Editorial: Health for all?

Sat, 07/26/2008 11:25 AM  |  Opinion

As a nation, we should be ashamed for allowing fellow citizens suffering acute illnesses to search desperately from one hospital to the next for accommodation after they were expelled from a state-owned facility.

Ironically, this occurred while Indonesia was supposedly moving toward an ambitious target called "Indonesia Healthy 2010", whereby all Indonesians would gain accesses to quality health care without economic or other obstacles.

So, will it be possible to invert the current situation in less than two years, while there is still a cataract patient who must travel hundreds of kilometers to get surgery? And what about health care for our fellow citizens who live far from Jakarta in areas like Papua, Aceh and East Nusa Tenggara?

These outpatients, who come from low-income families have had a very bitter experience. They now face additional suffering because they could not afford the cheapest accommodation or transportation fares from their hometowns to Jakarta to visit the hospital once a week.

"We don't have any relatives in the city and it is too expensive for us to commute. One way costs us more than Rp 240,000 (US$26)," Siti Hanifa, a patient with stomach cancer from Bandar Lampung, told The Jakarta Post recently, lying on mattress in a house prepared by a volunteer.

Siti is one of 26 outpatients who were told to leave a building owned by state-owned Cipto Mangunkusumo hospital (RSCM) which was reportedly going to be renovated.

Not surprisingly, the group and the case have came into the media spotlight. Many blamed the hospital management for the move, but perhaps forgot the greater issue; the failure of the government to address broader health care problems, particularly for the poor.

This incident should be a blessing in disguise for low-income families, because the media coverage can open the eyes of millions, including policy makers, to the fact there is a real problem at hand.

We should not simply blame the hospital for the incident without learning a lesson from it first. It is true there have been complaints about this hospital, including a lack of transparency about which beds are available on registering as an inpatient there. But in the case of the outpatient expulsion, we may need to address more serious problems otherwise we may see similar situations occurring again.

According to the RSCM management, the hospital has often been overrun with patients, who are referred by local hospitals from across the country. Unfortunately, most of these patients come from low-income families who can not afford accommodation while in Jakarta to receive treatment. Should RSCM foot their accommodation bill, or the local administrations from whose hospitals the patients were initially referred?

Hopefully, policy makers will take this incident into account when they are working out a new policy for health care for low-income families. The incident should provide momentum for them to look more closely at the spectrum of health care problems across the country.

Access for low-income families to proper health care is a complicated problem. We welcome the government's People Health Insurance (Jamkesnas) program. Some 18.1 million low-income families, or some 76.4 million people, are included in this free health care program, and this year the government has allocated Rp 4.6 trillion (US$50 million) to it.

But we still need to encourage the government to eradicate various weaknesses at the implementation level; the unreadiness or reluctance of hospitals supporting the program; fairness in deciding which families deserve the benefit; and provisions for poor families not included in the program.

Many local administrations have reportedly complained there are still many low-income families who do not hold the necessary insurance card -- the only document which can be used to gain access to free health care.

The mission to establish health for all by 2010 is, indeed, a noble effort in helping low-income families gain full access to improved health care. The government's commitment to allocate funds for the program is an initial step, however a more important step is now required to ensure all the funds reach the needy patients and not the pockets of greedy officials.

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