CALCULATION MODEL AND PREDICTION OF CONTRIBUTIONS BASED ON BPJS KESEHATAN DATA FOR ELEVEN TYPES OF DISEASE

• Main Author: Aristyo Nugroho, Benedictus
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/65062
• Institution: Institut Teknologi Bandung

Nowadays the public health becomes an important aspect for improving national human resources, increasing the nation’s resilience and competitiveness as well as nation development. Government, as the organizer, through the national health insurance, need to ensure the indisposed civilians get the health services financial assistance regardless of their economic condition. Based on operational history within 2014-2019, BPJS Kesehatan suffered a deficit, one of which due to imbalance between contribution incomes and benefit expenses or can be said that the applied contributions or premiums were underpriced. Sample data of eleven diseases on BPJS Kesehatan which contain health facilities visits in the period of 2015-2016, showed that collected contributions could only cover the total costs of claim by 33,43%. The calculation of new proposed contribution is done by applying the survival function into term insurance, defining the age of participants got infected by a disease as a random variable whose distribution form is determined through distribution fitting process. The criteria specified in determining the best distribution is the one with the smallest absolute value of AIC and RMSE. The distribution is used to generate a morbidity table consisting of several important parameters for calculating actuarial present value (APV) of benefits, annuities, and premiums or contributions. Based on data calculation, the contributions increase exponentially with the slope increment occurs after the age of 40, with average in 2015 and 2016 is Rp64.560 and Rp62.934, respectively. These amounts are sufficient to cover the total claim costs of disease in that year. The predicted contributions in 2017 are defined by time-series model, which result smaller values than in 2015 and 2016. The contributions have an average of Rp55.420 depending on the age distribution of population. The values are predicted to be sufficient to cover the claim costs by 143,4%.