Hard road for I'nesian public healthcare

With her husband earning about one million rupiah (Bt3,100) per month as a bricklayer, the family cannot afford costly medical treatment for her.

“Right now we can only surrender to God and hope that there’s a miracle,” Kanih’s daughter Nur Hasanah said.

With Indonesia set to roll out universal health coverage next year, there is hope for people like Kanih.

The programme aims to have every Indonesian covered by health insurance by 2019.

But experts warn that a pilot plan in the capital Jakarta is fraught with problems, and the national programme could be even more chaotic.

Jakarta’s health insurance scheme, launched last year after the election of popular governor Joko Widodo, has come under criticism following reports earlier this year that two patients died after failing to get adequate treatment in hospitals.

The hospitals said they did not turn away the patients, but did not have the facilities to treat them.

In May, 16 private hospitals threatened to withdraw from the programme, known as Kartu Jakarta Sehat (Jakarta Health Card), saying they were not fully remunerated by the local authorities.

City councillors threatened to launch impeachment proceedings against Widodo and doctors staged street rallies, accusing the governor of politicising health care.

Under the initial phase, about 4.7 million poor residents – half of Jakarta’s population – are entitled to free medical treatment in more than 100 public and private hospitals in the capital.

The city administration pays a premium of 23,000 rupiah (Bt72) per patient, higher than the proposed 15,000 rupiah for the nationwide scheme.

Jakarta’s health agency said there had been a rise of up to 70 per cent in patients seeking hospital treatment since the introduction of the scheme.

If there is a similar uptake in the national scheme, it could paralyse the health system, experts say.

“With the Jakarta programme still in disarray despite better infrastructure and a higher premium, I fear that health care providers in the regions will be overwhelmed and the public will be disillusioned,” said Kartono Mohamad, a former chairman of the Indonesian Medical Association and proponent of healthcare reforms.

The central government has set up an administering body to implement the nationwide health insurance programme, with an initial investment expected at US2.6 billion (Bt81 billion). It will take over the existing national and regional health schemes launched in recent years to help the poorest get access to health care.

Health Minister Nafsiah Mboi said that currently, 70 per cent of Indonesia’s 240 million people are covered by either government or private healthcare plans.

More than 130 million people are entitled to healthcare provision from the central and regional governments as long as they can produce evidence of limited means.

Around 38 million are covered by state-run or private insurance companies, she said.

That leaves 30 per cent of the population, or 72 million people, without any cover.

“It’s an ambitious programme,” Mboi said. “We are very optimistic that it will be on time and that it will bring better quality healthcare to our people in the next few years.” However, Karina Widowati, health specialist with the United Nations children’s fund Unicef in Indonesia, said the current health insurance for the poor has been fraught with mis-targeting and leakage to the non-poor. There is also a huge gap between the benefit packages offered and the actual availability, she said.

“2019 is not very far away and implementation challenges are enormous,” she wrote on the Institute of Tropical Medicine website.

The statistics are certainly daunting.

According to Health Ministry figures, Indonesia has 35 doctors per 100,000 people, short of the government target of 40 per 100,000.