New Regulation on Health Service Tariffs for PT ASKES Members

Minister of Health Regulation No.416/MENKES/PER/II/2011 on Health Service Tariff for PT ASKES Members (“Regulation”) has been issued to adjust the tariff for ASKES members, with the adjusted tariff being contained in the appendixes.

Pursuant to Articles 1 (1) and (2) members of PT ASKES that are entitled to receive health benefits are civil servants, state officials, veterans of war, their family members, as well as doctors and midwifes who are temporary employees. Health facilities that are classified as First Instance Health Facilities (Pemberi Pelayanan Kesehatan Tingkat Pertama / PPK I) pursuant to Article 1 (5) are individual health practitioners or community health centers (Puskesmas). Advanced Health Facilities (PPK II) are general hospitals and specialist hospitals (Article 1 (6)).  

Payment system by PT ASKES to health facilities for the services rendered are mainly stipulated in Chapter II, where pursuant to Article 5, PPK I facilities with a right to payment by PT ASKES on a capitation system, meaning that a doctor and/or Puskemas is paid in advance by PT ASKES based on the numbers of ASKES members located in their area of practice. Pursuant to Article 45, the capitation given to a Puskesmas for every ASKES member in its area of practice is IDR 2 thousand.

Pursuant to Article 9, ASKES members receiving medical treatment are initially required to seek services from a PPK I facility, where should a PPK I facility be unable to provide the needed services, then a member may be referred to a PPK II facility. Article 7 provides an exception to acquiring a reference letter to be treated in a PPK II facility in an emergency situation, whereas the ASKES member will then be entitled to a reimbursement payment. 

Appendix I lists the types of medical treatment/services that can be provided by PT ASKES health facility partners that are covered for payment by PT ASKES, whereas Appendix II states the maximum fee that a health facility can receive in payment.

Chapters IV through XII stipulate the type of treatment rendered by PPK I & PPK II health facilities, as well as stipulating what a health facility can receive in payment from PT ASKES. The services comprise of, among others:

Medicine that is crucial to the improvement of a patient are covered by PT ASKES, where in order to be covered an ASKES member must acquire a prescription from their medical advisor and collect the medicine from a pharmacy that is a PT ASKES partner pursuant to Article 22. 

The hospital room class differs for different level of civil servant and state officials, as set out in Article 38. Should a lower level civil servant acquire a hospital room not according to his civil servant rank, then the civil servant is required to pay the difference to the PPK facility.

Pursuant to Article 40 PT ASKES can only pay a maximum of 44 % from what a PPK facility renders to an ASKES member, suggesting that 54% is to be covered by ASKES members.

Additionally, as set out in Article 40, a PPK facility can impose an IDR 10 thousand fee for ASKES members, for every out-patient visit.

The Regulation repeals and replaces Minister of Health Regulation No. 518/MENKES/PER/VI/2008 on Health Service Tariffs for PT ASKES Members and their Family Members in Community Health Facilities and Government Hospitals, Minister of Health Regulation No. 474/MENKES/PER/VI/2009 on Amendments of Minister Regulation No. 518/MENKES/PER/VI/2008 on Health Service Tariffs for PT ASKES Members and their Family Member in Community Health Facilities and Government Hospitals, and Joint Minister of Health Regulation and Minister of Interior Affairs Regulation No. 138/MENKES/PB/II/2009 and No.12 of 2009 on Guidelines of Health Service Tariffs for PT ASKES Member and Their Family Member in PUSKESMAS, Community Health Facilities, and Regional Government Hospitals.

The Regulation has been in force since 1 March 2011.