Healthcare

Updates on KRIS and Co-Payment Regulation

 

  • MOH postponed KRIS until Dec25 due to equipment and space hurdles. Meanwhile, iDRG and new BPJS tariff are in finalization stage.
  • High claim ratio in BPJS/ private insurance are addressed through changes in referral and capitation scheme/ co-payment regulation.
  • We prefer names with stronger private patient base to overcome ST headwinds of high claim ratio operating environment. MIKA>HEAL>SILO

 

Updates on KRIS, iDRG tariffs and New BPJS Patients’ Premium

As of the latest MoH-DPR RI meeting, only 57% (exh.1) of 2,554 surveyed national hospitals are ready to implement the standardized inpatient rooms (KRIS). MoH targets another ~38% to fully comply by Dec25, leaving ~12% requiring more time to implement. Key hurdles include equipment shortages (nurse call, bed partitions) and space limitations (bed quality/density) (exh.2). Budget constraints particularly affect regional gov’t-owned and non-network hospitals. Meanwhile, the new service tariffs, which will refer to Indonesian patients’ actual cases and costs (iDRG), are still under preparation by MoH and reached their final stages, along with the new BPJS patients’ premium. With these, MoH postponed KRIS full-implementation until Dec25.

 

BPJS and Private Insurance Facing Similar Challenges: High Claim Ratio

Amid high BPJS utilization, a 10% INA-CBG tariff hike (Jan23), and pending premium adjustments, DJSN expects BPJS’ Net Asset Surplus to dip below the 1.5x monthly claim standard by Dec25. To ease pressure, MoH will revise the referral system—shifting from bed size to hospital competency—and update the capitation scheme to performance-based (KBK), incentivizing primary care to treat more patients and reduce advanced-care referrals. Private insurers, face similar pressures of high claim ratios (exh.10). OJK thus issued a new regulation mandating a minimum 10% co-payment/claim from Jan26, with out-of-pocket caps at Rp300k (outpatient) and Rp3mn (inpatient). Higher limits are allowed if stated in policies. While this could improve hospitals’ CF through upfront payments, it may reduce volumes as patients become more cost-conscious. Our initial estimates (exh.12) suggest a potential 100-500bps EBITDA margin contraction assuming a 10-25% decline in FY26F private insurance patient volume.

 

LT Prospect Intact, ST Headwinds from High Claim Ratio Environment

We believe KRIS postponement is already anticipated by the market, with consensus yet to reflect the potential higher rev/patient impact from the upcoming new iDRG (exh.13) and the expected upgrades of JKN patients to private care via CoB (exh.14) in hospitals’ FY25F/26F revenue forecasts. Meanwhile, BPJS deficit pressures could continue tighten claim approvals and reduce patient volume. Private insurance is also at risk, as patient behavior may shift in 2H25, ahead of policy enforcement. That said, we turn neutral for the sector in the short term (3Q25F view). Hospitals with stronger private patient bases should prove most resilient. SILO leads (exh.11) but carries FY25 earnings risk from debt-financed acquisitions. MIKA ranks 2nd, with better margins and attractive valuation. HEAL may see KBK-related referral impacts in FY26, but this should unfold gradually due to Indonesia’s facilities/health workers misdistribution issues. In the longer-term, we maintain OW on strong bargaining power and rev/patient uplift from full KRIS rollout and new iDRG tariff. Top picks: MIKA>HEAL>SILO.

 

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