Curing sick hospitals

Hardships now endured by the less privileged in our society seem to have no limit. However, many people may have been surprised by the news in one of our front page stories yesterday that 600 patients had managed to evade paying their medical bills over the last six months at the country's largest state hospital here in Central Jakarta. The patients, mostly from lower-income brackets, simply refused to pay their bills and left, leaving Cipto Mangunkusumo General Hospital, popularly known as RSCM, with between Rp 2 billion (US$235,000) and Rp 3 billion in annual losses.

The dirty trick has also been played on other state and private medical centers for many years now, according to medical sources. The number of these instances, they say, has significantly increased since the economic crisis began. The huge financial losses imposed on RSCM is probably the result of an old public belief that the hospital is a social institution.

RSCM has indeed provided special dispensations to low-income patients and allowed them to pay according to their financial abilities. Even the poorest patients are able to receive free medical treatment here, but such special allowances do not mean that patients can run away en masse.

Yet some people have learned, perhaps from long suffering, how to escape medical payment obligations. To financially protect themselves hospitals have actually imposed advance payment fees on patients, but some people still find a way to evade them. Public protests have been known to occur in response to hospital policies barring patients from leaving the hospital before paying their bill or in which new-born babies are held until the parents have paid for the medical service.

These protests are in fact illogical, especially now when sharp increases in drug prices have pushed some public hospitals and clinics to the brink of insolvency. These institutions can no longer afford to buy imported medical equipment.

A recent newspaper report indicates that half of the 123 medical clinics in Bekasi, West Java, are closing down because they cannot provide treatment and medication. Should massive shutdowns of major hospitals occur, what would happen to our nation? As in many other aspects of our economic crisis-bound lives, a dark cloud is now hanging over our public health situation. Today many low-income people cannot afford formal medical treatment, prompting them to nurse their ailments themselves until conditions force them to seek hospital services.

Foreseeing such a situation, the minister of health called on the medical sector early in the crisis not to increase fees. But such appeals have long lost their meaning in this country.

It is encouraging, however, to know that several countries have taken notice of our calamity. The United States, the Netherlands, the Philippines and China have indicated that they will help supply essential medical supplies and medicines to meet the immediate humanitarian needs of our poor, but nobody can say if the offer will actually materialize. We sincerely hope that these friendly countries will enhance their aid because public suffering caused by the economic storm here can be likened to the afflictions felt by the Iraqi people since the Gulf War.

In the meantime, the government should follow through on its promise to provide a Rp 700 billion ($85 million) subsidy for imported drugs and vital medical equipment.