Pay up first policy puts life at risk

Pay up first policy puts life at risk

It is not only the abject poor who are vulnerable in dealing with
the Indonesian health service. With only an estimated 40 million
people capable of paying for their insurance from their own
pockets or from insurance policies, most people have difficulties
in settling hospitals payments.

And anyone can find themselves in an emergency room without
their wallet.

This can be a potentially dangerous situation. With concerns
over mounting budget deficits and bad debts, hospitals are
increasingly wary of admitting patients who may not be able to
pay. This cautious approach has been known to extend to the
emergency room, a practice against Health Minister Decree
159b/1988 about hospital and Minister of Health regulation
920/1986 about private hospital.

Requiring deposits in emergency cases is a criminal offense
but patients and families faced with demands for money are
usually not in a position to argue.

In a notorious case which caused a major scandal over a decade
ago, a senior Ministry of Health official died at a Central
Jakarta hospital which had delayed giving him emergency treatment
because he did not have a Rp 1 million deposit.

Almost everyone has heard similar tales of people being forced
to wait unnecessarily in accident and emergency departments.

David Santoso, a 26-year-old employee at a five-star hotel in
South Jakarta recently collapsed with a fever in the middle of
the night and was taken to a nearby hospital by his friends.

"Before they would treat me, the hospital staff demanded a
deposit of Rp 2 million but I did not have it and neither did my
friends. Then they phoned the duty manager at the hotel where I
work to check I was earning a salary. After about 30 minutes I
was taken in for treatment," said David.

While emergency cases can be fatal and have resulted in
hospitals being sued by legal aid associations there appears to
be no sanctions enforced bar a mild reprimand. Apart from risking
lives this illegal practice results in stress and hardship for
families and friends who desperately try to meet the demands of
hospitals to pay in advance.

"My neighbors' three-year-old son stepped into a pail of
boiling water. I immediately rushed with him and his mother to
the hospital across the road from where we live. At the accident
and emergency department they said that we had to pay a deposit
of Rp 300,000," said Noviar, a 24-year-old room boy at a serviced
apartment complex in Central Jakarta.

"It was a big amount for us as middle class people. We
couldn't afford it and we worried about the condition of the
child while we discussed with the staff. I finally said, 'Of
course we will pay after, just take him in and get him treatment
or he will die!' As a temporary guarantee I told them we owned
our own brick house across the road."

Noviar finally convinced the staff to treat the boy while he
went to call on his neighbors to collect money for the deposit.
He succeeded in raising Rp 275,000 from 20 neighbors during
almost two hours running to and fro.

"At the time I did not know that there was a regulation
against asking for money for an emergency. But even if I did they
were still insisting on it. What could I do?"

Dr. Firman from the University of Indonesia's School of
Medicine suggested that if more people use legal aid to take
cases it could help to enforce the law. He called for
condemnation from the medical profession and for action from the
city medical authorities and the police.

"The doctors association cannot defend people doing this kind
of thing," he said.

Farid Anfasa Moeloek, former health minister and now chairman
of the Indonesian Doctors Association (IDI), suggested that
people could phone the police but he recognized that enforcement
of the laws was weak. He added that although it may not help at
the time of an emergency, IDI could put moral pressure on the
hospitals concerned through its ethics committee.

-- David Kennedy and Claudia Octora