"Who's next?" "You, who's the sick one? How much?"

Muktiono, who sat behind a reception desk at a registration room at Rumah Sakit Cipto Mangunkusumo (RSCM) hospital, Central Jakarta, aided a woman from a crowd of applicants concerning medical bill relief.

What seemed like a military roll-call session Wednesday was an official procedure to determine the applicants' eligibility for low-cost healthcare under the SKTM scheme.

What followed was an exchange that could easily be mistaken for bargaining in a traditional market.

An SKTM is a letter from a subdistrict chief, stating that a resident lives in poverty. The administration provides relief from medical costs to help cover health insurance for families living in poverty (Gakin). The letter is proof of one's poverty status and entitles him to the bill relief.

After attaining the letter, an applicant must attend an interview with officials from the Health Agency to determine an appropriate amount of relief. Most patients receive a 50 percent cut on costs. During the interview, officials assess patient's eligibility according to their living conditions.

The RSCM, a hospital with large number of patients, has an official from the agency stationed to interview the applicants. In smaller hospitals, applicants must go to the agency's nearest office for the interview. The complicated procedures inevitably trigger corrupt practice among officials.

Health rights activist Febri Hendri from the Indonesian Corruption Watch said that a recent survey found that subdistrict officials often requested between Rp 100,000 (US$10.5) and Rp 400,000 for anyone who wanted the letter, regardless of the applicants' financial position.

"A complicated administration process is the perfect climate for corruption," he said. With poor monitoring from the higher level administration, these practices have continued over the years, he said.

The agency's head, Dien Emawati, admitted that the current SKTM procedures are prone to corruption. However, she said it was the most effective system that the administration could offer at this stage. "We want to help residents during hard times," she said.

Dien said hospital officials also often reported they caught middlemen who processed documents for patients who did not live in poverty. The agency's recent findings were from Koja hospital in North Jakarta, and Kartika Pulo Mas hospital in East Jakarta, she said.

"Middlemen pretend they are the relatives of patients," she said. "They take care of the procedure at subdistricts," she said.

However, no fines were handed to middlemen or officers as the regulation does not prohibit it, said Dien.

Former Health Agency chief Chalik Masulili said the administration should have ended the SKTM scheme a long time ago. "Officials are unable to control the selection with an ineffective system," he said.

Jamkesmas is the government-run free healthcare insurance program for people living in poverty. It began in 2008.

"The letter is only based on a judgement of one or two officials at a local subdistrict," Chalik, who is now the Health Ministry's Jamkesmas chief, said. "Who can guarantee their honesty?" God, perhaps?