W

orsening traffic, higher living costs, a messier education program and barriers to healthcare have been the typical problems facing people in Jakarta. Therefore, when Governor Joko 'Jokowi' Widodo and Deputy Governor Basuki 'Ahok' Tjahaja Purnama launched the Jakarta Health Card (KJS), a free healthcare scheme for all, it was immediately lauded not only by his constituents but also by beneficiaries.

But six months down the road, problems have started to arise. Several hospitals have complained about overcapacity due to the increasing number of patients using the KJS, while the amount of doctors and medicines have been deemed insufficient for their treatment. Worse, the amount of coverage provided by the KJS for each patient is too low, according to hospitals and doctors.

Since the launch of the KJS in November 2012, community health centers (Puskesmas) have served 331,000 patients, while hospitals catered to 91,393 patients per day, according to the city health agency. In December, the number of people visiting Puskesmas climbed by 50 percent, while the number of patients in hospitals jumped by 62 percent.

Despite all the praise of more people now having access to healthcare, many have begun to question the effectiveness and sustainability of the program, especially since a child died after being denied treatment at several hospitals due to the unavailability of wards, equipment and treatment.

Jokowi has been criticized, with people saying his policy has backfired as overcapacity has rendered hospitals incapable of providing proper treatment.

However, he argued that only a small proportion of the capital's 4.7 million poor families had benefited from the program and only a small amount of Rp 1.2 trillion (US$ 122.57 million) allocated to finance the program had been used.

The KJS healthcare scheme has adopted a diagnostic-based reimbursement system, Indonesia Case-Based Group (INA CBG), since the Jakarta administration appointed state-insurer PT Askes to manage KJS funds in April.

The INA-CBG system replaced the previous fee-for-service reimbursement system used in the regional healthcare system, where services were paid for separately. The same system was applied to the national healthcare scheme (Jamkesmas) in 2009.

The rates applied by the system are currently the object of evaluation, as many private hospitals incorporated in the program complained about the low rates. The city administration has paid the premium of Rp 23,000 per person per month, which is higher than the sum the government would pay for cash aid beneficiaries under the national healthcare program that will begin on Jan. 1, 2014.

There is a plan to implement different rates between state and private hospitals.

As if the technicalities are not complicated enough, Jokowi is facing questions from the Jakarta Legislative Council over the scheme.

A total of 32 lawmakers, mostly from President Susilo Bambang Yudhoyono's Democratic Party (PD), as well as from
Coordinating Economic Minister Hatta Rajasa's National Mandate Party (PAN) and the United Development Party (PPP), signed a petition to exercise their interpellation right.

The governor, however, simply played down the threat.

'Being healthy is the people's right, why would you disturb [the program]? Even in wars we are supposed to help injured enemies heal. The KJS is for the people of Jakarta, are you going to abandon them? If so, you don't have much sense of humanity,' Jokowi said earlier this week. 'If you feel uncomfortable, come to us for an explanation. We are open to discussion, every single hour.'

Apart from the city administration's efforts to provide healthcare for the poor, stakeholders can help to educate the public about individual preventive measures.

The Indonesian Doctors Association (IDI) chairman Zainal Abidin said that preventive health efforts would save the city budget and individuals' spending on healthcare. He explained that the government and medical practitioners must raise people's awareness of healthy lifestyles by encouraging them to live healthily, exercise and maintain a proper diet.

'People need to get vegetables and fruit back on their tables because fiber is important to prevent obesity. Reduce sugar and salt. These efforts can prevent degenerative diseases that can be costly,' he said recently.

Basic Health Research (Riskedas) data from 2010 shows that the percentage of overweight people aged over 18 was 21.7 percent, a jump from 17.5 percent in 1997.

Prevention at the society level, Zainal said, could be done through providing better sanitation and sewage systems, regular fogging to prevent dengue fever, improving air quality, encouraging sports activity through car free days and immunization.

In Indonesia, free immunization for adults is only limited to tetanus vaccinations for prospective brides and imported meningitis vaccines for those performing the haj pilgrimage.

We should ask ourselves, how many hours in a week have we exercised? Do our children spend most of their time exercising or playing online games? As parents, have we encouraged them to go to the swimming pool instead of to the mall?

The city administration has allocated certain time and locations in parts of the capital for car-free day so that the people who do not have access to private gyms, can at least walk or use their bikes on Sunday mornings.

The administration can also encourage people to make better use of Puskesmas as the health centers have been equipped with better medical facilities and doctors. Despite the euphoria that followed the distribution of the KJS cards, the public must understand that they can access medical treatment at the nearest Puskesmas instead of going to hospital.

The initiative to provide better and wider healthcare for society needs public support. It is a pity that political interference is disrupting such a noble idea.

The writer is managing editor of The Jakarta Post.