Every cloud has a silver lining and Pembadi, resident of Tanah Abang, Central Jakarta, looked forward to it one Wednesday afternoon.

Sitting in a registration room for patients claiming medical insurance at Cipto Mangunkusumo hospital, Central Jakarta, he was preparing himself for an interview with an official to assess his eligibility to receive a discount for his wife’s labor bills.

Pembadi, who moves between jobs frequently, is not on the list of recipients for free healthcare insurance for families living in poverty (Gakin), provided by the administration.

His unstable job status mean his family are not categorized as living in poverty. Currently he is unemployed and is finding it hard to gather Rp 3 million (US$315) for the birth of his child.

“I work in construction. The job is contract-based,” he said. Pembadi applied for relief through the SKTM scheme, where a resident can claim medical bills by attaching a letter stating that they are living in poverty from subdistrict chiefs in their residencies.

The interview Pembadi attended that day would determine the amount of discount he could receive. 

Medical catastrophe can occur at any time. When it comes, it is not only people living in poverty who suffer.

Middle-class citizens who experience severe illness may draw their families into financial trouble due to hefty bills they have to pay.  

The Jakarta Health Agency recorded about 640,000 people were protected under the Gakin scheme from a total 8.5 million last year.

For uninsured residents, the SKTM scheme ease their burden who encounter difficult situations.  
Another SKTM applicant, Rosiana, said her family members chipped in to pay medication bills  for her father who suffered cancer.

After a month of treatment at a hospital costing Rp 50 million, however, she and her family decided to apply for the scheme.

“The doctors advised us to request SKTM because the treatment would be costly,” she said.

Tumpi, who had undergone retinal reattachment surgery for her left eye, said her husband’s income as a private driver was sufficient to make ends meet.

But when she encountered health challenges, she asked for loans from her family to help pay for her medication.

She finally received 50 percent medical-fund relief from the SKTM scheme to pay for her eye surgery, which cost Rp 12 million.

“I don’t know when I will be able to return the money [to my relatives].

“I hope [the surgery] can recover my eyesight,” she said. 

Large medical costs patients pay have increased the number of total claims for the SKTM program, much higher than Gakin.

The agency recorded that it had to allocate Rp 174.5 billion for 189,238 in and outpatients, while it pocketed Rp 82.2 billion for some 1.4 million cases of Gakin’s last year. 

The agency’s chief, Dien Emawati, said she recognized the needs of people not living in poverty concerning health protection.
But she said the large disparity in amounts of claims between the programs indicated misallocation.

JP/Irma
“The SKTM is aimed at people living in poverty who are not registered as Gakin recipients due to a data-gathering weakness.”

But she said many had “violated the cause for their own benefit”, citing examples that patients registered themselves for first-class treatment at hospitals, but applied for the SKTM on payment day.

Dien also admitted that corrupt officials also contributed to the adverse claims granted under the scheme. 

Health rights activist Febri Hendri from Indonesian Corruption Watch said healthcare was a basic right of citizens and the administration should extend healthcare insurance to people not living in poverty. 

“The administration should provide residents with basic medical insurance,” he said.

This way, he went on, the administration could avoid misallocating the SKTM that contributed to the inefficiency of budget allocation.

“Our administrations do not collect data effectively. “If everyone receives basic medical insurance, the administration will only accept claims from patients who need treatment.”