Fri, 07 Mar 2003

Health insurance to be made available to all citizens

Evi Mariani, The Jakarta Post, Jakarta

The Atmin family, who were hit by a train while passing an illegal crossing in Jakarta a couple of weeks ago, had to spend millions of rupiah to pay for medical services and the burial of their five-year-old son Anjar.

The family, who were about to start a small business selling chicken noodles, did not have enough money to pay for the expenses and expected the state railway company PT KAI to cover them. Their hopes faded, however, as PT KAI denied any responsibility, as they determined that the crossing was illegal.

As a result, the family had to rely on people's generosity.

To address such a problem the Ministry of Health is formulating a national health insurance scheme that will insure the health care of all citizens, including poor families.

The scheme, which will be called the National Health Insurance (JKN), will oblige each Indonesian citizen from all walks of life to obtain a health insurance card that will guarantee the person to have proper basic medical services across the country, said Director General for Community Health Services Azrul Azwar on Thursday.

The scheme was developed in accordance with the amendment of Article 34 (2) of the 1945 Constitution that requires the government provide social security to all.

The National Social Security System (SJSN) will cover insurances of health, life and workers' welfare, as well as severance payments and pensions.

"Consequently, the current insurance systems, such as Askes (health insurance for civil servants) and Jamsostek (health insurance for private workers) have to be integrated into the planned system so workers will only have to pay one premium for all services," Azrul said.

He said PT Askes and PT Jamsostek, the profit-oriented state companies managing civil servants and private workers insurance, will have to "adjust" themselves to the planned system, which is non-profit in nature.

When this system takes effect, all workers -- both from the formal and informal sector -- will have to pay monthly premiums to the JKN amounting to about 6 percent of their income.

"I expect private companies will cover the 3 percent and each worker will pay the remaining 3 percent. I have asked the government to give incentives to companies which pay half of the premium, such as tax deductions," Azrul says.

He could not explain how the government would gather premiums from informal sector workers.

The government hopes the JKN will increase the national health spending by 1.7 percent from the Gross Domestic Product (GDP) in 2000. The World Health Organization (WHO) standard for national health spending is 5 to 8 percent of GDP.

Currently 30 percent of the spending is covered by the state budget while the remaining 70 percent by household budgets.

Azrul said about the half of the state health budget was used to finance private goods, such as expensive health devices for hospitals.

"The devices are used mostly by rich citizens, so the budget practically subsidizes them. I expect the JKN can finance private goods so the state budget can be focused on subsidizing the cost of medical treatment for poor citizens," he said.

The state health budget this year reached Rp 5.7 trillion (about US$640 million).

Meanwhile, Indonesia's disability adjusted life expectancy (DALE) figure remains low. The figures of life expectancy and health spending show that a lot of sick people do not get proper health care.

The Ministry of Health has recorded that from the total health spending, only about 20 percent of it was covered by insurance companies. The remaining is imposed on household budgets.

Azrul said that citizens who needed more than basic health care could join commercial insurance programs.

The ministry has not determined what items will be paid under JKN, but it has been proposed that the scheme will cover emergency room service, confinement, doctor bills and medicine.

The government expects to complete a bill on social security system, including the JKN, by the end of June.