Not getting better: We need universal healthcare coverage

Coordinating People’s Welfare Minister Agung Laksono said in a statement (The Jakarta Post, July 14, 2011) that the government was not ready to provide universal healthcare coverage as mandated by Law No. 40/2004 on National Social Security System (SSJN) because of problems with access to healthcare facilities and the availability of health workers, particularly in remote areas.

The remarks appear to have fueled further the controversy over the delays in putting the bill into practice, following a Central Jakarta District Court ruling that found the government guilty for not doing so.

Prepared following the 1998 financial crisis, it took a long time for the bill to be enacted in 2004.

Seven years have passed in limbo waiting for the government to prepare infrastructure, including restructuring the existing social security system with the much-debated UU BPJSN (Social Insurers Bill). And now a minister says we are not ready because of inadequate infrastructure.

This is certainly not news, but is the problem of providing universal healthcare coverage really about being ready or not? Should the millions of Indonesians not covered by health and other social insurance have to wait until their government is ready? No!

First, as Thabrany, a prominent supporter of the SJSN, says, the statement about the government’s “unreadiness” is “one of the most frequent misleading opinions on the SJSN” (Thabrany, 2007).

Many other countries have started implementing social security systems when their economies were in even worse shape than that which Indonesia is currently in, such as our neighbors Malaysia, the Philippines or Thailand.

Sulastomo, in his testimony as a former team leader for the establishment of the SJSN at Central Jakarta District Court last March, said the government had lost the opportunity to mobilize up to Rp 278 trillion (US$32 billion) for welfare because of the seven-year delay. So, the longer we delay, the more we stand to lose.

Second, contrary to the logic the minister put forward, people with health insurance are less likely to seek medical services, near or far.

In the longer run, it may exacerbate their health condition, because poor people who have no insurance usually opt not to check their health condition earlier and are more likely to see doctors only when their illnesses become complicated (and thus treatment is more expensive), and the chance of recovery is diminished.

Routine checkups are definitely cheaper than costs incurred when illnesses are diagnosed only in the later stages.

On the whole, delaying treatments leads to poor national health outcomes. There is no need to remind the government that Indonesia will most likely be unable to reach its MDG targets related to health outcomes in 2015, such as for infant and maternal mortality rates.

Third, in the age of global competition and volatile financial system, it has been proved that our economy is largely dependant on the informal sector – a sector whose workers are almost entirely uninsured.

In addition to this, our labor force is one of the least competitive and least productive in the region, so a delay in providing universal social security means extending the un-productivity chain: workers will worry about their hospital bills, the unavailability of an adequate pension after retirement, or about mass lay-offs, and would certainly not be as productive as their counterparts who are adequately protected by health insurance or a pension scheme.

While it was indeed correct for the minister to say that the number of hospitals and health workers needs to be increased and that distances to healthcare facilities is a major problem.

But why is that? The minister must be aware that our health budget was just 2.2 percent of the state budget in 2010. It must be adjusted to the level mandated in the 2009 Law on National Health, which is 5 percent, or even to 15 percent as per WHO standards.

Once adjusted, we will see how many more hospitals can be built, and how many more health workers can be recruited and placed. Not to mention if the billions of leakage could be saved.

With the low budget, leakage and only a bit over half a million health workers nationwide (Health Ministry, 2010) to serve around 240 million people in Indonesia, the question of whether we are ready or not is indeed hypothetical. There are simply way too many reasons to say Indonesia is not ready, and never will be. This is as hypothetical as Soeharto questioning whether Indonesia was ready for democracy in 1998.

If we had waited until we were “ready”, we would probably still be under the autocratic regime. Luckily we did not wait too long. An affirmative step was taken, a breakthrough was made, and it brought us to the democratic state we are in now.

A similar step must also be taken to make Indonesia “ready for universal healthcare”. Providing universal healthcare is an affirmative step toward becoming a more respected country, not a pariah country whose citizens are tortured and murdered without sufficient bargaining power.

With healthy, more productive and more competitive workers, we can create our own jobs here rather than sending their necks to be hanged in rich countries. The long-term benefits of investment in universal health coverage are longevity and quality of life. And these things should be enjoyed by all Indonesian citizens, without delay.

*The writer is program manager at the Center for Welfare Studies, Jakarta, and a graduate of the Development Studies Program at the University of Melbourne.

Source :the Jakarta Post | Wed, 08/10/2011 7:00 AM 

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