Dessy Sagita & Ulma Haryanto – About 16 million people are likely to lose their state health insurance, known as Jamkesmas, due to a reported decline in the number of people living below the poverty level, a senior minister said on Monday.

"The poverty rate in Indonesia has declined. Therefore the coverage under Jamkesmas will be reduced from 76.4 million people to 60.1 million people. The rest, 170 million others, would be covered by self-paid health insurance," said Aburizal Bakrie, the coordinating minister for people's welfare.

Aburizal said the poverty rate had declined by 14.5 percent, meaning 2.5 million people were lifted from poverty. He did not explain how this decline justified 16.3 million people having their state health insurance coverage revoked.

Jamkesmas is a health insurance scheme for the poor introduced in early 2008.

Aburizal acknowledged that a 2004 law on the social security system guaranteed that every citizen would be covered by health insurance. But he said nothing in the law stated that the government would be required to pay for it all.

However, Abdul Chalik Masulili, the Health Ministry's director for Jamkesmas, said the 16.3 million people in question would not immediately face revocation of their coverage, and would continue to receive Jamkesmas coverage through 2010.

"It's true that only 60.1 million people are considered eligible to receive Jamkesmas through the poverty-eradication program, but we are still going to pay for the other 16 million anyway [through 2010]," he said.

Chalik said the eligibility of the 16 million people in question to receive the insurance in 2011 would be evaluated next year. "We will conduct a thorough survey and we will re-evaluate the program in 2010. We will then decide the best mechanism for Jamkesmas accordingly," he said.

Chalik said that for 2010, the figure for Jamkesmas holders was still pegged at 76.4 million people and the budget had even been increased, from Rp 4.6 trillion ($487 million) in 2009 to Rp 5.1 trillion in 2010.

Adang Setiana, deputy minister for people's welfare, said the government remained optimistic that the country would be able to reach universal health insurance coverage by 2014.

"Having health insurance is obligatory for all Indonesians, but it doesn't mean the government should pay for everything. The government will only pay for those who really need it," he said, adding that it was only sensible for every able citizen to pay for health insurance.

"People in Indonesia spend more than Rp 10,000 a month on their cigarettes. It's more than what they have to spend on health insurance."

Ratna Kusumaningsih, a researcher at Indonesia Corruption Watch, said that the reduction in Jamkesmas coverage should not only be based on the poverty rate from the Central Statistics Agency (BPS).

Rather, the government should also look into other indicators, including the mortality rate of babies, children and mothers, especially in poor communities.

"Health is a cross-section initiative and cannot be determined by one ministry only," she said.

Ratna also said that the standard government insurance fee had not changed for decades, at a mere Rp 5,000 monthly per person, making it difficult to cover current health care costs for all.

Under the Jamskesmas scheme, the government pays fees directly to hospitals and health clinics.

But critics have said that the sum allotted was far below what had actually been disbursed. Payments are also often late, causing financial problems for hospitals and clinics.