Hospitals unsure about definition of poor person

Bambang Nurbianto, The Jakarta Post, Jakarta

Doctors said many patients were financially unable to pay hospital bills, however they were not actually categorized as poor people and some who were poor did not have health cards.

These people often create confusion among the medical professionals about whether or not they deserve to receive health cards, which were intended for poor people to get health services free of charge.

Usmanawati, a doctor at Kampung Melayu's public health center (Puskesmas), said that she often had to deal with such cases.

"I received notes from doctors of the state-owned Cipto Mangunkusumo hospital (RSCM), asking to issue health cards for patients who could not afford hospital fees," she told The Jakarta Post on Tuesday.

"It is a problem for me as many of the people who have such recommendations from RSCM's doctors cannot be categorized as poor people who have the right to get the free health service," she noted.

Normally, health cards are issued by doctors at subdistrict health centers for people who are selected by neighborhood and community heads together with volunteer health workers in the subdistricts.

Because of the recommendation from doctors, Usmanawati said, she could not strictly comply with the prevailing procedures in issuing health cards.

"If I feel they really need help, I'll issue health cards as demanded by patients from Kampung Melayu subdistrict based on a recommendation from RSCM doctors. Sometimes I ignore some criteria if I think that someone really needs help," she added.

She also found another case which needed her own consideration in making a decision. She said there was a homeless woman without an identity card who was about to give birth. Based on the existing criteria she had no right to the card without her identity card.

"But, I issued the health card for her anyway as she urgently needed treatment," she added.

The criteria of a poor family is based on Jakarta statistics office data and includes, area of floor space in the house (less than 8 square meters), dirt floors, no access to clean water, no toilet, no furniture, a lack of meat, fish or eggs in the diet, an inability to buy new clothes each year, and an identity card which shows the person to be a legal resident of Jakarta.

There are 1,539 families classified as poor who hold the health cards from a total of some 5,000 families in Kampung Melayu subdistrict.

A number of health card holders said that the cards are very useful for them.

"Thank God that I never had to use this card for a major hospital visit, but with this card, I feel secure as I was informed that I could receive free health services," said Sutinah, 50, a resident at Manggarai Selatan subdistrict, South Jakarta.

A similar statement was made by Sumini, 45, a resident at Kampung Melayu. Sumini said that she and her husband, who is a construction worker, received the health card from a volunteer health worker in the subdistrict.

Usmanawati admitted that there were some people, who did not fit the criteria but they somehow managed to obtain the health cards. "There is still collusion, corruption, and nepotism in deciding upon those who receive health cards. But the number is not so significant," she claimed.

Another case she found was when a man had a blank health card. The man from Pandeglang, Banten asked her to fill the health card in for him. He claimed he got the card from certain health officials.

"Based on my experience, it is very possible that many people do not deserve the free health services as they are not poor people," she added.