Poor Jakartans say free health care still denied them

Leony Aurora, Jakarta

More than 40 percent of poor Jakartans, whose health care services are supposed to be covered by the government, claim they still have to pay part of their hospital medical bills.

A recent survey by the Indonesian Health Consumer Empowerment Foundation (YPKKI) showed that 91 out of 211 inpatients had to pay for medicine, administrative fees, surgery and laboratory tests.

Among the 860 outpatients surveyed, 9.1 percent also said that they had paid for similar services, said Marius Widjajarta, the head of YPKKI, in a press conference early this week to announce the results of the survey.

"Most had to pay for medicine," said Marius.

The survey, conducted between November 2003 and February 2004, was intended to evaluate the effectiveness of the welfare cards for poor families (Gakin). The local administration introduced the cards last year to free poor people from having to pay medical bills.

Those who do not yet have a card can ask for a letter to confirm that they are economically disadvantaged from their neighborhood unit chief to get free medical services or at least discounted ones.

However, according to the Jakarta Health Agency head A. Chalik Masulili, this letter was the biggest problem. "It is not easily obtainable," he said.

Such a letter could only be used once, he elaborated. "For subsequent visits to the doctor, patients have to get Gakin cards," he said, adding that the cards were the safest way to ensure that only poor people received free services.

The agency plans to issue new technical and operational guidelines that will spell out in detail who can avail of such a card.

According to the Central Statistics Agency, the definition of a destitute family is a family that has a living space of less than eight square meters per member, no floor covering -- only a dirt floor -- and only able to afford to buy one set of new clothes per person per year. The family is not able to afford its own clean water facilities or toilet. The family cannot afford to buy living room chairs and is limited in the variety of dishes it can consume in a week.

"If a family fulfills at least five of the requirements, they can get a letter confirming that they are economically disadvantaged," said Salimar, the agency's head of planning and budgeting.

As the survey shows that 34 percent of the respondents received the information regarding this policy from neighborhood unit chiefs, the agency plans to involve them by holding meetings to make them familiar with the requirements.

Salimar said the agency was still discussing whether those with a Gakin card would only get a discount of up to 50 percent or the decision would be left to the hospitals, which can evaluate the condition of the patients themselves.

This year, Rp 40 billion (US$4.44 million) in funds from the city budget were set aside for health services for the underprivileged. Last year, the city provided Rp 54.3 billion in funds, and the state, from the oil and gas subsidy compensation funds, provided Rp 19.9 billion.

There would also be funds made available from the oil and gas subsidy compensation this year, said Salimar, but the amount is yet to be determined.

I-box ----------------------------------------------------------------- Region Families (Oct. 2003) Families (April 2004) ----------------------------------------------------------------- North Jakarta 21,513 31,383 West Jakarta 19,375 28,060 Central Jakarta 19,327 19,527 East Jakarta 17,897 29,218 South Jakarta 6,515 9,543 ---------------------------------------------------------------- Total 84,627 117,731 ---------------------------------------------------------------- Source: Jakarta Health Agency