Nivell Rayda – Strict implementation of the 2004 National Social Security System Law is needed to prevent millions of Indonesians from slipping through the cracks in the health insurance system, a lawmaker said on Thursday.
Indonesian Democratic Party of Struggle (PDI-P) legislator Rieke Diah Pitaloka said in a discussion hosted by Indonesia Corruption Watch that the House of Representatives health commission was pushing the government to implement the law. More and more low-income people are finding themselves inadequately covered or subject to inappropriate fees within the public health insurance system, commonly known as Jamkesmas.
"By implementing this law, there shall be no more discrimination against the poor because every citizen in the country would be protected," Rieke said.
The law combines into a single entity existing state-run insurance schemes such as Asabri, the military insurance and pension fund; social security fund Jamsostek; and national health insurer Askes.
"Existing state-owned insurance firms are profit-oriented, with limited target members. The new system would ensure equality for all citizens, including the poor," Rieke said.
Indonesia Corruption Watch researcher Ratna Kusumaningsih said the lack of transparency over claim procedures had led to widespread corruption within the system. The antigraft watchdog said that as much as 78.3 percent of the Jamkesmas members surveyed last year were still being charged by public and private hospitals, even though the program entitles them to free health care.
"Hospitals must be more transparent and accountable in treating their patients and complying with minimum service standards. The [Health Ministry] must immediately create a body to supervise and monitor the conduct of hospitals, as stipulated in the law," Ratna said.
Aswanah, a 50-year-old mother of three, said at the ICW discussion that she still had to pay a portion of her medical bills despite being covered by Jamkesmas.
"I had an accident at work and injured my eyes. I was taken to a public hospital in Tangerang and the doctors told me that I needed surgery," she said. "I was shocked when the hospital said that Jamkesmas only covered half of my Rp 20 million [$2,140] bill. When I got my Jamkesmas card, I was told that all my medical expenses would be covered by the government."
But inappropriate fees are just part of the problem. Abdul Cholik Masulili, a Health Ministry expert, said low-income people often can't join Jamkesmas. Meanwhile, those who shouldn't qualify often do.
"There are poor patients who are not listed as eligible for Jamkesmas. In contrast, there are those who receive memberships but actually can afford their medical bills," Masulili said.
The official said the ministry had estimated that only 70 percent of 71.8 million members of Jamkesmas can be considered as poor, while there are five million underprivileged people still not covered by the scheme. "The problem is getting credible and up-to-date data," he said.