Reportage

‘Jokowi-care’ a pilot
project for upcoming national
health plan

An officer tries to identify a KJS card, which is equipped with ID barcode that links to an online record of the patient’s history, at a community health center in Koja, North Jakarta. (JP/P.J. Leo)

Jakarta’s progressive healthcare program — then known as JPK Gakin — has been officially named since 2011 as a pilot project for nationwide universal health care, which the central government must implement beginning in January.

The program later rebranded and expanded under the Jakarta Health Card (KJS), becoming the centerpiece program for Jakarta Governor Joko “Jokowi” Widodo when he took office in 2012. The former mayor of Surakarta launched the program within a month of moving into his new office in Jakarta.

KJS instantly became the envy of people in other towns and cities who wondered why they could not have the same benefits. Surveys show that Jokowi is the most popular candidate for the 2014 presidential elections, even though it remains uncertain whether he will run or be nominated.

Like Obama, Jokowi’s political fortunes hinge on the rise or fall of his healthcare program.

If the KJS fails — and there are many who want to see it fail — it could stymie Jokowi’s presidential ambitions. But success might mean Jokowi will cross Monas Park from the governor’s office to the Presidential Palace next October.

“Jokowi-care” faces major problems that need addressing, especially when the program is introduced at the national level. There are questions about the availability of resources (doctors and hospital wards), funding and its sustainability, and about the overall efficiency and effectiveness of government health care.

Some of these problems have already emerged.

In March, 16 private hospitals threatened to leave the KJS, citing unfair soaring costs.

They backed off after Jokowi agreed to reimbursement rates for hospitals under the KJS.

The program’s effectiveness depends on the collaboration between the government, state-owned health insurance company PT Askes and hospitals, according to Hasbullah Thabrany, a public health expert at the University of Indonesia (UI).

“The problem is there is still little trust between these three,” he says.

While welcoming the move to standardize hospital rates under the Indonesia Case Base Groups (INA-CBGs), he questions why the government must further allow some hospitals to charge vastly different rates.

“When you buy a cup of coffee, why would you want to pay so much more for the same cup? Hospitals essentially provide the same treatment, so why should we allow some to charge more?” he asked.

The KJS uses the INA-CBGs to set reimbursement rates from the Jakarta government.

INA-CBGs is an online software system that calculates claims for 14,500 ailments and 7,500 procedures, and includes doctor’s fees, facilities, medicine and third-class rooms.

The rates were set through negotiations led by the Health Ministry, hospitals and doctors. The INA-CBGs differentiates the rates for 12 different reference hospitals, allowing up-market facilities to file higher claims.

Officials at Askes believe that the national healthcare system will follow the KJS mechanism, including requirements for local health community center referrals.

Askes will deploy staff at hospitals and train hospital workers to administer the program, says Irfan Humaedi, Askes chief public relations officer.

Taufiqqurahman, a member of the Jakarta Legislative Council and a vocal critic of KJS, has toned down his opposition to “Jokowi-care.”

“I am not opposed to the program, I actually support it,” says the politician from the Democratic Party.

“But I had problem when Jakarta enlisted the services of PT Askes, because it makes the program prone to graft,” he says. “Health care should be provided by the government, not by private companies.”

Still, Taufiqurrahman did not miss Jokowi’s penchant for populism, such as when the governor visited neighborhoods and personally handed over health cards at the start of the program.

“Jokowi is politicizing this healthcare issue to boost his own image,” Taufiqurrahman says. “He should be working to improve the number of doctors and hospital workers, improve their salaries. He should not be out there giving out cards.”

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