The ancient saying "health is wealth" has taken on new meaning these days when one is sick, says 33-year-old Tito Adi Suwasto, an official at the tax office in Banten.

As a civil servant on a meager monthly salary, the breadwinner has always tried to adequately balance his families health needs with all the other necessary costs, such as his children's education and expenses for the home.

His skills with money were no match however for the staggeringly high costs involved with treating cancer, something he encountered upon being diagnosed with malignant lymphoma in March last year.

Tito, a father of two children, first became suspicious when he felt a painless lump in his left chest. But he didn't take it too seriously, and neither did his doctor, who let him go with a clean bill of health.

When playing soccer however he noticed that his armpit had begun to swell, and decided to follow up on his nagging concerns and head to the Dharmais cancer hospital in West Jakarta.

"After a biopsy and other tests the doctor told me I had malignant lymphoma. It was shocking to learn how expensive proper treatment for lymphoma can really be," he said.

"But I was more shocked to hear my doctor telling me to use ASKES because I am a civil servant. It's no secret that health insurance for civil servants has long been associated with second-class treatment and mediocre drugs that hardly work effectively or quickly," Tito said.

Devastated by the alarming news about his health, Tito went to see what the notoriously inadequate ASKES program could provide. He was told the insurance company had imposed a new policy for "catastrophic" diseases and was working with cancer drug manufacturers to ensure the latest line of cancer medicines were available.

He began his battle with the disease in December last year through chemotherapy. Doctors signed him up for eight cycles of treatment, and he has done six well so far.

"Each chemo session takes seven hours and I only ask permission from my superior to skip one day for every time. The widely rumored side effects of chemotherapy do not occur with me. Only once did I get hair loss during my first chemo session, but since then I have been nothing but fitter."

Midwife-turned-housewife Zurnel Hanifah has a different story. The 54-year-old said she knew she was at high risk of developing cancer because she underwent many years of hormonal treatment for a health problem.

"When I was 46 years old, I was diagnosed with an hormonal imbalance that caused continuous menstruation. To avert the bleeding, I had to undergo hormone treatment, which posed a risk of stimulating cancer cells.

"I had no choice then. It began with a benign tumor and later developed into a malignant cancer on my left breast."

Her husband, a civil servant, registered her for the cancer treatment using ASKES.

"In August I had a mastectomy and continue to have further examinations to ensure the cells had not grown or spread to other organs," said Zurnel, whose husband and son closely monitored her medication.

"They know the names of the seven pills I have to take everyday and study what effects they cause on me. I trust them," she said.

Faced with serious diseases and no alternative but medical treatment, people like Tito and Zurnel are benefiting from this new policy enacted by ASKES which enables low-to-middle rank officials to receive top-line medicines for aggressive diseases such as cancer.

"Beginning in 2009, we began paying more attention to diseases that caused huge financial burdens to ASKES members," the state-run health insurance president director, I Gede Subawa, said.

"Conventional treatments with old-style medicines used to be fine but they caused a heavier burden *for us* because we still had to cover treatments for side-effects caused by the medicines. As you know, for medications used to treat diseases like cancer, heart disease and others, require a longer period of recovery for the patient."

Other than easing the burden for ASKES members, Subawa said they were also moved to improve the image of health insurance for civil servants facing the financial reality of a serious disease.

"A patient suffering from cardiac disease for instance has to save between Rp 30 million and Rp 180 million to receive treatment ranging from regular check-ups to surgery. For civil servants whose salaries vary between Rp 2 and 5 million, the prospect of setting aside that sort of money for treatment is out of the question.

"For high rank officials to state officials, perhaps they can spare more savings for their treatment," Subawa said.

The new scheme, he said, was made possible through efficient changes at the company along with transparent coordination with doctors *and hospitals* and drug companies. There were no unethical considerations in their relationship, he said, as doctors must abide by the agreed conditions laid down by their patients before prescribing them a certain type of medication. The requirements for innovative drugs are jointly agreed to by doctors and the insurance company.

"For this scheme, we do not suspect fraud or abuse with affect the system because who in their right mind would want their bodies injected with chemicals or their chests cracked open just to make some cash?" Subawa said.

"Medical science keeps evolving and advancing. The old methods of cancer treatment are effective but take longer to work and are more expensive. They also cause side effects which affect the patient and we end up covering those costs."

Officially launched in Bali in May 2009, the policy was tested mid last year. So far, 160 civil servants and their family members with serious diseases have enjoyed access to new, innovative drugs.

To run the scheme, ASKES works together with Roche Pharmaceutical. This company has a Rp 25 billion Patient Assistance Program (RPAP) which it launched in 2004.

The program, which aims to provide access to therapy and medication for cancer patients, began with Mabthera (rituximab) for lymphoma, followed by Herceptin (trastuzumab) in 2005 for breast cancer and later with Avastin (bevacizumab) for breast cancer and colorectal cancer. The company has donated Rp 1.5 billion to AKSES to assist implementing the program.

While only a fraction of the total amount goes Tito, he said he is very thankful to be healthy and have a normal life again. Nothing is more precious than health, he said, because now he can play with his children again.

"And perform my duties as a tax analyst and mediator for tax payers," he joked.

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