When Heni Karmila sought to find a doctor for her ailing mother using
Indonesia’s new healthcare system, she faced a nine-hour wait in a line
outside a crowded public hospital in Jakarta.
“The queue at the hospital is always very long, packed with young and
old people, pregnant women, people who have had accidents, those in
need of operations and even tiny babies,” the small business owner, 43 exclaimed.
The case illustrates the challenges for Indonesia as it seeks to roll
out one of the world’s biggest universal healthcare systems. The scheme aims to make healthcare accessible to the country’s entire
population of 255 million by 2019, part of the government’s efforts to
direct some of the benefits of strong economic growth into improved
welfare.
Joining is compulsory, with most members paying a small premium.
Civil servants are automatically enrolled, private companies must sign
up staff while the self-employed and those working in the informal
sector are required to join themselves.
The poorest get care for free under the system, known as the JKN. A total of 160 million people are so far members of the programme in
the world’s fourth most populous nation, and it has been credited with
helping many since its 2014 launch.
Numerous challenges
But it faces numerous challenges, from underfunding, to slow and
patchy implementation, to cases like Karmila’s, where the system has
become a victim of its own success in densely populated areas, leading
to long queues.
Karmila, whose 72-year-old mother suffers from multiple ailments,
said she also suspected that one public hospital was turning ordinary
people away and instead reserving places for privately-insured patients,
who bring bigger profits.
In the remote and poor east of the country, the problems are
different — people may theoretically have access to healthcare under the
JKN, but often there are not enough hospitals and doctors to provide
it.
The most pressing challenge in recent months has been underfunding as
patients flocked to use the system, prompting the agency that runs the
JKN to warn it could run out of money as its funds may not cover claims
from medical providers.
\Despite resistance from lawmakers and the public, the government in April increased the premiums paid by some users.
Monthly premiums now range from 80,000 rupiah (around six US dollars)
in the top category of the JKN — which provides better services, such
as private rooms in hospital as opposed to wards — to 25,000 rupiah
(around two US dollars) in the bottom category.
In the past, most Indonesians relied on private insurance of some
sort while those deemed living in poverty got free public health care —
but this left millions stuck in the middle, too poor to afford care but
not poor enough to qualify for government assistance.
Under the JKN, all citizens should get access to health services
provided by public facilities as well as those from a few private
providers who have joined the system, although wealthier Indonesians are
still likely to opt for private insurance.
‘Many have benefited’
There are currently no punishments for people who fail to sign up,
but when the system is fully rolled out, they will face small fines.
Government spending on health in Indonesia is just three percent of
GDP, lower than other countries in the region. It has the equivalent of
one physician per 5,000 people, compared to two in Thailand and six in
Malaysia, according to the World Bank.
The quality of medical services is also criticized as poor compared to its neighbors, and horror stories abound. Last year, two patients at a high-end private hospital outside
Jakarta died when medics trying to anaesthetise them for routine surgery
administered the wrong drugs due to a labelling mix-up.
Despite the challenges, the JKN has won much praise and its supporters are urging patience.
