I

t has been a year since the government launched the national health insurance (JKN) program.

Initially mired in problems such as a lack of health infrastructure, leading to overcapacity in some hospitals and the rejections of patients, the JKN has come a long way since its birth on Jan. 1, 2014.

'€œI'€™ve seen a lot of progress. The program was only plagued with problems in its first six months due to a lack of information [from the Healthcare and Social Security Agency to hospitals],'€ Indonesian Diaspora Global Network Health Group chairwoman Hanny Moniaga told The Jakarta Post.

'€œBut now information dissemination is improving and doctors and hospitals have been informed that the program is not detrimental to them.'€

Hanny, who is also chief operation officer of Siloam Semanggi Hospital said the lack of information made hospitals reluctant to join the program and as for those who had already joined, some were not prepared to implement the program.

'€œSome private hospitals might refuse to join the program because the tariff payment plan is too low, but they seem to forget that it'€™s better to have patients than to let medical equipment, doctors and nurses sit idly because these are fixed costs that hospitals must pay either way,'€ she said.

Moreover, according to her, due to a lack of preparation, some of these hospitals were unable to properly manage their doctors and finance during the implementation of the program, which caused problems.

'€œWhen a hospital joined the program with such a low tariff, there was a standard of procedure [that could be implemented to lower operating costs]. For example, a hospital could renegotiate the prices of laboratories and it could buy generic medicine in bulk,'€ Hanny said.

She cited an example of Pelni Hospital a private hospital that had successfully joined the JKN and had managed it well.

'€œAfter Pelni Hospital joined the program, it had a regular flow [of patients], it could predict the volume [of patients] and it could lower costs so its doctors and nurses were happy with more income,'€ said Hanny.

She also applauded improvements in health infrastructure, especially in community health centers (puskesmas) at subdistrict level.

'€œThese health centers are already good because they can accommodate patients who need to stay, such as Tambora puskesmas and Kelapa Gading puskesmas. They can even assist with birth. In some regions, puskesmas have also improved,'€ Hanny said.

Echoing Hanny, Health Ministry health development director general Akmal Taher said primary health facilities such as puskesmas were already enough to handle the number of patients in the JKN program.

'€œ[Most patients] can still be handled and there are many puskesmas in major cities that work together with medical faculties [in universities] and hospitals so they have sufficient medical staff,'€ he told the Post.

While the number of puskesmas is deemed sufficient, Akmal admitted there were still some cases of patients being rejected for lack of beds in hospitals.

'€œBut the [seriousness] of the problem is relative because we are only lacking beds in major cities like Jakarta, Surabaya and Bandung,'€ he said. '€œThe more serious problem is actually the lack of ICUs [intensive care units], while the lack of beds is not too severe.'€

While the government claimed the lack of beds was not serious, there are cases like Nurhayati, a 31-year-old resident of Cipayung, East Jakarta, who lost her 2-year-old son Abiyasa Rizal Ahnaf because of an infection in his intestines.

Abiyasa passed away after his parents frantically searched for a hospital that had available equipment and a bed in Jakarta to treat him last month.

The boy was already registered in the JKN program but it did not prevent his parents being rejected at 21 hospitals throughout Jakarta, with some saying no doctors and rooms were available, including Fatmawati Hospital, Pelni Hospital and Permata Hospital.

Conversely, there have been cases where patients have directly reaped the benefits of the JKN program after registering online.