Ulma Haryanto – Although the state health insurance system has been widely criticized for its shortcomings, millions of poor people across the country still depend on it for much-needed medical care.

Sarwiah, a 55-year-old widow from Tangerang, recently found that she had cervical cancer. She had been in pain for three years until the state insurance scheme, known as Jamkesmas, was introduced in early 2008, enabling her to get a medical examination at Tangerang Regional General Hospital, as well as to afford necessary medications.

"Before Jamkesmas, we had to pay for everything ourselves," she said. "I just went to a public health center for the pain because that was all we could afford."

Sarwiah said she still had to spend Rp 100,000 ($10) every two months for her pain medications.

After she received her Jamkesmas coverage, a doctor at Tangerang Hospital referred her to an oncologist at Cipto Mangunkusumo General Hospital (RSCM), in Jakarta, where she expects to receive treatment for her cancer.

According to a Jamkesmas administrative worker at RSCM, the hospital receives up to 300 patients a day from all over the country under the insurance scheme.

But some 16.3 million Indonesians may lose this health insurance next year, as the government says the number of people living below the poverty level has declined.

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

Prof. Hasbullah Thabrany, a leading health expert from the University of Indonesia, said the government should be expanding health care coverage instead of reducing it.

"The government is responsible for health care, as is mandated in the Constitution's Article 28 H.1 statement on health care," he said. "The government should not confuse Article 34.1 of the Constitution: 'The State should care for the poor,' with 34.2: 'Social insurance for all,' meaning not only the poor," he said.

Meanwhile, people like Minik, a housewife from Lampung who was in RSCM to have a tumor removed, are hoping they are not among the 16.3 million who may lose their coverage.

With months of chemotherapy ahead of her, Minik is certain that even though her husband is employed they will not be able to afford her treatment.