Free
Medical Program (Kartu Jakarta Sehat)
Not
a guarantee of the Community Health Status Improvement
By:
Muhammad Ali
- Free Services Program
is still a mainstay of electoral campaign
Incessant
free programs usually appear in the era of Indonesia political campaigns and
especially in a regional head election, those programs free services include:
free food, free education and free medical care, these activities take place
from a situational programs during the campaign to a post elections or the
realization of the promise of the campaign, in the other hand, meaning of “free”
in view of the public assumption is "no expense I spend" to get the
free goods or services.
The
term of "free" for goods and services in the social life of the
community is the fact that the transfer of financing. Community connoisseurs
free products or free services does not take money out of his own pocket but
there are others (individuals, private or government) funding, a simple example
such as groceries purchased by the organizers and given to the community, as
well as for medical services usually covered / funded by the government to be
paid to the hospital.
One
side we will see connoisseurs free public excitement and on the same time we
have also seen social righteousness form public / private providers of free
services, but behind it all there was a problem that often arise from programs
that smelled "free", especially the "treatment Free "is the
extent to which the quality of service from the service provider resulting from
claims procedures between hospitals and finance administrators sometimes result
in disruption of medical supplies in the hospital, and the question of
excessive use of the service recipients, people become hypersensitive to health
problems but not offset by the prevention of disease, in the science of health
insurance known as "moral hazard" that bad behavior arising from the
financing of the health system "not out of my pocket".
Cililitan Public Health Center (megapolitan.compas.com)
Pangkalan bun Kalimantan (antarafhoto.com)
Who
is the real and most obligated to pay for treatment? community itself or the
government? many local governments have argued that the obligation to bear the
medical expenses territory. However, it should be more emphasized the role of
the community to maintain their health, and even public health experts agree
that individuals should be responsible for the health, for the most dominant
factor affecting the health care but not the behavior of individuals to carry
out the concept of Healthy Living.
(madacutie.wordpres.com)
My
Experience while on duty in the office of Kelurahan (Kantor Lurah) at west
Jakarta City Government, I often encounter
citizens requesting to made Certificate of UnAbility to Pay (Surat Keterangan Tidak
Mampu/SKTM) for the treatment of their children to the health center,
ironically, a head of the family pleaded not afford (read: will not) pay for
his family to go to a public clinic (Puskesmas) which costs no more for 3 of
cigarettes, but was able to buy 3 boxes of cigarettes a day for him, That is a
concrete example of "moral hazard" of free medication program, maybe
this person believes that if he got illness then government must be responsible
for that.
Another
case when I see people not able to queue to buy “rice for the poor” (Beras
miskin/raskin) whose quality is sometimes not suitable for consumption because
of the smell of bug-infested that cost even Rp.1.600 / kgs, I noticed a father
who lined up to buy cheap rice while he smoked, where cigarette prices more expensive
than the price of 1 kilogram of rice with excellent quality.
The
next case is the lack of awareness in the prevention of diseases such as dengue
fever (DHF), local governments sometimes willing to provide a huge budget to
eliminate dengue treatment when it entered the category "Exceptional
Circumstances"(Kejadian Luar biasa/KLB), while Figures Free Flick (Angka Bebas
Jentik/ABJ) as a strong connected to DHF but lack of concern and sometimes have
no effective action by the Government, Even Government give an attention but is not accompanied by
adequate prevention portion of the budget.
dhiez.wordpress.com
azharmind.blogspot.com
As
a Public Health officer who work at Kelurahan office (kantor lurah) I always visit
to the DHF patient’s house and often find mosquito larvae in his house (in water
reservoirs),such as bath, flower vases, bottles, no fish ponds and stagnant
water around the home where mosquitoes lay their eggs as, those are the root
cause of the onset of DHF.
That's
a simple example which turns social programs should also consider their social
impact, especially on people's behavior, and the program should be able to
resolve the problems caused by source (upstream) instead of focusing on the
problems seen today (downstream), a program that over- rather aimed at the
welfare of the community is plunged society into a society that does not have
the independence to help themselves which makes it healthy or sick.
- Health Paradigm
The
Health concept of L.Blum Hendrick is still relevant to be applied. To achieve
good health requires a harmony in maintaining a healthy body. HL Blum explained
that there are four factors that affect people's health. The fourth factor consists
of lifestyle factors / behavior, environmental factors (social, economic,
political, cultural), health provider/health Services factors and heredity
factor (genetics). These four factors interact that affect the health of
individuals and the health of the community.
( syaidahtuddiniyah.blogspot.com )
Among
these factors, human behavior and environmental factors are the major
determinant influence on the health status of 30% for behavior factor and 45%
environmental factors while 20% of Health Services and is a descendant of the
smallest factor of 5%, of the concept is clear that the behavior of individuals
and more environmental influence on health than health services factor, and is
then a basic change in the concept of "sick paradigm " that health
efforts focused on the treatment of switching to the concept of "health
paradigm" that health efforts is seen as a measure to maintain and improve
the health of individual or society.
Unfortunately
in Indonesia, where the concept of health paradigm is already well understood
and agreed by health experts, but rather, in many areas of the hospital
paradigm used. Local government policy-oriented treatment, should such an
attempt has long been abandoned as financially in the long term detriment of
local finance. Is health experts not involved in the program?
Should
we look for answers as to “why the budget for the free treatment is increasing
every year ?”, even in one of the provincial budget (Jakarta) for the free
medical service for the poor to Spend money more than 500 billion just to treat,
then where is the success? What indicators of success? the growing number of
people sick? Increasing the amount of medical expenses portrait of the growing
number of people sick, and of course no matter how prepared this year's budget
will never be enough for next year, because there is no limit to the cost of
treatment.
Of
the various programs that are sorely lacking right as free or cheap rice and
medication without being accompanied by public awareness programs on the
importance of the role of the family in prevention and promote health result many people who are malnourished, the
cost of drugs to health centers and hospitals to increase, the treatment is not
rational (moral hazard provider ), environmental pollution and latent
corruption due to uncontrolled financial system.
