Treatment strains health, finances


IN Indonesia, where a third of the population lacks health insurance, some Covid-19 patients have had both their health and their finances strained by the virus.

While the government is reimbursing both state-run and private referral hospitals for the expenses of treating Covid-19 patients under a government plan, the lack of capacity at these facilities and patients’ fears of not getting prompt or sufficient care have left some with little choice but to pay tens of millions of rupiah for private treatment.

Naufal Dhany Rizaki, a 25-year-old resident of Surabaya, said his family had to pay R97mil (RM28,000) for his mother’s two-week hospital stay in January because she did not have insurance. Naufal had searched for a bed at state Covid-19 hospitals, but to no avail.

Fearing for his mother, who was diabetic, a noted Covid-19 comorbidity, he booked a bed at a private referral hospital.

His mother’s condition worsened after she heard of the death of her sister from the virus, but she eventually survived.

Naufal was informed by a doctor about the estimated medical expenses, but still found it “a large amount” of money.

“My family didn’t have cash. What we had were land investments, but thank God we found a way to get the money, ” he said.

The hospital informed him that it could submit a claim to the government to cover part of the expenses.

“The reimbursement can take three months or more – or even not happen at all. But the hospital said it would still try, ” Naufal said.

Some 34% of Indonesians lack health insurance entirely, while about 56% are covered by the state’s Healthcare and Social Security Agency (BPJS Kesehatan) and about 1% by private insurance.

The remainder are covered by a variety of other schemes, according to the 2019 Social and Economic Survey (Susenas).

Some 30% of people above the age of 60 – a group that now accounts for almost half of the country’s Covid-19 deaths – lack health insurance, as do some 42% of low-income families.

Higher income correlates with higher rates of coverage in the country. BPJS Kesehatan does not cover Covid-19 treatment. It only verifies the medical expenses of referral hospitals to be reimbursed by the government.

Recent data from the Indonesian Life Insurance Association (AAJI) shows its members paid some R651.8bil (RM188mil) in claims related to Covid-19 made by 8,849 policyholders between March and October 2020.

Most of the claims were for Covid-19 treatment at local or foreign hospitals, and 6.3% were for Covid-19 deaths.

Insurance penetration in Indonesia has been low in the past years.

Organisation for Economic Cooperation and Development (OECD) data shows that Indonesia’s insurance spending in 2018 was only 1.79% of the country’s GDP, lower than neighbouring Malaysia’s 4.4%.

While the ratio of out-of-pocket payment to total health expenditure declined from 54.8% in 2010 to 31.8% in 2017, the gross out-of-pocket payment figure grew from R211.2 trillion to R436.5 trillion (RM60.8bil to RM126bil) over the same period. — The Jakarta Post/ANN

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