Agnes Winarti, Jakarta – Dozens of people with tense faces and a set of documents in their hands on Wednesday huddled in front of a healthcare counter for the poor (Askeskin), at state-owned Cipto Mangunkusumo Hospital, Central Jakarta.

There was no organized queue or system and no accessible information about procedures. Some fired off a lot of questions, which seemed to get on the nerves of the hospital's officers, who in turn, occasionally barked at them.

In the same room, dozens of customers with regular health insurance (Askes) sat neatly, in a more relaxed manner, in front of another counter. In contrast with the poor, the fee-paying patients enjoyed a digital queuing system; their numbers blinked on a digital board above the counter.

The contrast was immediately palpable. The sight of that packed room could be described as a window to the country's healthcare discrimination, where the poor have to struggle hard to survive.

Soni Widaningsih's family was an example of how hard it was for them to receive proper treatment for their daughter, a diminutive and ill 12-year-old named Nur. For a girl her age, she is different from her peers – she weighs 14 kilograms and is no taller than the average 6-year-old.

"Since Nur was eight, she has frequently had anemia, low hemoglobin levels and stomach aches and these symptoms have worsened as she has gotten older," Soni told The Jakarta Post.

"We have run out of money to bring her back to the hospital after several visits with no adequate diagnosis. A doctor in a local hospital said she might be suffering thalassemia."

While Soni was holding her daughter, Nur's father, Asep Safrudin, was fighting the crowd and struggling to receive approval for a set of seven documents which would prove them a poor family and eligible for assistance.

Toting a salesman's black bag, Asep said he had prepared the documents well in advance. They are important for Nur, he said, because the documents should guarantee a free medical check.

The family lives in Cimanggis, Depok, West Java, and Soni said, "We have been using Askeskin relief letters for Nur, since last year, when she was hospitalized here for four days."

On December, Nur was brought to Cipto Mangunkusumo Hospital weighing in at 12 kilograms and with a very low hemoglobin rate measuring 2.8.

Soni acknowledged the process of gathering documents to get the Askeskin relief letters took time and effort.

"That time, Nur was in critical condition and we had not completed the document set," she said. "I am very grateful that the hospital's emergency unit made available a folding bed for her. Instead of paying a sum of money, like normal patients, we, poor people, submit a set of document copies when we have a doctor consultation or a lab test," said Soni, as she opened a plastic bag of snacks for her daughter.

For a day of treatment in the hospital, Soni said her family would need some Rp 200,000 (US$21.5) for their trip from their hometown in Depok to Jakarta, snacks and meals and photocopies.

"Sometimes, if the doctor asks Nur to get a rather affordable lab test, which costs under Rp 50,000, we just pay it with our own money, so that we don't have to waste time at the healthcare counter."

Askeskin holders usually hold a green and yellow card.

Nur's father said they did not get the card, but that the local health agency had instead given them a letter stating they were allowed Askeskin relief.

However, Asep, who works as a food street vendor near a school, said, "both Askeskin card and relief letter holders undergo the same tedious document procedure for every treatment".

That day, Nur's parents submitted two stacks of copies of the above documents because she had a medical test called Echo Magnetic Resonance Imaging and a consultation with a pediatrician.

While an Askeskin card is valid for a year, Asep said that Askeskin relief letters must be renewed every three months at a local health agency.

It is said Askeskin holders are freed from all medical expenses. In reality, an expensive Eijkman lab test that Nur needs is apparently not covered. Soni said the hospital staff at the counter said Askeskin did not cover the some Rp 1 million-worth of tests.

The lists of discriminations continue in the way the hospital officials served them at the counter.

Soni, however, said she did not hold any grudges. "If we don't understand about certain procedures, we can ask other Askeskin holders."

Soni acknowledged the hospital counter officers dealt with hundreds of poor patients every day. "It must be tiring for them as well," he said.

Nur's parents are among hundreds of other poor families from regions outside the capital that are referred to Jakarta's hospitals for treatment by the Askeskin scheme, which stands for Health Insurance for Poor People. The Askeskin scheme is applied nationwide, but excludes Jakarta ID card holders.

The Jakarta administration provided a different scheme for poor families in the capital: the Poor Family Cards (Gakin) predate 2004 and the SKTM relief letter has existed since 2006. Both are issued by the Jakarta Health Agency and are funded by the administration.

Gakin cards are still valid but distribution stopped after the SKTM was introduced in 2006. Gakin card holders can still receive free medical treatment at referral hospitals. SKTM holders include the poor and "nearly poor", so these card holders may not get completely free-of-charge treatment.

The Gakin card was useful for the whole family, while SKTM usage is limited to one patient. All Gakin and SKTM holders must go back-and-forth from the hospital to the Jakarta Health Agency for any authorization of expenses, including medication, doctor consultation, medical tests and other associated health expenses.

Ita is in her 40s, she is a Gakin card holder and resident of Cempaka Putih, Central Jakarta, and she said much time and effort was needed for her health-related trips. "The most important thing is my father received treatment."

Her father died after suffering Parkinson's and heart disease in July, 2007, however, the entire treatment he required for the last two years of his life was do-able thanks to their Gakin card. She said her father's entire treatment at the Gatot Subroto Army Hospital cost up to Rp 300 million.

Ita said her son, her brother and herself were still receiving the benefits of the Gakin card. Ita said, "If because we are poor, we must go through all this trouble with the document application, then so be it, as long as we can get the free treatment."

Many poor people, like Ita, Soni and Asep, prefer to put their energies toward getting their documents completed, instead of taking more time to complain about discrimination. They are the ones who realize time is ticking away for their sick loved ones, and the existing system allows no compromise.