can get if your payments aren't used exclusively for your healthcare.
Never mentioned BPJS, a social health care system that's probably as good as you can expect in Indonesia.
 
Copy to @Shadrach ..
In France 24% of my gross salary went in contribution to Social Security, Pension, and a few other minor taxes.
The employer contributes also, more than me.
This is before income / revenue taxe !
Means if my gross salary is 1000, I bring home 760. Before income taxe.
And even with that level of contribution, the Social Security system has every year an abyssimal loss...
So what do you expect from BPJS for 10 $ per month ?
I agree with you about paying only $10 a month is not much. As I said before, I would be happy to pay more, if they would provide better coverage.
 
What depends on individual circumstances?
I was talking about the american paranoia about making contributions that might be used for somebody else's healthcare because they consider it about as close to communism as you can get if your payments aren't used exclusively for your healthcare.
Never mentioned BPJS, a social health care system that's probably as good as you can expect in
I agree with about the Paranoia of Americans not understanding that if everyone paid more, then everyone would be covered. I would be more than happy to do this.
As to BPJS. Providing substandard medical healthcare, should NOT be acceptable! Maybe if they offered much higher levels of coverage/ more expensive, then they could be a more reliable healthcare insurance company? With so many thousands of people paying monthly, there should be enough funds to provide better coverage. Maybe there is corruption and the money is being drained and used for personal profit for a few.
 
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Anyone experience with this insurance company?

Edit: I found some reviews on the internet ...

"It is a travel insurance policy and the coverage, limitations and exclusions are typical for this type of cover. It isn't a medical insurance policy and won't provide the level of cover that a real medical insurance policy is intended to provide.
The limit of Euro 100,000 is also too low to contemplate a catastrophic accident or illness and/or full medivac expenses."

"Another thing to consider: If a serious accident or illness occurs, and in the insurer's opinion the policyholder is fit to travel back to their home country to obtain treatment, coverage would not continue if the policyholder decides to stay abroad. If the policyholder repatriates, coverage under the policy would also terminate and further treatment in the home country would be at the policyholder's (or their regular medical insurer's) expense. Read Article 6 2.2."

"Article 8, Special Exclusions, it lists "deterioration of Pre-existing Medical Conditions" as an exclusion.
The definition of pre-existing conditions is anything, whether diagnosed or not, that is present at the time of policy inception or start of travel. This is also true of some medical insurance policies, so careful review of policy terms and conditions is advisable, as is clarification from the insurer in the event of any ambiguity, before entering into a contract of insurance. A stroke or heart failure could be considered a deterioriation of your chronic hypertension."
 

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With so many thousands of people paying monthly, there should be enough funds to provide better coverage.
Millions of people are paying, but remember millions of people are also using it.

You do not need a meticulous calculation, common sense will be enough to know that the money from the premium Rp 35.000, Rp 100.000, Rp 150.000 per month will not be enough. As a matter of fact they are running deficit every single year and the government (e.g taxpayers) are paying for the shortfall.

Maybe there is corruption and the money is being drained and used for personal profit for a few.

There is corruption within the hospital system, including instances where doctors themselves contribute such as by performing unnecessary treatments to inflate claims. Additionally, there are cases involving phantom patients used to create false claims. However, this type of corruption is likely only on a small scale in term of the amount of money.

It’s important to note that, unlike other departments, the funds are already spent directly for patient treatments and medications, and there is a deficit every single year leaving little room for manipulation. Therefore, the scope for corruption is limited and generally small-scale.
 
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Millions of people are paying, but remember millions of people are also using it.

You do not need a meticulous calculation, common sense will be enough to know that the money from the premium Rp 35.000, Rp 100.000, Rp 150.000 per month will not be enough. As a matter of fact they are running deficit every single year and the government (e.g taxpayers) are paying for the shortfall.



There is corruption within the hospital system, including instances where doctors themselves contribute such as by performing unnecessary treatments to inflate claims. Additionally, there are cases involving phantom patients used to create false claims. However, this type of corruption is likely only on a small scale in term of the amount of money.

It’s important to note that, unlike other departments, the funds are already spent directly for patient treatments and medications, and there is a deficit every single year leaving little room for manipulation. Therefore, the scope for corruption is limited and generally small-scale.
So then, what can be done to improve the level of service? Just keeping the status quo, is not a solution. How about the Government create an investigative department to keep check on Hospitals and Doctors, misusing the system? And give ones that misuse the system large fines?
All I know, is currently receiving inadequate care, is unacceptable.
 
With BPJS you get what you pay for and in their case if you pay Rp35,000 to Rp150,000 you get the same care. Oh, you do get a room as an inpatient that varies in size and number of people with beds. The level of care does not change but the cost between classes does concerning if you have a gp or specialist seeing the patient. Each class has it's limit on what each class member gets and anything above that for care is supposed to be covered by the patient. From many I have had conversations with, the 3rd class due to all being considered to be in poverty don't see the added charges but government does. One reason those with wealth choose class 3.

I have been an advocate for years that price for BPJS not be classified in what they say is financial class and entitled level of treatment. To me, it should be built upon packages that grow in what is covered medically. One class starts at basic medical coverage and needed emergency care. Next level includes the basic and with added areas of coverage. Next the second level with additional areas of coverage. And so on. At a certain level, Pukesmas is avoided. All priced accordingly and any changes in class takes 2:to 3 months eliminating those that start having a problem not covered and jump to a better class before treatment. All get basic National Health Care but if you want more, it will cost more depending on the level you choose.

This won't help the congestion one finds at Pukesmas with all those sniffing kids and pretty basic needs and only being seen by nurses who prescribe medication for the symptoms, do not run test, and haven't a clue to what may be the cause of the ailment. I see this often. Pukesmas is also full of the poverty level free coverage. BPJS has led the population to get away from just taking care of these small illnesses at home and run to a clinic for anything and everything. This is in all likelyhood the biggest expense to BPJS and they really need to start educating people on the things they just don't need to see a clinic for. People know since BPJS is free for them and they get free cough meds, that's what they are going to do.

Because of the coverages more will be choosing the higher cost classes. Those that qualify for the poverty free coverage are limited to the basic and anything else by evaluation approval. If you were to open the books for BPJS (ha, ha, ha) I believe one would find that the higher levels have less claims than the lower levels except for those that have a problem and immediately upgrade to get better coverage.

In order to work and have less drain on the government purse, radical changes need to take place. Now, wanting to change it all to one price, one level of care is going to be a disaster. Free members flood clinics and hospitals and more go out of nation for better care. If I am forced to pay cash for getting better needed care I would go to Malaysia where the prices are basically the same as here but they have better trained doctors and better equipment.
 
Do not forget that KRIS (Standard Inpatient Class), a universal class that will be implemented by July 1, 2025. All people will receive treatment in standardized patient rooms in hospitals, irrespectively how much premium they pay, as discussed in here.


Employees working in the company partially subsidize the BPJS Health, but the government covers most of the financial shortfall. For example, in 2020 alone, the government provided a subsidy of Rp 46.53T for just six months. Multiply that figure by two for the entire year.


The existing level of government subsidies for BPJS Health may need to be reduced to redirect funds towards providing free meals and milk to all school children.
 
Do not forget that KRIS (Standard Inpatient Class), a universal class that will be implemented by July 1, 2025. All people will receive treatment in standardized patient rooms in hospitals, irrespectively how much premium they pay, as discussed in here.


Employees working in the company partially subsidize the BPJS Health, but the government covers most of the financial shortfall. For example, in 2020 alone, the government provided a subsidy of Rp 46.53T for just six months. Multiply that figure by two for the entire year.


The existing level of government subsidies for BPJS Health may need to be reduced to redirect funds towards providing free meals and milk to all school children.
If as you say all people will covered the same by July 1st. Then wont everyone switch back down to the lowest class fee? Why would anyone pay more for the same service? This Kris standard class doesn't make sense to me. My friend told everyone is being forced into having BPJS, and they can look up someones financial standing, wouldn't that stop a lot of the free care? And make people pay?
 
If as you say all people will covered the same by July 1st. Then wont everyone switch back down to the lowest class fee? Why would anyone pay more for the same service? This Kris standard class doesn't make sense to me. My friend told everyone is being forced into having BPJS, and they can look up someones financial standing, wouldn't that stop a lot of the free care? And make people pay?
KRIS will only have one level and one price for all. The thing people will need to look at are what hospitals and doctors will be allowed to charge for any service above what is provided in the new plan. These differences will be charged in cash. The top class who primarily support the lower class cost will be paying less per month but will be surely higher cost overall. Personally, I think they have uneducated misfits designing these programs.
 
BPJS and I suppose KRIS are already mandatory for everyone in Indonesia.
 
Rp600,000 for what? Companies pay a big portion of the employees cost and a portion of it goes towards the retirement savings through BPJS.

The Rp600,000 is for BPJS Kesehatan (which is what we are talking about here).

"Retirement Savings" is on BPJS Ketenagakerjaan.

Different department, separate office, each their own entity.
 
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The Rp600,000 is for BPJS Kesehatan (which is what we are talking about here).

"Retirement Savings" is on BPJS Ketenagakerjaan.

Different department, separate office, each their own entity.
OK, but the top cost for BPJS Kesehatan is Rp150,000 per month and part of that is supposed to be covered by the employer. What does the remaining Rp450,000 go towards?
 
OK, but the top cost for BPJS Kesehatan is Rp150,000 per month and part of that is supposed to be covered by the employer. What does the remaining Rp450,000 go towards?

To those unemployed, the top cost is Rp150,000.

But to those employed, the top cost is Rp600,000.

All goes to the same pool of funds for the benefit of you and me.
 

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