Double Burden Haunts Policyholders, Here’s an Explanation from an IPB University Economics Expert
The issuance of the Financial Services Authority (OJK) circular letter Number 7/SEOJK.05/2025 has recently sparked serious concerns among insurance policyholders. This regulation is believed to have the potential to impose a double burden on customers.
Dr Syamsul Hidayat Pasaribu, a lecturer at the Faculty of Economics and Management (FEM) at IPB University, explained that this policy was implemented to address two main challenges in health insurance operations: the rising cost of medical services, which far exceeds general inflation rates, and addressing the imbalance of risk between insurance providers and participants.
According to Dr Syamsul, healthcare costs have been increasing significantly each year, even exceeding 10 percent, while general inflation remains around 2–3 percent. Healthcare inflation is primarily driven by rising prices of medications and medical devices, most of which are still imported. Therefore, the OJK is promoting cost-sharing between insurance companies and participants through a copayment scheme.
“The primary objective is to promote accountability from both insurance companies and hospitals, while also increasing participants’ awareness in choosing efficient and quality healthcare services,” explained Dr Syamsul.
Under this copayment policy, participants are required to cover a small portion of the healthcare costs they claim. For outpatient services, participants pay a minimum of 10% of the total cost, with a maximum cap of Rp300.000. For inpatient services, the maximum copayment cap is set at Rp3.000.000.
Additionally, this policy requires insurance companies to have a Medical Advisory Board (DPM) to ensure that claims submitted align with medical standards and are accountable.
However, Dr Syamsul emphasized that the success of this policy must be assessed based on its effectiveness in controlling premiums. “If premiums continue to rise annually after the copayment policy is implemented, it means the policy is not yet sufficiently effective,” he stated.
Furthermore, the OJK also encourages coordination of benefits among insurance providers, including between commercial insurance companies, sharia insurance, and social security providers such as BPJS Health. This collaboration, regulated in Chapters VI and VII of the circular, is expected to expand access and improve the efficiency of the insurance system as a whole.
“The effectiveness of this copayment policy will continue to be evaluated. If successful, it is hoped that insurance premiums will not only remain stable but also decrease in the long term,” he concluded. (AS) (IAAS/PRO)
