C

ity administration shelters have found life more difficult since the introduction of the new national health insurance (JKN) program as the system obliges patients to get reference letters from their nearest community health center (Puskesmas) before being treated.

Yuni Purwaningsih, head of administrative affairs at the Tunas Bangsa shelter for toddlers in Cipayung, East Jakarta, said that since the implementation of the JKN, the shelter had to take sick children to different locations in order to get their bills covered by the JKN.

'€œThe children have to spend a whole day to get a reference letter from their nearest Puskesmas and to wait in a long queue to see a medical specialist at the hospital. We usually send the kids back to the shelter and return to the hospital to collect the medicine,'€ she told The Jakarta Post recently.

She said in the shelter it was common to have several children fall sick at the same time, especially with contagious ailments like ear infections.

Under the previous insurance program the shelter could just send someone with an official letter from the shelter to get reference letters from the Puskesmas for the children.

'€œHowever, under the new program, each sick kid has to show up at the Puskesmas,'€ she said.

Yuni said the JKN program was also not entirely free as the shelter still had to pay around Rp 4 million (US$ 344) when a child suffering from a respiratory infection was hospitalized for several days.

The head of the Social Agency, Masrokhan, said the obligation to get a reference letter from a Puskesmas also created unnecessary delays in getting medical treatment for hundreds of psychiatric patients in the agency'€™s four mental institutions. He claimed that patients from mental institutions should get priority to go directly to the hospital.

The Social Agency manages 27 social shelters that are homes to 5,742 people. Of these one shelter caters for children under five and four mental institutions cater to around 900 patients.

Masrokhan said he had met the city'€™s Health Agency on Monday to discuss the issue. '€œThe head of the agency told me that she would support us by allowing us to bring patients to the hospital directly. In the near future each of our shelters will have a clinic equipped with medicines and staffed by general and specialist doctors,'€ he told the Post over the phone.

He said the clinic service used to be available until the national health-insurance system was over-hauled this January.

The country used to have several free health-insurance programs for the poor such as the government-run community health protection scheme (Jamkesmas) and the Jakarta Health Card (KJS), which was provided by the Jakarta administration. Those systems were amalgamated into the JKN system managed by the Social Security Management Agency (BPJS).

BPJS spokesman Irfan Humaidi said psychiatric patients could get long-term medical services from mental hospitals, but they might have to go to the Puskesmas prior to being seen by a doctor for the first time. '€œThese psychiatric patients can get a reference letter directly from the doctor for their next visits,'€ he told the Post over the phone.

He said hospitals could also treat patients with emergency conditions. However, the standard procedure of going to a Puskesmas or doctors and clinics that cooperate with the BPJS would strictly apply to patients whose illnesses were covered by the BPJS.

Irfan said the BPJS would cover all hospital expenses as long as the JKN patients received treatment that complied with the medical indications.