Agnes Winarti – While other provinces have taken advantage of the health care system managed by state-owned insurance firm PT Askes (Askeskin), the Jakarta administration has chosen to run its own.

In 2005, the administration launched its Poor Family Cards (Gakin) system to identify residents eligible for low-cost or free health care and food. The administration also allows residents to apply for a relief letter (SKTM) stating they are eligible for discounted or free medical care.

However, observers have said that the city's scheme is no more efficient than the Askeskin-run program.

According to Sri Indiyastuti, a campaigner from the public service policy-oriented Yappika Foundation, every scheme required patients or their families to go through a large amount of red tape in order to prove their economic status.

"All the schemes are effort- and time-consuming," she told The Jakarta Post recently. "It is time for the administration to evaluate the schemes' effectiveness, especially in creating an accountable and transparent scheme with a simpler bureaucracy."

Tuti said that even though all the health schemes were several years old, there were still many poor families who did not know about them. "During my field advocacy work, I met poor families that said they had not heard of Gakin," she said.

A lack of knowledge about the health care programs has resulted in the widespread belief among the city's poor that medical treatment is only for the wealthy. Poor people are more likely to simply take over-the-counter medication they have bought at local markets.

Tuti said many of the city's poorest people also did not have ID cards, which meant they could not access the programs. "Not having an ID card does not mean a person is not a citizen of this country. All citizens still have the right to get the assurance of access to health care services."

Indonesian Health Consumer Empowerment Foundation chairman Marius Widjajarta said Gakin and SKTM should not be continued because both hamper their members from getting health care outside of Jakarta.

"What if a poor person happens to be hit by a bus in Bekasi (West Java)? The person will not be treated at the local hospital because Gakin and SKTM are only applicable in Jakarta."

He emphasized the importance of a nationwide health care service. "It is against the law for an administration to manage its own program."

According to Marius, last year, the administration allocated Rp 260 billion (about US$ 28.6 million) for both Gakin and SKTM.

Meanwhile, the central government recently re-appointed Askes to manage Askeskin program. However, the Health Ministry and PT Askes are having an ongoing dispute about whether to send the budget directly to the insurance firm or to Askeskin's referral hospitals.

Last year, the Health Ministry allocated Rp 4.6 trillion for 76.4 million people in the Askeskin program. However, Askes president director I Gede Subawa told the Post that the ministry had only allocated a total of Rp 3.4 trillion for the 2007 Askeskin program, which resulted in an extra Rp 1.2 trillion in unpaid hospital claims.

The ministry accused PT Askes of marking up the hospital claims, although an audit is yet to be conducted.