T

he government needs to improve public health clinics across the country to prevent patients from flocking to the larger hospitals in cities ahead of the 2014 implementation of its health insurance program.

Once those public clinics are ready to take care of patients, people will not have to spend more money on travel costs seeking treatment in the cities.

“Without strengthening primary healthcare services, patients [health insurance holders] will seek medical assistance in hospitals when, in fact, their health problems could be treated at public clinics,” Ascobat Gani, a public health professor from the University of Indonesia (UI) told a press conference in Jakarta on Tuesday.

According to Ascobat, without improvements to public health clinics, popular hospitals will become overwhelmed by patients.

The 2011 Law on Social Security Providers (BPJS) is expected to begin operating in 2014 with the hope that by 2019, all Indonesians will be covered by health insurance.

The government will pay the monthly premium (Rp 22,201 [US$2.33] per person) for low-income people eligible for the program. It will allocate a total of Rp 25.68 trillion to pay for the premiums of 96.4 million beneficiaries considered impoverished and near impoverished.

Wealthier people, meanwhile, will have to pay their own insurance premiums. “If people know that they are insured, they will try to get medical assistance at hospitals,” said Ascobat.

To anticipate the increasing number of patients going to hospitals, the government is working on a referral system, in which people would need to have a referral letter from a physician to obtain treatment at hospital.

Currently, 3,800 private clinics along with the Indonesian Clinic Association (ASKLIN) are ready to deliver health care services for insurance holders once the BPJS comes into effect in 2014. As of 2011, the number of community health centers (puskesmas) totaled 9,323, comprising 6,304 centers with outpatient facilities only and 3,019 centers equipped with inpatient facilities.

Meanwhile, Health Minister Nafsiah Mboi said all preparations had been made according to the BPJS road map.

A shortage of third-class beds is considered one of the critical challenges facing the government as it prepares for the implementation of the BPJS Law.

In total, about 220,000 third-class beds are available but they tend to be concentrated in particular areas, resulting in huge disparities across the country. Up to 96,000 third-class beds are needed to ensure that once the BPJS comes into effect, health care providers can adequately serve all their patients.

“I can assure you that by 2013, we will resolve this problem by increasing the number of third-class beds, both in public and private hospitals, and develop more Pratama hospitals [third-class hospitals] in remote areas, cross-border provinces and outlying islands,” said Nafsiah.