Govt strives to improve national health system

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.