AIDS poses heavy funding burden

JAKARTA (JP): The already inadequate health funding from the government here may face a "triple burden" given the possibility of an upsurge in people infected with AIDS, an expert on public health says.

Indonesia already faces a two-fold burden: As ailments usually associated with poverty, such as infections and tuberculosis, remain prevalent, affluence-related ones like heart disease are brewing, Ascobat Gani told a seminar Saturday.

Official figures show that as of this April, the number of people in Indonesia reported to have been infected with the Human Immunodeficiency Virus (HIV) that causes AIDS had reached 213. But officials acknowledge that the actual number could be 200 times higher.

A recent report by the World Health Organization (WHO) notes an "explosive increase" of people in Southeast Asia with HIV. By the end of the decade, 10 million people in the region may be infected with AIDS, the report says.

The shift in diseases such as cardiovascular ailments, require higher costs related to advanced technology and specialists, Gani said at a one-day conference on hospital management held here under the ongoing Australia Today '94 promotion program.

The seminar was held by the Indonesian Hospital Association (PERSI) and the Australian Commonwealth Department of Health, the Indonesian government and community services.

Gani said the government currently is able to provide 30 percent of health expenditures while "the majority of people...rely on out-of-pocket payment mechanisms."

He said he supported calls to open competition to the private sector in health insurance services, as the state owned ASTEK insurance company mostly covers employees in the middle income bracket.

The health law here gives ASTEK a virtual monopoly to mobilize resources of private companies, he said.

Market

Gani estimated that the market for health insurance here may double in the next 25 years to an estimated 53 million people, despite problems.

"A rough estimate based on present income levels may increase the current 13 percent coverage of health insurance to 24.6 percent," Gani said.

The increase will be slow, he said, given that around 75 million of the 185 million Indonesians live close to the poverty line.

President of the Indonesian Hospital Association, Samsi Jacobalis, added that it would be difficult to add coverage of private health insurance to the higher income brackets.

"Very rich people among us have opted for foreign-owned insurance services, such as a Holland-owned insurance here," he said.

A number of people with cardiovascular ailments are clients of the American-based private Blue Cross and Blue Shield insurance, he added.

"The insurance companies cannot go to private companies either because the managers say they have to cover employees under the (state-owned) ASTEK," Jacobalis said.

Regarding the lower income bracket, the government has recently started a free medical scheme to eventually reach 20,000 poor villages, providing clinics, medical supplies and a total of Rp 20 million (US$9,260) to each village.

Jacobalis also suggested that the government duplicate Singapore's practice of allocating annual funds to private hospitals to set aside beds for the poor, though he acknowledged the sheer number of poor people here pose a major obstacle.

"The government's request for hospitals to set aside 10 to 20 percent of beds simply cannot be done," Jacobalis said.

The poor, he noted, are reluctant to go to elite hospitals "with gleaming floors" such as the Medistra and Pondok Indah hospitals in South Jakarta, where subsidized beds are still priced far beyond their financial capacity at Rp 25,000 ($11.57) a night.

Diana Hovarth, National President of the Australian Hospital Association, said health financing in Australia includes a 1.5 percent "levy" on taxable income, introduced in the early 1980s.

"The younger generation usually opts for `extras' like health insurance only when they have children," she said, as without children they feel secure that the levy will cover their basic health needs.

In her presentation on the Australian health service provision, she pointed out that large costs such as medical education, high-tech sophisticated diagnostic and surgical procedures come from the public sector. (anr)