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November 19, 2025

Kebijakan cost sharing BPJS Kesehatan dinilai akan melegalkan oknum “RS nakal”

Kebijakan cost sharing BPJS Kesehatan dinilai akan melegalkan oknum “RS nakal”
Hery Susanto, Koordinator Nasiona Masyarakat Peduli BPJS
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Foto : Kornas Masyarakat Peduli BPJS, Hery Susanto

Zonasatu News–Berkembangnya wacana bahwa BPJS Kesehatan tidak akan membiayai penyakit katastropik, atau penyakit berat, memantik reaksi keras dari berbagai kalangan.Dirut BPJS Kesehatan Fahmi Idris sendiri telah membantahnya.

“Cost sharing itu belum akan diterapkan. Jadi saat ini tetap dibiayai semua oleh BPJS. Cost sharing harus melalui pengkajian mendalami. Itu pemikiran jangka panjang untuk mengatasi persoalan anggaran”, katanya dalam wawancara televisi.

Dia lantas memberikan contoh praktek cost sharing dibeberapa negara seperti Filipina dan Thailand.

“Itu sebaga perbandingan beberapa negara yang menetapkan jaminan kesehatan. Bentuk dan skemanya berbeda-beda”, terangnya.

Oki Asokawati anggota DPR RI yang membidangi Kesehatan menolak skema cost sharing itu. Menurutnya justru BPJS hadir untuk membantu pembiayaan jenis penyakit yang berat atau katastropik.

“Justru untuk membantu pembiayaan penyakit katastropik, yang relatif berat biayanya. Cost sharing itu kebijakan yang tidak populis”, kayaknya.

Sementara menurut Kornas MP BPJS, Hery Susanto merujuk UU Nomor 40 tahun 2004 Tentang Sistem Jaminan Sosial Nasional (SJSN) pasal 22 ayat (1), menyebutkan manfaat jaminan kesehatan bersifat pelayanan perseorangan berupa pelayanan kesehatan yang mencakup pelayanan promotif, preventif, kuratif dan rehabilitator I, termasuk obat dan bahan medis habis pakai yang diperlukan. Sementara ayat (2), menyatakan, untuk jenis pelayanan yang dapat menimbulkan penyalahgunaan pelayanan, peserta dikenakan urun biaya.

“Dari dua ayat tersebut, secara tegas menyatakan BPJS kesehatan wajib melayani seluruh peserta JKN atas seluruh jenis pelayanan kesehatan termasuk kuratif. Sedangkan urun biaya, baru bisa dikenakan bila ada penyalahgunaan pelayanan, “ paparnya.

Menurut dia, tidak ada kebijakan cost sharing saja, sudah banyak rakyat yang masuk “jebakan batman” dari oknum rumah sakit nakal, dengan menambah biaya lain di luar iuran BPJS.

“Apalagi kalau wacana itu jadi kebijakan. Ini kan sama saja akal-akalan direksi BPJS Kesehatan untuk melegalkan tindakan ilegal oknum rumah sakit nakal mitra BPJS, “ tukasnya.

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