People wait to undergo a documentation process at the Healthcare and Social Security Agency at the Pasar Rebo regional general hospital in Jakarta on Saturday. As of Oct. 1, the number of National Health Insurance-Indonesia Healthy Card participants has reached 182.03 million people or more than 70 percent of Indonesia’s total population.
It was already 9:30 a.m. Sitting cross-legged on the tiled floor, Rusohartono, 55, munched on a snack and looked at the hundreds of patients standing in line for the internal medicine department at Dr M Soewandhie Regional General Hospital in Surabaya.
“I have been here since 7:30 a.m. My ticket number is 158,” said Rusohartono, a resident of Sukorejo subdistrict, Tegalsari district, Surabaya, on Friday (27/10).
That morning, the hallway to the waiting room for the hospital’s internal medicine department was filled with hundreds of people. There were not enough chairs to seat everyone. Several patients or their families chose to sit on the floor or wait outside. Still others had seemingly tired of waiting and were asleep in their chairs.
Rusohartono has diabetes and needs to see an internist once a month. On a single visit, the participant of the National Healthcare Insurance-Indonesia Health Card (JKN-KIS) program can wait up to five hours until he can get his medicines. “The service has improved these days. It’s just that we need to be patient, as it’s always crowded,” said the civil servant.
Agung, 30, of Pacar Keling subdistrict, Tambaksari district, shared Rusohartono’s sentiments. Despite having registered with the city’s online healthcare system at ehealth.surabaya.go.id on Monday (23/10), he still got ticket number 142.
Agung can spend from five to six hours on a single visit, depending on the number of patients waiting in line. “The longest wait is for the medicines. I could wait one or two hours just for that. This is despite the note on the pharmacy’s wall saying that it would take only 30 minutes,” Agung said.
Queueing several hours for healthcare services seems inevitable for JKN-KIS participants at many hospitals. Hospital fees are no longer obstacles for poor patients, as access to healthcare is more open.
East Jakarta-based masseuse Renny Shafitri, 52, said that she could go to hospitals now. The previous impression that going to hospitals is costly no longer holds true with the JKN-KIS program.
Before she registered as a JKN-KIS Class III participant, Renny said that she had been afraid to go to the hospital, even though she had Rp 500,000 (US$37) in her wallet. “Now, even if there is only Rp 50,000 or Rp 100,000 in my wallet, I can go to a hospital,” she said while standing in line to see a cardiologist for an endoscopy referral.
Despite only getting 5 minutes with the cardiologist, Renny did not complain. For her, the most important thing was that she received the endoscopy referral.
As the number of JKN-KIS participants grows, the program’s utilization rate increases. Consequently, hospitals are now crowded with JKN-KIS patients. Long queues are inevitable, especially as the reference system is note yet optimal.
South Jakarta’s Lenteng Agung resident M Ishak, 65, said that he needed to spend nine hours of his day to seek treatment at Fatmawati regional. He said that his friends told him to just be patient while queueing at the hospital, as was normal for JKN-KIS patients.
Apart from being patient in line, Ishak, a cardiac disease patient, said that he also needed to be patient when the hospital did not have the medicines that he needed. He then had to go look for the medicines elsewhere.
Limited services
On the other hand, healthcare facilities are being overwhelmed with the high number of patients. Jakarta’s Pasar Rebo Regional General Hospital marketing head S Prabowo said that the limited healthcare services and number of employees in the hospital resulted in a backlog of patients. “Currently, six patients are waiting for available rooms,” he said.
To tackle the problem, the hospital often referred its patients to Budhi Asih hospital or Pasar Minggu hospital. Sometimes, however, patients refused the referrals, as the hospitals were far from their homes.
JKN-KIS Class II participant Ekson Hasiholan, 30, was among those patients waiting for available rooms. Two weeks ago, he had been scheduled for muscle surgery on Oct. 27. However, as of 5 p.m. on Thursday (26/10), he was still waiting for an available Class III room, as all Class II rooms were full. “I am disappointed, because I cannot get a room in my designated class but, more importantly, I should have my operation soon,” he said.
Healthcare problems in go beyond referral hospitals. Service at first-class healthcare facilities (FKTP) are also not optimal. Yogyakarta resident Yanuar, 35, needed to take his son, who was diagnosed with possible dengue fever, to a laboratory in Sleman 20 kilometers away because the FKTP where his son is registered does not have the proper treatment facility.
Apart from the distance, Yanuar also had to pay for his son’s medical examination himself, as the FKTP did not cover it. Yanuar was disappointed further when he found out that the doctor had gone home for the day just as he was about to take his son’s test results to him for consultation.
Even as access to healthcare facilities becomes wider through the JKN-KIS program, many have still not registered. Aep Saepudin, 60, of Ciemas district in Sukabumi, said that he had to borrow his neighbor’s regional healthcare insurance card when taking his grandson to Jampang Kulon regional.
In Banten, 2.6 million people have yet to register as JKN-KIS participants, due to the lack of information and their inability to pay the premiums.
