Indonesia's health care system is failing to provide even the most basic care to vast swathes of the population, specialists say.

Many who cannot afford doctors' fees often receive no treatment at all, while the wealthy fly abroad just for check-ups.

The system is plagued by under-funding, decentralization, lack of qualified staff, rising medical costs and outdated equipment, according to insiders.

"The health system desperately needs improvement," said Kartono Mohammad, a senior doctor and former chairman of the Indonesian Medical Association (IDI). "There are no laws that protect the patient," he said.

In June, the system's failures were the focus of nationwide debate when Prita Mulyasari was sued by Omni International Hospital in Tangerang after she sent e-mails to friends complaining about the allegedly poor care she received there.

In 2008, she had checked into the hospital, where doctors allegedly misdiagnosed her with dengue fever. It later emerged that the mother of two actually had the mumps.

Omni sued Prita for defamation, but even after an outpouring of public support, including from the House of Representatives, and a virtual U-turn by the hospital last week, the lawsuit may still go ahead. "Doctors are very protective of each other. It is a conspiracy of silence," Kartono said.

But for most of the country's 230 million inhabitants, even the lowest quality health care is often inaccessible.

Access to health facilities across Indonesia's 6,000 inhabited islands varies greatly. Although cities usually offer a range of services for most medical problems, in remote areas such as the easternmost province of Papua, it can take several days to reach a doctor.

In addition, many low-income earners or the unemployed avoid going to a doctor, said Ajriani Munthe Salak, from the Legal Aid Institute (LBH). "They stay at home, hoping the illness will disappear. They are afraid of bills and the bureaucratic system."

Critics say a new health insurance scheme for the poor, known as Jamkesmas, launched by the government in early 2008, was too complicated, requiring patients to provide documentation on income, identity, hospital registration, family records and a doctor's referral notice.

The Health Ministry has spent seven years drafting an ambitious new universal health care bill, but it has faced delays, budget problems and technical hurdles, such as a lack of a common definition for malpractice, said Mariani Akib Baramuli, a Golkar Party lawmaker.

House members hope the bill will pass during the current term that expires in October, but say there is a huge backlog of other work to be done. (IRIN)