The abuse of poor cards rampant in Palu,doctor says

Ruslan Sangadji, The Jakarta Post, Palu, Central Sulawesi

A senior medical practitioner revealed here on Monday that many wealthy people in Palu carried certificates identifying them as being unable to pay for medical treatment.

Asmarany A. Lamadjido, the president director of Undata General Hospital in Palu, said that the improper practice had caused the state financial losses as rich people were receiving health subsidies they were not entitled to. "We can establish that those people are rich from their appearance. They arrive at the hospital in cars... they have cell phones," said Asmarany.

"Although the hospitals are aware of the practice, they can do little to stop it", he said, explaining that the certificates were signed by district or subdistrict authorities.

The issuance of the inability-to-pay certificates was carried out last year as part of the governmental policy to provide poor people with health benefits. Money generated from last year's utility tariff hike was allocated for the health subsidy funds.

The total amount of funds generated from the fuel, electricity and telephone tariff hikes last year amounted to Rp 1 trillion (US$118 million). But the funds were also allocated for other purposes, such as soft loans for small and medium enterprises.

It is unclear how much money is available for health subsidies for Palu's poor.

Asmarany did not specify the number of rich people who had been issued inability-to-pay certificates, he only said that there were a "good number of them."

He said that although he had conveyed the problem to government officials, the certificates were still used by those who could afford health care.

Asmarany promised that Undata General Hospital would be more careful in determining the financial status of its patients.

"The financial status of all patients who present certificates will be checked", he said.

"We will increase communications with the National Coordinating Body for Family Planning (BKKBN) so that we can determine whether the applicants are poor or rich," he added.

Last year, the Undata General Hospital admitted 9,026 patients with certificates. The total amount of subsidies claimed by those patients amounted to Rp 2 billion.

The number of patients using certificates last year increased, from 8,698 patients in 2002. The total amount of subsidies claimed by those patients was Rp 1.3 billion.

The most common ailments that patients using inability-to-pay certificates suffered from were high blood pressure, hepatitis, bronchitis and diabetes mellitus.

The abuse of the certificates seems widespread as other regions of Indonesia have reported similar concerns.