Jakarta, Indonesia - Andre Soni Asmara isn't sure of the exact cause of the

sporadic pain he feels in his chest, or the frequent tiredness he experiences. For
the past two years, he has suspected heart disease, which is hereditary in his
family. His symptoms worry him, but he is more concerned for his son, Rizky.

Telling his story on the front steps of the specialist National Cardiovascular
Centre in Jakarta, Andre fights back tears as he recounts the battle to save his
four-year-old boy's life. Rizky was born under-weight in June 2009 and
experienced heart failure shortly thereafter. He has needed intermittent hospital
treatment ever since.

"He was turning blue when he was born, he needed round-the-clock care and had
to have fluid drained from his lungs. I was worried sick," Andre says.

To fund his son's treatment Andre was forced to borrow 70m rupiah ($5,917) more than three times what he earns in a year as a self-employed interior designer.
"When I came to the hospital they refused me treatment [unless I met all the
costs]. For ICU, it's 4m rupiah just for one day. I asked them, 'Can the poor not be
sick?' If you're poor you can't be sick in this country because you can't afford it,"
Andre says.

The 44-year-old says the stress of meeting his son's medical bills has triggered his
own health condition. "I've had to make a choice, and I decided I would be
prepared to die so my son can have the treatment," says Andre.

Doubts voiced over Indonesia health scheme

Until now, he would rather not know the reason for the discomfort in his chest
because he's unable to pay the cost of his own therapy. But this is set to change.

As of January 1, Andre is able to register for a new national health insurance

programme managed by Indonesia's Social Security Organising Body (BPJS). The
scheme is set to become the world's largest by 2019, when the government
projects all 247 million Indonesian citizens will be covered.

'Sandwich people'

Indonesia's multiple existing health insurance carriers will be united under the
BPJS umbrella, changing little for those who are already covered by insurance.
But for 80 million Indonesians who, like Andre, are not deemed poor enough to
qualify for the current Jamkesmas healthcare system and are not rich enough to
buy private insurance, BPJS will mean affordable access to therapies for lifethreatening illnesses.

One of the primary aims of BPJS is to provide coverage for those between the rich
and extremely poor, whom policy analysts refer to as the "sandwich people". Now
those who are self-employed or work in the "informal sector" will be able to pay
contributions of between 25,000 rupiah ($2.10) and 60,000 ($5.10) rupiah a
month to gain access to any service deemed medically necessary, from a routine
checkup to open-heart surgery.

Integration of the service also means patients will have more choice in where they
can access treatment, as long as they can afford to travel.

On the third-floor ward of the National Cardiovascular Center, 51-year-old Bapak

Untung is being treated for acute decompensatory heart failure. He has suffered
severely swollen feet, breathlessness and fluid in his lungs, exacerbated by the
inadequate treatment he received from his local hospital in Bogor, 70 kilometres
away in West Java. All he requires is a simple drug treatment to reduce the fluid in
his lungs, but this was unavailable to him in his hometown.

Andre Soni Asmara was forced to borrow $5,920 for his five-year-old son's heart
treatment [Al Jazeera]
After hearing about BPJS through a friend, he immediately took advantage of the
access to specialist treatment in the capital, Jakarta.

"If this system had existed a long time ago, I probably would be better by now,"
Bapak says. "I think this programme is a bit late, but I'm very relieved it's here.
Better late than never."

Long time coming

It's taken the government 10 years to set up BPJS - mandated by the Law on the
National Social Security System passed in 2004, which ruled that all Indonesians
must be covered by social insurance.

Critics claim government delays have been partly attributable to opposition from
employers, for whom paying mandatory insurance premiums will increase labour
costs. "President Susilo Bambang Yudhoyono's government has not been keen to
implement because his cabinet is too neoliberal - they don't think it will be a good
programme for business," says Hasbullah Thabrany, a health-policy expert from
the University of Indonesia.

In an effort to expedite the Yudhoyono administration's glacial progress, in 2010

the government was successfully sued by the Social Security Action Committee
(KAJS), which advocates for workers' rights.

"The central Jakarta Court decided that the government had failed and neglected
[its duties], and the government was sentenced to implement the law as soon as
possible," Hasbullah says, chuckling. "Maybe only in Indonesia do you hear about
cases like that."

The professor welcomes the arrival of the scheme, but sees several obstacles in its
rollout. He is primarily concerned by the lack of public information that has been
made available about BPJS. According to Hasbullah, there has been a limited
campaign through TV and radio advertisements, but public knowledge about the
programme is poor.

The central Jakarta Court decided that the government had failed ... and was
sentenced to implement the law as soon as possible. Maybe only in Indonesia do
you hear about cases like that.

- Hasbullah Thabrany, University of Indonesia

In his consultations with the government, Hasbullah recommended an allocation

of at least 1tn rupiah ($83m) for public education, and the "socialisation" of the
programme, but he says the Department of Health has set aside only 20bn rupiah
($1.7m).

"I suppose with many people on the street, for example a taxi driver - a good
example of the sandwich people, [who until now have not been able to get
coverage] - they don't know about this, about the national insurance," he says.

"More than 50 percent will not be aware that they have cover. If you ask me to
grade this, I would give it a grade C - a fail [in the Indonesian education system]
for socialisation."

Enough money?

Hasbullah also anticipates the 19.9tn rupiah ($1.7bn) that has been allocated to the
health ministry for 2014, will only meet 40 percent of the market costs of care.

Hasbullah says while the new system will push much of the burden of payment to
employers and healthcare providers, and the health budget will be inadequate to
maintain, let alone improve, the quality of care.

Defending the financing for the scheme, Deputy Health Minister Ali Ghufron
Mukti said he was presiding over the largest health budget in Indonesia's 69-year
history, and more funds would be allocated in the coming years.

"I think that we will spend more money in the future. It is necessary to increase
our health infrastructure. So we are planning step-by-step, so if not today, then
tomorrow or the day after tomorrow," he says, adding the process of spreading the
word would be spread over five years.

"Indonesia is a big country, we cannot socialise the programme in one or two

days. We have a roadmap, and we hope this roadmap will finish in January 2019,"
he said.

According to the Department of Health Indonesia's population is currently cared

for by 85,000 general practitioners and 25,000 specialist doctors. While this meets
adequate standards of coverage determined by the United Nations, there remain
concerns over the regional distribution of doctors.

In Jakarta there is a high concentration of specialists, but outside of the

archipelago's major cities specialist numbers are much lower and the quality of
facilities can be hazardously poor. The task of coordinating the merger of
Indonesia's half dozen existing state health insurance providers will also present
significant challenges.

For Andre his optimism and relief that BPJS has finally arrived is tempered by his
doubts about the healthcare programme's future.

After working as a journalist between 2000 and 2004, his work reporting on an
endless succession of corruption scandals leaves him unsure whether or not the
government is capable of presiding over the world's largest health insurance
scheme.

"All the bureaucracy here is very bad. Unless you're rich, you can't take anything
for granted," Andre says.

Source: Al Jazeera