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Children Most Threatened by Change in National Health Service Scheme


APRIL 04, 2018

Jakarta. Million of infants could see their access to health services restricted should the government proceed with its plan to cut deficits in national health insurance, or JKN, watchdogs warn.

Under the plan, BPJS Kesehatan, the agency which provides JKN, will apply a cost-sharing scheme for catastrophic illnesses for children, such as cancer and thalassemia, an inherited disorder affecting blood cells.

Differing from full coverage currently implemented, cost-sharing requires patients to pay out of pocket for part of the costs incurred for their medical treatments.

The government is considering this drastic approach, largely because BPJS Kesehatan accumulated about Rp 9 trillion ($654 million) in deficits from 2014 to 2017, which threaten the agency's sustainability.

But this could mean that children with life threatening illnesses from poor families may no longer be able to receive expensive treatments.

"The plan to apply this cost-sharing scheme contradicts the laws about the national social security system and children's rights protection," said Sitti Hikmawatty of the Jakarta-based Commission for the Protection of Children (KPAI).

Studies have found that cost sharing in the United States discourages people from poor families to seek health care and actually delays their treatments, according to Aaron Carroll, a pediatrics professor at Indiana University School of Medicine.

However, in France and Singapore, Carroll said, cost-sharing is waived for people with chronic illnesses -- like asthma -- children and pregnant women.

KPAI's Sitti said that she feared the change in the health insurance scheme would only exacerbate problems for the country's children.

For one, Indonesia's infant mortality rate remains among the highest in Southeast Asia. In 2016, the rate was 25.5 deaths out of 1,000 newborns, according to Central Statistics Agency (BPS) data. Malaysia's and Singapore’s infant deaths both recorded under 10 deaths for 1,000 newborns.

According to BPJS Watch, a non-profit watchdog organization, many Indonesian mothers still give birth outside clinics or hospitals, or are not assisted by certified medical professionals.

Sitti also noted that intensive care for infants is still lacking among the country's hospitals and clinics.

It is estimated that 1-3 percent of births would need neonatal intensive care units (NICU) for newborns of 28-days-old, or pediatric intensive care units (PICU) for children who require special treatments to prevent and treat the failure of vital organs. But even Jakarta only had 143 NICUs available for more than 156,000 births, according to the latest data from 2014.

Last September, four-month year old Debora died at Indonesia's largest listed hospital operator, Mitra Keluarga Kalideres Hospital, in Jakarta after spending more than six hours waiting to be transferred to another facility.

Referral patients at Harapan Kita Hospital, which is the national heart center, also have to wait more than a year to get treatment for heart disease.

If there is no revision in the universal healthcare plan regarding this, these cases are feared to increase the mortality rate in infants, Sitti said.

German Anggent, coordinator of the health insurance presidential regulation task team, said that health services for infants and children must be differentiated from adults in the health insurance scheme.

"The revision is expected to provide room for child protection. Children are the hope of the nation, so poor handling in infancy and childhood can have an impact on their future, which also means the future of the nation," German said.

But the discussion to revise the regulation, which is not open to the public, has garnered complaints from some parties.

Indra Munawar, coordinator of BPJS Watch, requested that the revision of the health insurance presidential regulation be publicly conducted to allow people to monitor the process. The closed discussion on the revision will potentially keep the public from getting better health insurance, as it does not consider laws concerning child protection and medical practices.

"These laws must be taken into consideration. […] The hospital should not prioritize administrative matters, it should prioritize how to save patients through emergency phase," Indra said.