Erwida Maulia, Jakarta – Cases where hospitals reject patients living in poverty because they cannot pay the advance was a common occurrence in Indonesia several years ago.

In the past few years the prevalence has been reduced but unfortunately it happens frequently, according to media reports, even after the government launched a health insurance scheme for the people living in poverty, called the Community Health Insurance Scheme, or Jamkesmas (previously named the Poor Health Insurance or Askeskin), in 2005.

Under the scheme, 76.4 million people living in poverty and those in near poverty should be covered by the government-paid insurance. In reality, however, that is often not the case.

Enter keywords such as Jamkesmas, pasien (patient), ditolak (rejected), or rumah sakit (hospital) in search engines; and you will find dozens of links to local news stories about how underprivileged patients are often denied their rights to health care, not to mention quality health care.

The incidents have been reported to occur across a number of regions, including big cities such as Jakarta and Surabaya.

Many of these cases were recorded as happening this year, four years after the Jamkesmas program first took effect.

These include one that led to the death of an East Java town of Gresik resident, Bambang Sutrisno, 50, who died of heart complications after a local hospital rejected him, as reported by kompas.com.

Some patients denied their rights are holders of Jamkesmas cards, revealing how many hospitals treat their patients discriminatively.

It is common knowledge that Jamkesmas patients receive poor treatment compared to those received by non-Jamkesmas patients, for example, those paying hospital bills using their own money or their companies.

Others, meanwhile, are not entitled to Jamkesmas cards, although they may be equally in poverty or worse than cardholders, such as the case with Bambang.

This reveals problems with the country's data collecting system.

Indeed, the Health Ministry has been using the 76.4 million figure based on the Central Statistics Agency (BPS)'s 2005 estimation of 19.1 million households living in poverty times four (a household is considered to have four members on average).

The ministry will only update the data pending results of a population census to be carried out by the BPS in 2010.

This appears to create problems in the field, as a person's eligibility for a Jamkesmas card is based on the recommendation of local officials, many of whom have been found to distribute the cards to those who pay them or their relatives; not necessarily those who are eligible.

Despite the slow progress of the relatively welcomed Jamkesmas program, however, 2010 brings hope for more equal treatment, and also an improvement of the country's health service quality in general.

In September, two crucial health-related bills were passed into law. First, the new health law, which replaced the outdated 1992 Health Law, and second, the hospital law.

Although the new health law has been facing rejections, especially from religious communities due to its legalizing of abortions on certain conditions, the law, said then justice and human rights minister Andi Mattalatta during the House of Representative's plenary session to endorse it, authorizes the government to control prices of essential and generic medicines to ensure they are affordable to people living in poverty.

The law, Andi added, also obliges the central government to allocate 5 percent of state budget and local administrations 10 percent of their budget to the finance health sector.

This, if implemented, would significantly boost the health budget and is expected to help expand health care service coverage to those in need, including those with barely no access to services, for example, those living in rural areas and outlying regions.

The hospital law, meanwhile, guarantees everyone's right to receive medical treatment by imposing fines on hospitals that reject patients.

The hospital law also forbids government-owned hospitals to provide class-based services in a bid to ensure equal treatment for all patients, which has sparked some hospital outcry in a number of regions.

In an interview with The Jakarta Post last month, Health Minister Endang Sedyaninigsih said, "I expect no more hospitals to reject poor patients by 2014.

"Everybody should have health insurance by 2014".

"This is part of our effort to implement the hospital law," she said. "Everybody will get access to health regardless of their status, ethnic group or religion."

Endang added the move was also part of the administration's strategy to achieve the Millenium Development Goals (MDGs), including the reduction of infant and maternal mortality rates, as well as to war against communicable diseases.