Many in dark over right to healthcare under bylaw
Muninggar Sri Saraswati, The Jakarta Post, Jakarta
Many patients at public health centers in the city are unaware that they are entitled to receive basic medical treatment, including medicine, for only Rp 2,000 (about 19 US cents), according to Article 8 of City Bylaw No. 3/1999.
"I didn't know anything about it. I usually pay Rp 7,000 per visit," said Turmina, who was seeing a doctor at a health center in Petamburan, Central Jakarta.
Turmina, whose husband is a street vendor in the nearby Tanah Abang market, and her family prefer to use the public health center because of the affordable fees.
"It would be better if the center only charged us Rp 2,000 per visit, including medicine, as stated in the bylaw," she said, adding that she always paid additional fees for medicine.
According to data, many centers in the city charge patients more than Rp 2,000 just for the administrative fees, which excludes medical treatment and medicine. Some people pay up to Rp 15,000, or 750 percent higher than the official fee, each time they visit a center.
The public health centers say they have to charge people more to cover their operating costs.
However, each center in the city receives monthly operational funds of at least Rp 5 million from the City Health Agency. They amount received depends on the size of the center, the number of patients seen each month and the types of illnesses the center treats. Each center also receives a supply of subsidized generic medicine.
Dr. Susy, who works at a public health center in Central Jakarta, said most centers in the city had not been obeying the bylaw for the past two years.
"So far, we haven't had any complaints from our patients or the agency," said the doctor, who asked that the precise location of her center not be given.
"Most of the money paid by patients is used to pay the salaries of several part-time workers here, whose monthly salaries are below the provincial minimum wage."
The part-time workers -- from janitors to administration staff -- receive monthly salaries of between Rp 150,000 and Rp 500,000. The minimum wage in Jakarta is Rp 590,000.
Doctors at the centers, who are classified as public servants, receive a monthly salary of about Rp 1.5 million from the government.
The health center where Susy works makes between Rp 2.5 and Rp 4 million each month from about 300 patients. This money is used to pay the salaries of five employees and to maintain the center's building.
Responding to reports that many health centers were in violation of the bylaw, Dr. Marius Widjajarta of the Indonesian Health Consumer Empowerment Foundation said the agency had failed to enforce the bylaw.
Marius, who at one time worked at public health center in East Java, said he believed the centers would be able to cover their operating costs by charging patients Rp 2,000 per visit, as the centers received funding and medicine from the government.
A reliable source at the agency confirmed that many public health centers were in violation of the bylaw.
"We (the agency) expect the health centers will be able to finance themselves in the future. We can tolerate (the violation of the bylaw) because we believe the public can still afford the fees," the source said.
Given the situation at the centers, it seems unlikely that the government will be able to realize plans to have public health centers provide medical treatment free of charge. The government has said it hopes to implement this policy in 2006.