UNS Conference Portal, IndoMS International Conference on Mathematics and Its Application (IICMA 2021)

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Determination of the Premiums on Certain Diseases Covered by the National Health Insurance BPJS Kesehatan
Annaztazza Kusumajiasni Murwono, Benedictus Aristyo Nugroho, Novriana Sumarti

Last modified: 2021-11-19

Abstract


Nowadays the public health becomes an important aspect that should be provided by a nation for looking after the citizens. Indonesia’s government shows this responsibility by establishing health insurance system, namely BPJS Kesehatan. Operationally, BPJS provides a full coverage of costs of certain registered diseases. In fact, a deficit had  occured in BPJS Kesehatan’s finance due to an imbalance between premiums income and benefit costs. Based on sampel data of years 2015 and 2016, the level of adequacy of participant premiums to cover the costs of claims for infectious and parasitic diseases and pregnancy, childbirth, and puerperium diseases only reached 38.83% and 31.33%, respectively.        By applying distribution fitting methods on the simulated empirical survival function, the gamma distribution model is selected to generate morbidity table in order to calculate the value of APV (actuarial present value) of benefit, annuity, and expected premium as an end-product. The result shows that expected premium for infectious and parasitic diseases range between Rp 6.250 and converges to Rp 8.500 with a significant increment in early age, then slightly sloping after age of 15. Expected premium pregnancy, childbirth, and puerperium diseases rise gradually at the age of 15, then constantly rise until the age of 40, before the increment slope getting fewer.