POOR COMMUNITY HEALTH MONITORING IN INDONESIA

SINCE MONETARY CRISIS

By : MARIUS WIDJAJARTA

INDONESIAN HEALTH CONSUMER EMPOWERMENT FOUNDATION

BACKGROUND• Since monetary crisis in Indonesia, there are a

lot of poor community's complaints about public health services because they can not afford the cost. It can be seen by the number of poor community rejected by hospital services. It also against the chapter 28 H ( point 1 ) amendment of Indonesian Constitution, health as human rights.

• As government’s responsibility ( according to chapter 34 Indonesian Constitution ) Poor Family Health Protection Fulfillment Program has been made and the community has responsibility to monitor and evaluate this program.

• Letter of acknowledgement ( SKTM ). With this letter the cost of health services can be reduced or free. In reality there are still many illegal cost and corruption. Many non poor person can buy this letter and on the other hand many poor person must pay for the letter every time they want to get the services. In DKI Jakarta there are still many Letter of not acknowledgement holder than Poor Family Card Holder.

• Health Card ( KS ). With this card, poor community can get the health services in health facilities pointed by the government. In reality there are still a lot of difficulties in card distribution and how to determine the poor community.

METHOD FOR IMPLEMENTATION OF THE PROGRAM :

• Safety Net in Health Society (JPSBK ) and Response of Impact Reducing of Energy Subsidy for Health (PDPSE-BK).

• Monetary and economy crisis in 1997 caused many poor people. There are many corruption suspect cases from Asian Development Bank Loan for JPSBK (1998 – 2002 ) 200 Million USD at early program for basic health service i.e. : JPSBK fund used for JPKM Rp 500 millions per district per year, fee for executive council of JPKM 8 % (SE DIRJEN BINKESMAS1446/BM/DJ/BPSM/X/98 ) and executive council of JPKM TAKES PREMI FROM GOVERNMENT Rp 10.000,- per poor person per year.

• In Year 2001 – 2002 advance health program from PDPSE –BK .

• Fuel Subsidy for Compensation Program (PKPSBBM).This program is similar to JPSBK program where the fund is given directly to health services officers. Pure fund is from the reducing of fuel subsidy compensation.

• There are many difficulties in monetary responsibility. Until now there are no details of report from Hospitals, Health Center, Health office, and other fund receiver.

• The unclear function of health facility whether as the place for health services or also fund management.

• There are different cost at the same services caused by the self determine billing by each provider (PPE)

• The accountabilities and transparencies of this program is unclear.

PROBLEMS

• Year 2003 – 2004 .Fund from PKPSBBM. Examined at 2 provinces and 13 districts / cities with quality and cost control principles. The operator get management fund 5% maximum. In 2004 area were developed JPK – GAKIN area at 2 provinces and 12 districts / cities . Indonesian Health Consumer Empower Foundation (YPKKI) survey at DKI Jakarta has found out that there are still many problems at this program i.e.: It’s difficult to get JPK-GAKIN card. The last information mentioned that this card has been sold Rp 250.000 per card illegally, the distribution is uncertain, and the operator is unprofessional.

HEALTH POOR FAMILY INSURANCE ( JPK – GAKIN ).

• SK MENKES NO. 1241 TAHUN 2004 pointed PT. ASKES as a program operator of JPKMM in 2005

• There are 36.146.700 poor people.• The community has responsibility to monitor and

evaluate this program.• The number of poor people have raised since year

2006. The member of JPKMM becomes 60 millions

HEALTH INSURANCE FOR THE POOR PROGRAM (JPKMM)

• The monitoring results at 18 cities (year 2005) and 5 cities ( in 2006 ) there were still many problems i.e. :

The members had to pay for health services, Many people used letter of acknowledgment, not ASKESKIN card, bad services, verification problem at PT. ASKES and Hospitals. Generally the poor community services have many progress.

Unfortunately in the middle of year 2007 Ministry of health have plan to change the fund allocation system from PT. ASKES to hospitals. But from the last information ministry of health has been appointed as verification provider .

MONITORING

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

1 Jakarta _ _ _ _ Poor community without ID card will not get SKTM from DKI Government and so is health Insurance card from MKJ (North Jakarta)Too many SKTM because it is difficult to get Gakin Card

2 Kupang Yes _ Yes Non DPHO Medicine

Hospital management is complaining about small health service cost because in reality

3 Samarinda _ _ Yes • Health equipment

(Triway infusion set)

• Laboratory

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

4 Balikpapan _ _ Yes •ICU service down payment•DPHO medicine•Non DPHO medicine

More than one health training centerToo many SKTM because it is difficult to get Gakin Card

5 Semarang _ Yes _ • No extra charge

Askeskin card with photograph attachedExpensive medicine has been given already even sometimes lateAlbumin therapy is not running well

6 Magelang _ Yes _ • Non DPHO medicine

Askeskin card is misused unofficially by District government officer

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

7 Sleman Yes Yes _ • Non DPHO Medicine

Heavy health case of JPKM is transferred to Askeskin

8 D.I.Yogyakarta

Yes Yes _ _ More than one Health Training CenterHeavy health case of JPKM is transfferred to Askeskin

9 Tuban _ Yes _ _

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

10 Surabaya _ Yes __

Illegal administrative mediator with Rp.200.000 illegal cost

11 Medan _ Yes _ _ Rp.30.000 for SKTM charge SKTM inpatient is not refund with Askeskin (Binjai hospital)

12 Binjai _ _ _ _ SKTM inpatient is not refund with Askeskin card (Binjai hospital)

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

13 Makassar _ _ _ • Non DPHO Medicine

• ICU inpatient medicine

• Double room (care and ICU room)

Rp.200.000 for SKTM charge Nurses illegally sell The Gangrene medicine Rp.500.000.Inpatients move to ICU but the abandon room/bed is still charged Rp.39.600./dayFree hemodialisis but there is still illegal cost Rp.20.000 blood insurance from blood bank

14 Maros _ _ _ • Non DPHO Rp.30.000 for SKTM charge SKTM inpatient is not refund with Askeskin (Binjai hospital)

15 Menado _ _ _ • Non DPHO medicine

• Health equipment

• USG held at outside hospital (Rp.200.000)

Officer ask illegal cost to issued JPKMM card Rp.50.000/cardUrology surgeon ask illegal cost

Rp.9.500.000. before surgery

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

16 Tomohon _ _ _ • USG cost Rp.175.000.

17 Tondano _ _ _ _ Anesthetic ask for illegal cost Rp.750.000.

18 Bitung _ _ _ • Non DPHO medicine

Many non DPHO medicine because Pharmasist gave Doctor Rp.500.000/monthJPKMM inpatient sometimes doesn’t want to take 3 rd class or below servicesJPKMM patient have social health insurance (arm forces retired)

YEAR 2005

CITY TO GET HEALTH SERVICE OTHER THAN ASKESKIN

CHARGING EXPLANATIONS

JPKMCARD

SKTM/ HEALTH CARD

WITHAOUT ASKESKIN CARD

1 Surabaya _ _ _ Better services

2 DI.Yogyakarta _ _ _ Good progress and services

3

4

5

Semarang

Tanjung Balai Karimun

Batam

_

_

_

_

_

_

_

Illegal transaction of Askeskin card

_

Better services

Good services

Good services

YEAR 2006

• Ministry of Health Policy about social health insurance for poor community is appropriate and a good starting point, but the changing of the fund allocation system will make difficulties for monitoring even to get the verification from PT. ASKES and health service operator it self if the fund is running out before it’s time. But from the last information from ministry of health has been appointed as verification provider .

• Local government must support the program to make it successfully and prosecute someone doing the illegal operation of JPKMM

• For provider : do the duty as the agreement. • By changing the current better system with the old one, the

community must do tight monitoring

CONCLUSION

JPSBK BUDGET TO JPKM PER DISTRICT PER YEAR Rp. 500 MILLION

HEALTH SERVICES FOR POOR PEOPLE AT KUPANG HOSPITAL, YEAR 2005

POOR PEOPLE AT DKI JAKARTA DOES NOT HAVE GAKIN CARD AND REJECTED BY RSCM ( NATIONAL HOSPITAL )

WITH THE REASON HOSPITAL IS FULL.BORN JUNI 2ND 2005, DIED JUNI 5TH 2005

POOR PEOPLE AT TANAH MERAH, BETING VILLAGE TANJUNG PRIOK, NORTH JAKARTA ( YEAR 2005 )

POOR PEOPLE WITH BURN WOUND (GRADE III – IV, 90 %)INPATIENED AT dr. KARIADI HOSPITAL, SEMARANG, MORE THAN 1

MONTH. COST MORE THAN 50 JUTA RUPIAH ( YEAR 2005)

7 POOR PEOPLE FROM 9 PATIENT AT ICU AT Dr. SUTOMO HOSPITAL SURABAYA USING JPKMM CARD

(ASKESKIN ). YEAR 2005

ASKESKIN PATIENT ALREADY 7 MONTH HEMODIALISIS WITH 2 TIMES A WEEK FREQUENCY,

FINANCE BY JPKMMAT MEDAN HOSPITAL,

YEAR 2005

ASKESKIN PATIENT WITH NECK TUMOR.INPATIENT AT CHILDREN WARD AND USED BED FOR

CHILDREN AT MEDAN HOSPITALYEAR 2005

ASKESKIN PATIENT POST HEART SURGERY AT Dr SOETOMO HOSPITAL SURABAYA, (FREE)

YEAR 2006

ASKESKIN PATIENT AT HIDAYATULLAH HOSPITAL, YOGYAKARTA . CA MAMMAE OPERATION. YEAR 2006

ASKESKIN (SIAMISE TWIN) PATIENT AT Dr SARDJITO HOSPITAL YOGYAKARTA PART OF SURGERY

FINANCE FUND BY ASKESKIN, TAHUN 2006

ASKESKIN PATIENT AT ICU DR KARIADI HOSPITAL SEMARANG. YEAR 2006

ASKESKIN PATIENT AT ICU TANJUNG BALAI KARIMUN HOSPITAL ( TAHUN 2006 )

THANK YOU