When Heni Karmila sought to find a doctor for
her ailing mother using Indonesia's new healthcare system, she faced a
nine-hour wait in a line outside a crowded public hospital in Jakarta.
"The queue at the hospital is always
very long, packed with young and old people, pregnant women, people who have had
accidents, those in need of operations and even tiny babies," the small
business owner, 43, told AFP.
The case illustrates the challenges for
Indonesia as it seeks to roll out one of the world's biggest universal
healthcare systems.
The scheme aims to make healthcare accessible
to the country's entire population of 255 million by 2019, part of the
government's efforts to direct some of the benefits of strong economic growth
into improved welfare.
Joining is compulsory, with most members
paying a small premium. Civil servants are automatically enrolled, private
companies must sign up staff while the self-employed and those working in the
informal sector are required to join themselves.
The poorest get care for free under the
system, known as the JKN.
A total of 160 million people are so far
members of the programme in the world's fourth most populous nation, and it has
been credited with helping many since its 2014 launch.
Numerous
challenges
But it faces numerous challenges, from
underfunding, to slow and patchy implementation, to cases like Karmila's, where
the system has become a victim of its own success in densely populated areas,
leading to long queues.
Karmila, whose 72-year-old mother suffers
from multiple ailments, said she also suspected that one public hospital was
turning ordinary people away and instead reserving places for privately-insured
patients, who bring bigger profits.
In the remote and poor east of the country,
the problems are different—people may theoretically have access to healthcare under
the JKN, but often there are not enough hospitals and doctors to provide it.
The most pressing challenge in recent months
has been underfunding as patients flocked to use the system, prompting the
agency that runs the JKN to warn it could run out of money as its funds may not
cover claims from medical providers.
Despite resistance from lawmakers and the
public, the government in April increased the premiums paid by some users.
Monthly premiums now range from 80,000 rupiah
(around six US dollars) in the top category of the JKN—which provides better
services, such as private rooms in hospital as opposed to wards—to 25,000
rupiah (around two US dollars) in the bottom category.
In the past, most Indonesians relied on
private insurance of some sort while those deemed living in poverty got free
public health care—but this left millions stuck in the middle, too poor to
afford care but not poor enough to qualify for government assistance.
Under the JKN, all citizens should get access
to health services provided by public facilities as well as those from a few
private providers who have joined the system, although wealthier Indonesians
are still likely to opt for private insurance.
'Many have
benefited'
There are currently no punishments for people
who fail to sign up, but when the system is fully rolled out, they will face
small fines.
Irfan Humaidi—a spokesman for the healthcare
and social security agency, which runs the scheme—admitted there were teething
problems but insisted that overall the JKN was working well.
"There are so many people who have been
benefited from the system," he said.
One such person is Ramot Siagian who recently
had a heart attack while visiting his daughter in Jakarta from western Sumatra
island.
"We took him straight to hospital and he
got treated using the JKN," said his daughter Lia Siagan.
An overhaul of Indonesia's healthcare system
was long overdue, as it lagged behind many others in the region.
Government spending on health in Indonesia is
just three percent of GDP, lower than other countries in the region. It has the
equivalent of one physician per 5,000 people, compared to two in Thailand and
six in Malaysia, according to the World Bank.
The quality of medical services is also
criticised as poor compared to its neighbours, and horror stories abound.
Last year, two patients at a high-end private
hospital outside Jakarta died when medics trying to anaesthetise them for
routine surgery administered the wrong drugs due to a labelling mix-up.
Despite the challenges, the JKN has won much
praise and its supporters are urging patience.
"Indonesia has just begun adopting a
national healthcare system, so of course there are problems," said
Hasbullah Thabrany, a health expert from the University of Indonesia.
"But with commitment, it will survive in
the long run."
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