Govt strives to improve national health system
Fitri Wulandari, The Jakarta Post, Jakarta
The government is determined to revamp the national health system in a bid to help provide better and more affordable health services for all levels of society, Minister of Health Achmad Suyudi says.
Suyudi said that the existing system was being changed because it had been in effect since 1984 and was no longer suitable to the current situation, particularly with the introduction of regional autonomy and a paradigm shift in health development.
Under the new model, health development will no longer be centralized, meaning that health planning will be executed using a bottom-up scheme, involving wider public participation, and getting rid of the old top-down system, he said.
"The revamped system is designed to function as a guideline for the implementation of health development nationwide in the current reform and decentralization era," Suyudi told a media briefing.
The reforms are expected to be completed by April, Suyudi said, adding that he believed health was increasingly being considered a basic right for all Indonesians.
Under the new paradigm, health will no longer be considered an expense, but instead an investment in the future, he said.
The change is part of the ministry's efforts to achieve its goals in line with the slogan "Healthy Indonesia 2010" -- a government drive to improve health conditions in this decade.
Suyudi acknowledged that the country remained one of the least healthy in the world, particularly in terms of an inability to educate people and prevent communicable diseases.
The ministry said new cases of tuberculosis still stood at 580,000 per year with dengue fever remaining rampant with infections reaching 23,675 reported cases in 2001, up from 21,686 reported in 2000.
Malaria infected some 15 million Indonesians in 2001 and claims 30,000 lives annually.
Azrul Azwar, director general of public health, said that the revamped system was expected to change both the health services and the overall health care scheme.
Under the new system, Azrul said, the government will change health service programs provided by public health clinics (Puskesmas).
He said that the services in the public health clinics would be arranged in line with the regions' need so that each region would have programs tailored specifically to health issues in that area, whether they were in cities, mountains or jungles.
At present, Azrul said, each of the clinics across the country are required to run 18 central government-standardized health service programs.
"As a result, the clinics cannot provide programs specifically targeted to the health issues in that region," he said.
He also said that around 800 state hospitals would gradually be changed into state nonprofit companies, he said.
Under this scheme, the hospitals will no longer have to hand over their revenues to the government.
"They can use their incomes to improve their services," Azrul said, adding that the hospitals will not rely on government subsidies and will be encouraged to seek income from alternative sources.
The government has already changed 11 state hospitals into independent nonprofit hospitals, including Sanglah Hospital in Denpasar, Bali, and Harapan Kita Coronary Hospital in Jakarta.
Commenting on the health care system, Azrul said the health ministry was preparing a health insurance tax, which would guarantee people get health care at affordable prices, without necessarily abolishing the existing insurance schemes -- Jamsostek and Astek.
According to Azrul, the health system will be applied nationwide and be obligatory for all citizens. The insurance will be deducted directly from monthly salaries at a rate of 3 percent for singles and 6 percent for families.
"But the government will cover the premiums for poor people (the 40 million jobless)," Azrul said. The system will employ what he termed "a cross-subsidy system" in which people with jobs pay into the system and the accumulated funds can be used so that those who do not work can still get health services.