The 12 Criteria for Standard Inpatient Classes (KRIS) mandated by BPJS Kesehatan are indeed ideal. However, according to Dr. drg. Iing Ichsan Hanafi, MARS, MH, Chairman of the Indonesian Private Hospital Association (ARSSI), not all private hospitals are ready. Therefore, implementing KRIS presents a unique challenge.
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BPJS Kesehatan requires private hospitals to meet 12 KRIS (Indonesian Hospital Rehabilitation and Health Insurance) criteria, which serve as standards for facilities and services for inpatients. These include: building, ventilation, lighting, bed amenities, bedside tables, room temperature, room division, room density, curtains/partitions, indoor bathrooms, bathroom accessibility, and oxygen outlets.
The KRIS implementation was originally planned for 2022. However, due to the COVID-19 pandemic, it was not possible to implement it at that time. "Regarding KRIS, the regulations are under the Ministry of Health, including the 12 KRIS criteria. It was originally planned to be implemented in 2022, but post-COVID-19, hospitals were not ready. This is still under discussion," said Iing Ichsan Hanafi.
According to him, it is currently in a transitional period. "The regulations established by the Ministry of Health and private hospitals are still being discussed. Should there be only one class, or will the existing classifications remain, namely Class I, II, and III? We also need to examine whether hospitals will incur losses if all rates are set at one level," he explained.
Currently, BPJS Kesehatan contributions, based on Presidential Regulation No. 63 of 2022, are set at Rp 35,000 per month for Class III, Rp 100,000 per month for Class II, and Rp 150,000 per month for Class I.
According to Iing, incentives are needed for hospitals to implement KRIS. "We propose incentives. They could start with government hospitals first, followed by private hospitals," he told VOI's Edy Suherli and Bambang Eros during a recent interview at Hermina Tower in Kemayoran, Central Jakarta.
How prepared are private hospitals to meet the 12 KRIS criteria established by BPJS Kesehatan (Social Security Agency for Health)?
Regarding KRIS, the regulations are under the Ministry of Health, including the 12 established criteria. This regulation was originally scheduled to be implemented in 2022, but since COVID-19, hospitals have not been ready. This is still under discussion. Discussions are ongoing between the regulations established by the Ministry of Health and private hospitals, regarding whether there will be only one class or whether the existing classifications of Class I, II, and III will remain. However, the 12 criteria remain consistent. The issue concerns the tariffs for Class I, II, and III. Also, regarding premiums, whether they will be the same or remain different. If premiums are the same for all, it's necessary to calculate whether this will lead to a deficit.
Regarding the readiness of private hospitals, frankly, with KRIS, inpatient capacity will be reduced. This will certainly impact patient access to hospitals. However, in terms of patient comfort, patients will be better served in the future.
What are the biggest challenges in implementing KRIS, especially for Type C and D hospitals in the regions?
The challenge is indeed related to the reduction in bed capacity. We must prepare a budget to address this change. Furthermore, we don't yet know what the rates will be. This must be communicated well to prevent patients from complaining to the hospital. For example, a patient who is usually treated in two beds may suddenly have to be accommodated in three or four beds. In principle, we will comply with the regulator's regulations, but the obstacles we mentioned earlier need to be eliminated.
Does ARSSI have data or projections of the investment costs required for renovations to meet KRIS standards?
Each hospital faces different challenges. If building a new hospital, the costs can already be calculated. But for existing hospitals, conditions certainly vary.
Are there any alternative solutions or suggestions from ARSSI to the government regarding the KRIS implementation deadline?
We propose providing incentives. Implementation could begin with government hospitals first, followed by private hospitals.
What is ARSSI's view on allegations of fraudulent practices in BPJS claims submissions by a number of private hospitals?
Regarding fraud, it's not only perpetrated by hospitals, but also by BPJS and patients. So, anyone has the potential to commit it. We don't deny that some of our members have committed such acts. However, BPJS has provided guidance. As an association, we have also urged hospitals to improve themselves to prevent future incidents.
What steps does ARSSI take to guide its members to comply with procedures and avoid fraudulent claims?
We don't provide technical guidance, as that falls within the purview of BPJS. Typically, if a case arises, we are notified. After that, we participate in providing guidance to the member in question.
So far, do you think the BPJS claims control and verification system has been fair and transparent?
Regarding verification, there must be transparency between verifiers and hospitals. Sometimes claims have been paid by BPJS, but we are still audited again. Verifiers should be able to guarantee that the payments are accurate and that there are no further changes. Going forward, this system must continue to be improved.
BPJS patients go to hospitals through lengthy procedures, while general patients go through toll roads. Why is this?
Currently, Universal Health Coverage (UHC) has reached 94%. More than 80% of patients in hospitals that collaborate with BPJS are BPJS members. Going forward, if the referral-based hospital system is strengthened, this will be even more helpful. We hope BPJS can increase access to health facilities (faskes) to reduce hospital queues.
Since the introduction of BPJS, there has been a surge in the number of patients in hospitals. Is this due to a lack of public health awareness campaigns, leading people to prefer hospitals?
It's our collective responsibility to increase preventive efforts over curative ones. Currently, the reality is that curative measures are more important. I hope there will be regulations that promote the importance of preventive measures.
The role of integrated health posts (Posyandu), village and sub-district cadres, must be revitalized in prevention campaigns. So, in addition to preventive efforts, the community can also self-medicate. The principle is that prevention is better than cure.
On the other hand, hospitals must also continue to develop. What is your view?
Hospitals must continue to develop. Employees must receive salary increases, new medical equipment must be purchased, old equipment must be refurbished, and doctors must be educated and trained. This means that hospitals must remain profitable to be able to do all of this.
Although profit-oriented, the social side of hospitals continues. We still accept class III patients, and hospitals cannot refuse patients.
For healthcare workers, are working hours standardized so they can provide optimal patient care while remaining physically healthy?
In hospitals, working hours depend on the unit. Some have only one shift for back office staff, while others have two or three shifts for urgent units, such as nurses, pharmacists, or doctors on duty.
They are usually divided into three work shifts. Technically, this arrangement is left to each hospital. Safety is not only important for patients, but also for healthcare workers. They must work within a reasonable workload and duration to ensure optimal patient care.
To improve service quality, are private hospitals using technology?
Some hospitals have implemented electronic medical records. Others are also starting to use the latest technology, including artificial intelligence (AI). In the future, the use of technology will continue to evolve, making hospitals more efficient.
Information technology (IT) is very helpful, but the human touch is still needed from doctors, nurses, and physical services. The presence of healthcare workers will not be replaced by technology. Regarding AI, we are still awaiting government regulations.
What about the implementation of robotic surgery?
This technology is already used in several hospitals, but the investment is still expensive. In the future, if the price is more competitive, it is likely that more hospitals will be able to use this technology.
How can healthcare workers emerge from technological advancements?
The government must assist and facilitate healthcare workers to improve their competencies. Hospitals can also collaborate with third parties through mutually beneficial agreements. Human excellence will be unmatched by robots and technological advancements. ARSSI frequently conducts training, both online and offline, to improve the competency of healthcare workers.
How is the implementation of TKDN in private hospitals currently going?
We fundamentally support it, but we will use quality medical equipment at an affordable cost, especially if it is produced domestically. This will help the national economy. Almost all medical equipment can actually be produced domestically, except for highly sophisticated ones, which still have to be imported. For imported medical equipment, we request tax relief.
How does ARSSI respond to the entry of international hospitals into Indonesia?
We ask the government to create clear regulations regarding this so that private hospitals can survive the influx of foreign hospitals. Currently, there are nearly 2,100 private hospitals in Indonesia, approximately 65% of the total. The most urgent need to protect are small, stand-alone private hospitals, not affiliated with any group. They must be strengthened to survive.
What regulations are in place?
So far, foreign hospitals that have entered the country have been public companies (IPOs). If the goal of the presence of foreign hospitals is to reduce the number of Indonesian patients seeking treatment abroad, that's fine. But the regulations must be clear.
What's still lacking is the development of medical tourism. If the government could provide attractive incentives, I'm sure private hospitals would be interested. However, what's crucial is price competitiveness and, especially, service quality. Neighboring countries are already seriously developing medical tourism with full government support. Patients seeking treatment usually come with an escort, and they also enjoy the trip. There's an economic domino effect there.
What are your calls for ARSSI members to improve their performance in the future?
We must be able to improve hospital performance. Human resources must continue to improve their skills, because human resources are a crucial investment. Medical equipment must also be upgraded, even if necessary, importing new ones to meet community needs. By improving the quality of service, I'm sure patients won't travel abroad just for treatment.
Equally important is preventive measures, which are better and cheaper than curative ones. This must be a shared concern. Adding specialist doctors and their equitable distribution across regions is also crucial and requires government support. The welfare of healthcare workers must also be a priority so they can work optimally.
Iing Ichsan Hanafi: Go with the Flow
According to ARSSI Chairman Iing Ichsan Hanafi, a balance is needed between primary duties at the hospital, organizational duties, and the role of head of the family. (Photo: Bambang Eros VOI, DI: Raga Granada VOI)
Besides being a dentist, Dr. drg. Iing Ichsan Hanafi, MARS, MH., also serves as the General Chair of the Indonesian Private Hospital Association (ARSSI). His weekends are packed with organizational activities, yet he enjoys them.
"I prefer weekends to manage the organization, because on weekdays I carry out routine duties as a doctor. Almost every weekend I have to carry out ARSSI activities. Coordination is carried out almost weekly with several branch administrators," he said.
What's his tip for balancing his duties at the hospital and his duties as ARSSI Chairperson? "What I do is like going with the flow. However, flowing water must be directed," he said.
This way, he continued, he achieves balance in his life. Despite being busy with a myriad of activities, he still manages to maintain calm and mental balance. "Maintaining physical health is just as important as maintaining mental health," he said.
Sports are also important
Exercise is also important for Iing Ichsan Hanafi. Due to his busy schedule, he doesn't have much time. "No matter what, even if I'm busy, I have to make time for exercise. Usually I ride a stationary bike at home and do some light exercise. The important thing is to break a sweat, hehehe," he said.
The duration of the exercise doesn't have to be long. "For someone like me, it doesn't need to be long, the important thing is to break a sweat. It lasts about 30-45 minutes," he said.
One habit that keeps him energized is drinking black coffee in the morning. "When I sip coffee, I feel energized," he said, adding that his wife and family are very understanding of his habit of drinking black coffee.
To maintain his health, Iing has reduced his sugar intake. "I've learned to reduce sugar intake, one way is through drinks. Tea and coffee no longer contain sugar," added the man, who has no specific dietary restrictions.
He also consciously reduces his carbohydrate intake, although there are no restrictions. "I used to eat rice three times a day, but now I only eat twice. I usually don't eat rice at night. If I'm still hungry, I usually eat fruit," said Iing, who doesn't turn down dinner parties, as long as the key is not to overeat.
Attention to Family
Every day, Iing Ichsan Hanafi sets aside time to communicate with his children, usually on video calls. (Photo: Bambang Eros VOI, DI: Raga Granada VOI)
Despite his busy schedule at the hospital and in organizations, Iing still pays attention to his three children. "Two of my children are studying outside the city, and one still lives with us. In the evenings, we usually video call together. We not only greet each other, but we can also see each other even though we're in different cities," he said.
The conversations are usually lighthearted. "I never ask about their academic performance, because I trust them to be responsible for their assignments. Even though they're busy with various activities, family comes first," he emphasized.
By giving his children trust and responsibility while studying outside the city, he is confident that they will fulfill their duties and responsibilities. "They're grown up now, and it's impossible to constantly supervise them like children. My wife and I trust our children to fulfill their academic obligations," he explained.
Learning for Iing doesn't stop at school. "Nowadays, we can learn not only in school or college. We can gain knowledge and apply it anywhere. So, the combination of knowledge gained in school and outside of school will enrich a child. Don't be afraid of making mistakes and don't be afraid of losing. That's what I instill in my children," he said.
There's no need to be afraid of competition. "There will be competition everywhere, so there's no need to be afraid. The important thing is to try, work hard, and work smart. That's the key," Iing Ichsan Hanafi emphasized.
"It's our collective responsibility to increase preventive efforts over curative ones. The reality is that curative measures are now more important. I hope there will be regulations that will reinforce the importance of preventive measures. The role of integrated health posts (Posyandu), village and sub-district cadres, and preventive campaigns must be revitalized. This way, in addition to prevention, people can seek self-medication. Prevention is better than cure."
The English, Chinese, Japanese, Arabic, and French versions are automatically generated by the AI. So there may still be inaccuracies in translating, please always see Indonesian as our main language. (system supported by DigitalSiber.id)
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