Regent and mayor are requested to immediately decide number, names and addresses of poor and almost poor population in their areas as well as to control provision of poor statements (SKM/SKTM) so that it cannot be misused. Hospitals and other health facilities are not supposed to be local income sources (PAD).
It was mentioned by Minister of Health, Dr. dr. Siti Fadilah Supari, Sp.JP(K), in Coordination Meeting of JPKMM-Askeskin Program Implementation 2007 at Jakarta (4/9). It was attended by 1,518 stakeholders from center and region, and purposes to create coordination and stabilization of Askeskin Program 2007 as well as financing by provincial/district/municipal government.
The meeting is also to provide comprehension of payment standardization for health services in hospitals through Indonesia Diagnosis Related Group (Ina-DRG). Ina-DRG is a prospective payment pattern and a penetration on payment system of health services in hospitals related to health insurance mechanism. Therefore, fee at all hospitals will be the same each others. It will be a reference for PT. Askes to verify claims.
According to Health Ministerial Decree No. 989/Menkes/SK/IX/2007, government will make Ina-DRG effective starting on September 1, 2007 for 3 rd Class at government hospitals throughout Indonesia and on October 1 for other classes.
Relating to hospital delinquent claims, Minister of Health asks hospital directors to keep continuing health service to poor people and responding budget delay problems. She ensures that all unpaid claims must be paid after verification, and Ministry of Health (MOH) is attempting additional budget.
Use of drugs, except formularium, is for life saving. Therefore, she requires the use of formularium or others having similar content with it. It is as an effort to control the cost considering the limited budget. In addition, providing services should refer to the exist reference, and there should not be irrational therapy and health service. List of additional drugs has been prepared to be informed.
To all head of medical committee and Medical Advisory Board (MAB), she asks them to run their duty and function in arranging medical service standard and monitoring the implementation, conducting supervision of profession ethic, managing profession authority of functional medical staff and developing service programs.
Meanwhile, to head of provincial health office, she requires them to continuously supervise and monitor Askeskin program as well as strengthen provincial and district/municipal Coordinating Team and Safe Guarding Team in order to do their job and function well for socialization, supervision and monitoring that they could inventory problems and also formulate the solutions.
It was attended by all regents/mayors, directors of government general hospitals, minister coordinator for people's welfare, minister of domestic affairs, PERSI, ARSADA, KKI, MKDKI, Medical Advisory Board, profession organization, head of provincial health offices, management boards of PT Askes (Persero) and officials in MOH. Minister of health admitted that there are still some problems in implementing Askeskin Program.
At least, there are 4 problems needed to be solved together by stakeholders both from central and local. First, unfinished registration of Askeskin target 2007 that poor statement letter (SKTM) is still used by poor people. It causes many SKTM misuses. Many people, who are not poor, use Askeskin, and it gives disadvantages to poor people's right in getting health service.
Second, many poor people have not still got service because of limited health facilities. On the other hand, there are overloaded service, uncontrolled drug use and non optimal monitor and control of hospital medical care. All of these affect to high hospital cost.
Third, financing problem. Every year, number of Askeskin members is increasing, while its budget is limited. The realization is not efficient and claim payment is usually late. In addition, local contribution on additional budget for poor people health service and the utilization of profit as PAD have not been optimal.
Fourth, Safeguarding and Provincial/District/Municipal Coordinating Teams have not bee optimal, therefore problems on field are not discussed and solved immediately.
According to Mrs. Supari, health status of poor people is now still low, and economic problems are one cause for relating to community incapability to pay health service. ?Therefore, in the beginning of SBY-JK era, strategic policy has been made on providing free health service for poor people. Since January 1, 2005, it has been called as Program Jaminan Pemeliharaan Kesehatan Maskin (JPKMM) and familiar as Askeskin,? said her.
Askeskin Program purposes to improve access and quality of health service for poor people that there would be no poor people are difficult to get health service because of economic reason. ?This program is a part of poverty elimination,? she added.
In early 2005, program target was 36.1 million poor people throughout Indonesia . In line with local government plan and the same time with PKPS-BBM program, starting from mid 2005 to 2006, the target was increased to 60 million of poor and almost poor people. In 2007, the target is adapted from number of poor households obtaining SLT (a cash aid program), that are 19.1 million of poor households or about 76.4 million people.
Poor people get health service in stages, from out- and inpatient at health center to referral of specialistic outpatient care and inpatient care on 3 rd class of hospital. The health service including drugs and other medical needs are referred to rational service standard.
Increasing number of program members causes increasing budget need in every year. It is Rp.5,000/person/month. In 2005, the budget was Rp.2.1 trillion and increased to Rp.3.6 trillion in 2006 and to Rp.4.6 trillion in 2007.
Monitoring and evaluation since 2005 to mid 2007 have shown significant increase on health care utilization by poor people. It indicates that Askeskin program has been known and comprehended by poor people, who need health services without any fee.
For example, utilization of outpatient care in hospital increased almost five times, which was from 1.4 million visits in 2005 to 6.9 million visits in 2006; while, inpatient care increased almost three times, which was from 562,167 cases in 2005 to 1.6 million cases in 2006.
Meanwhile, during first semester in 2007, outpatients in hospital have reached 2.6 million visits, and inpatients have reached 831,139 cases. It is predicted that in second semester utilization of hospital service will increase as years before.
It covers from common cases to specific cases (catastrophic) that need much money, such as heart surgery, cancer surgery, haemodialysis, Caesar surgery, etc. For example, heart surgery increased almost eight times from 380 people in 2005 to 2,950 people in 2006, and haemodialysis increased from 4,862 people in 2005 to 5,418 people in 2006.
This information is published by Center for Public Communication, Secretariat General MOHRI. For further information, please call 021-522 3002 or send e-mail to: puskom.depkes@gmail.com.
