Cancer, insurance and regret

By Santi W.E. Soekanto

JAKARTA (JP): Mrs Surtiningsih has breast cancer, and since she was diagnosed in March, her family has been spending millions of rupiah for her treatment.

Money that they can ill-afford and which only served to remind them that being sick is indeed a luxury in this country.

"First, there was the cost of the medical checkups leading to the diagnosis, followed by the cost for the operation itself. Next, we also had to pay for the various medications I was given. There are so many drugs that I have been taking that my children teasingly call me a "drug abuser," said the 64-year-old grandmother of 21 children and grandchildren.

Following the operation, she had to undergo a series of radiotherapy, to not only kill any remaining cancerous cells but also prevent them from growing and spreading. The doctor placed her on a course of 33 radiotherapy sessions and this drained the family financially, physically and mentally.

"We have had to pay millions of rupiah. To others, the sum might have been peanuts. I was treated at Cipto Mangunkusumo General Hospital, so the cost was much lower than it would have been in any other hospital," she said.

The daily trips to and from the hospital was also very expensive. This is the uncalculated cost of being ill. Neither Surtiningsih nor her husband was insured.

"The only insurance we have is our children, all grown up, all struggling to feed their own families while caring for their ailing parents."

Surtiningsih's husband of 45 years has never taken out any life insurance policy, even when they were still struggling to raise their seven children, not because he did not care but simply because he was too busy making ends meet to take care of it.

"My late mother-in-law, however, would have said that we did the right thing by not taking out any insurance policy because she believed in the Javanese saying, Ana dina ana upa (when there is a day, there is rice, money and everything else). She believed in letting God take care of our fate. I now wonder if we have been stupid."

"But what makes me wonder are my children -- all university educated and hard workers but do not seem to care about the matter," she said.

She speculated that this indifference might have something to do with religion because her children had pointed out that "traditional" insurance schemes contained elements of usury, which was haram (religiously forbidden).

Indeed, Islamic fiqh (jurisprudence) scholars have ruled that traditional insurance is haram due to the presence of three main elements: gharar (uncertainty), maisir (gambling) and riba (interest/usury).

Prophet Muhammad said, as narrated by Al Hakim and Baihaqi : "It is not permissible to sell an article without making everything (about it) clear nor is it permissible for anyone who knows (about its defects) to refrain from mentioning them."

The gambling element is due to the possibility that the insured may receive a huge amount of money without the equivalent input, or that the insured may spend a lot of money on premiums and not receive anything in return in the end, or when premiums collected exceed the claims, the insurer makes huge profits.

The usury element is in the fact that investment of insurance funds are placed in interest-bearing instruments such as bonds, equities or financing that are not permissible in Islam.

"I wonder if it is a combination of the "surrender your fate to God" culture that my mother-in-law hammered into our mind and the fear of the haram elements that has prevented my children from taking out insurance policies," she said.

The last element, however, should no longer be a problem because since 1994 not only has Indonesia had Islamic banking but also sharia insurance schemes, the most noted of which is Asuransi Takaful.

Takaful simply means social guarantee. Al Takaful refers to the act of a group of people reciprocally guaranteeing one another by providing mutual financial assistance should anyone among them be inflicted with predefined mishaps.

Participants contribute an agreed sum regularly to a Tabarru' (donation) fund. The Takaful (insurance) operator then manages the Tabarru fund based on a set of guidelines and on the Al- Mudharabah (profit sharing) concept. Participants are the sahibul maal (owner of the wealth or capital providers) and the operators are the Mudharib (entrepreneurs).

Today, not only do Indonesians have access to Islamic insurance schemes but also Islamic fund management bodies called baitul maal wat tamwil, or more popularly known as BMT, which serves as a cooperative for low-income clients.

"So what reasons do my children have for not being insured? Beats me, but it sure would have been nice to have a sense of financial security as I was getting ready to go under the knife or the radiotherapy machine," Surtiningsih said.