AIDS poses heavy funding burden<\/p>\n
JAKARTA (JP): The already inadequate health funding from the
\ngovernment here may face a \"triple burden\" given the possibility
\nof an upsurge in people infected with AIDS, an expert on public
\nhealth says.<\/p>\n
Indonesia already faces a two-fold burden: As ailments usually
\nassociated with poverty, such as infections and tuberculosis,
\nremain prevalent, affluence-related ones like heart disease are
\nbrewing, Ascobat Gani told a seminar Saturday.<\/p>\n
Official figures show that as of this April, the number of
\npeople in Indonesia reported to have been infected with the Human
\nImmunodeficiency Virus (HIV) that causes AIDS had reached 213.
\nBut officials acknowledge that the actual number could be 200
\ntimes higher.<\/p>\n
A recent report by the World Health Organization (WHO) notes
\nan \"explosive increase\" of people in Southeast Asia with HIV. By
\nthe end of the decade, 10 million people in the region may be
\ninfected with AIDS, the report says.<\/p>\n
The shift in diseases such as cardiovascular ailments, require
\nhigher costs related to advanced technology and specialists, Gani
\nsaid at a one-day conference on hospital management held here
\nunder the ongoing Australia Today '94 promotion program.<\/p>\n
The seminar was held by the Indonesian Hospital Association
\n(PERSI) and the Australian Commonwealth Department of Health, the
\nIndonesian government and community services.<\/p>\n
Gani said the government currently is able to provide 30
\npercent of health expenditures while \"the majority of
\npeople...rely on out-of-pocket payment mechanisms.\"<\/p>\n
He said he supported calls to open competition to the private
\nsector in health insurance services, as the state owned ASTEK
\ninsurance company mostly covers employees in the middle income
\nbracket.<\/p>\n
The health law here gives ASTEK a virtual monopoly to mobilize
\nresources of private companies, he said.<\/p>\n
Market<\/p>\n
Gani estimated that the market for health insurance here may
\ndouble in the next 25 years to an estimated 53 million people,
\ndespite problems.<\/p>\n
\"A rough estimate based on present income levels may increase
\nthe current 13 percent coverage of health insurance to 24.6
\npercent,\" Gani said.<\/p>\n
The increase will be slow, he said, given that around 75
\nmillion of the 185 million Indonesians live close to the poverty
\nline.<\/p>\n
President of the Indonesian Hospital Association, Samsi
\nJacobalis, added that it would be difficult to add coverage of
\nprivate health insurance to the higher income brackets.<\/p>\n
\"Very rich people among us have opted for foreign-owned
\ninsurance services, such as a Holland-owned insurance here,\" he
\nsaid.<\/p>\n
A number of people with cardiovascular ailments are clients of
\nthe American-based private Blue Cross and Blue Shield insurance,
\nhe added.<\/p>\n
\"The insurance companies cannot go to private companies either
\nbecause the managers say they have to cover employees under the
\n(state-owned) ASTEK,\" Jacobalis said.<\/p>\n
Regarding the lower income bracket, the government has
\nrecently started a free medical scheme to eventually reach 20,000
\npoor villages, providing clinics, medical supplies and a total of
\nRp 20 million (US$9,260) to each village.<\/p>\n
Jacobalis also suggested that the government duplicate
\nSingapore's practice of allocating annual funds to private
\nhospitals to set aside beds for the poor, though he acknowledged
\nthe sheer number of poor people here pose a major obstacle.<\/p>\n
\"The government's request for hospitals to set aside 10 to 20
\npercent of beds simply cannot be done,\" Jacobalis said.<\/p>\n
The poor, he noted, are reluctant to go to elite hospitals
\n\"with gleaming floors\" such as the Medistra and Pondok Indah
\nhospitals in South Jakarta, where subsidized beds are still
\npriced far beyond their financial capacity at Rp 25,000 ($11.57)
\na night.<\/p>\n
Diana Hovarth, National President of the Australian Hospital
\nAssociation, said health financing in Australia includes a 1.5
\npercent \"levy\" on taxable income, introduced in the early 1980s.<\/p>\n
\"The younger generation usually opts for `extras' like health
\ninsurance only when they have children,\" she said, as without
\nchildren they feel secure that the levy will cover their basic
\nhealth needs.<\/p>\n
In her presentation on the Australian health service
\nprovision, she pointed out that large costs such as medical
\neducation, high-tech sophisticated diagnostic and surgical
\nprocedures come from the public sector. (anr)<\/p>",
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"sponsor": "Okusi Associates",
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