Being Poor and Needing Medical Care In Indonesia

fastpitch17

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Something I have been watching now for 2 months.

Housekeeper's son falls ill with difficulty breathing and fever. Second day she takes to Puskesmas since he has BPJS. Only sees a nurse who gives her some pills and sends her on her way. 3 days later, no improvement. My wife tells her to go back to Puskesmas and insist on seeing a doctor. She does but is told no doctor available and gets different pills from a nurse. Son does get to feeling better but weak.

A week later comes back again and breathing is more diffecult. No one else, her or daughter are ill. Again, goes back to Puskesmas and told them they were staying right there until he sees a doctor. Finally, they did, some 6 hours later. Doctor checks him over. Yep, he is sick so here are some pills to fix him up. Referral to a clinic refused.

Up and down sick for weeks after. Looks to be losing weight and doesn't have much appetite. 2 more trips to Puskesmas with no results.

2 nights ago, started bleeding from ears and nose. Housekeeper said enough is enough and called an ambulance and went to the hospital. Run a bunch of test and told her he has bleeding from his nose and ears, wet lung, (fluid in lung) and one kidney has failed. From what she relayed to us is that the failed kidney is the reason for all his problems and the fact that he only weighs 10 kilos is because of her. He's not very big for a 9 year old but 22 kilos is very low.

Housekeeper was informed that son would need to stay in the hospital for 3 months and receive dialysis every 2 weeks. Of course, BPJS will cover the hospital stay but not the dialysis. They want 6 juta up front.

I instructed her to get answers as to why there is bleeding from nose and ears. I have never heard of kidneys causing this problem. Infection, injury, and a few diseases yes. Also, why the fluid in the lung? Again, no association with kidneys.

I also told her to find out the GFR number from his blood test and gave her a list of what the various levels would indicate. I told her to ask what happens after 3 months? If the kidney has failed then if the doctor wants to keep treating she would be better off removing the kidney now which the surgery would be covered by BPJS.

The hospital they have the boy in is the catch all for poorer people. I visited it once and swore I would never go back inside. Dirty as can be. Google Maps has hundreds of complaints and it has a lot of deaths. While no one told her he son may die, which he just may, she is preparing for that to happen. Surprising thing, she is blaming Allah. Never thought I would here that from her of all people.

All we can do right now is give her encouragement and try to fill in the science related blanks. Hopefully, everything works out for her son. They are really great people, a single mom of 2 children. Ex husband to be refuses to give assistance unless she sells her house and gives him half. She aint stupid. That is another story though.
 
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SamR

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All we can do right now is give her encouragement and try to fill in the science related blanks. Hopefully, everything works out for her son.
This is the best thing that can be done right now. Hopefully the fact that she's seeking medical treatment despite a health system that is far from perfect will work out well from her son. I can tell you it's even more distressing if the person that requires the health treatment belongs to the "I don't like going to doctors" crowd and when they finally do, it's too late.

It is depressing indeed. To the point that "Orang miskin dilarang sakit" has become an unofficial proverb in these parts of the world.
 

Hawk256

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Is this a widespread problem with BPJS? My wife has it and went to the doctor complaining of shoulder pain. They did an xray which led to an MRI and then a follow up CT scan all within a couple of weeks. Turns out she has torn ligaments and they are ready to do the surgery when she is. It seems odd that she gets such good treatment from a relatively minor issue and the same insurance is basically letting someone die. Very strange.
 

fastpitch17

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Is this a widespread problem with BPJS? My wife has it and went to the doctor complaining of shoulder pain. They did an xray which led to an MRI and then a follow up CT scan all within a couple of weeks. Turns out she has torn ligaments and they are ready to do the surgery when she is. It seems odd that she gets such good treatment from a relatively minor issue and the same insurance is basically letting someone die. Very strange.
I think it has a lot to do with your class and the facility being tested/treated at. Like I said, this particular hospital is the cities chosen facility for the lower class individuals. Dirty as can be and my guess is the medical employees are the kast in class type. Then again, I and my wife have BPJS with the idea it is just used for energencies. I had one and the follow up visit after hospitalization I was told directly by the doctor that I should come in non BPJS so he could get paid more. Ass was 2 hours late.

Sure, they can just let someone die. Still get paid the same and patients have no recourse if doctors neglect their patient. I believe that if you have a complaint you need to file a police report and the one time that I seen that happen the doctor in question got off because his doctor coworkers said they would quit. They have no responsibility what so ever.

I am hoping something can be done for the young man but I fear ge has doctors that takk just to hear themselves talk. To me, it doesn't sound promising with the diognosis and treatment ordered. Hopefully, I am wrong.
 

MamangDudul

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I hope he will be fine and gets the treatment he needs.

Different places have different situations I guess. In Batam we can even choose the hospital, but the standard is probably a bit higher here. I have class 3, so by that logic I should be in the worst hospital. That's not how it actually works, but of course I have no illusions about it happening. It works pretty well in Batam, even for annual check ups. I guess Jakarta has too many people.

I would advice to make very sure what are your rights and what not and what BPJS pays and what not. If you only go along with what someone tells you (no matter if at the hospital or Puskesmas) then you might be denied your right. I deleted my first post cause I didn't want to make false accusations. All Iam saying is, they try to keep their costs as low as possible and some things may even violate your actual rights. So people have to make sure what are their rights in such cases and be "loud" about it..
Ps:
For example the father of my wife's friend is on dialysis and BPJS pays it. So again, Iam not sure about every case but people have to make sure what's up.
 
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Hawk256

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I think it has a lot to do with your class and the facility being tested/treated at. Like I said, this particular hospital is the cities chosen facility for the lower class individuals. Dirty as can be and my guess is the medical employees are the kast in class type. Then again, I and my wife have BPJS with the idea it is just used for energencies. I had one and the follow up visit after hospitalization I was told directly by the doctor that I should come in non BPJS so he could get paid more. Ass was 2 hours late.

Sure, they can just let someone die. Still get paid the same and patients have no recourse if doctors neglect their patient. I believe that if you have a complaint you need to file a police report and the one time that I seen that happen the doctor in question got off because his doctor coworkers said they would quit. They have no responsibility what so ever.

I am hoping something can be done for the young man but I fear ge has doctors that takk just to hear themselves talk. To me, it doesn't sound promising with the diognosis and treatment ordered. Hopefully, I am wrong.
Overall sounds like a strike against socialized medical care. I have to ask though, how do they determine your "class"?
 

MamangDudul

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Overall sounds like a strike against socialized medical care. I have to ask though, how do they determine your "class"?
BPJS has 3 classes, class 1 is the most expensive (but still not that expensive compared with non-gov insurances. I think class 1 is " Only" 150 ribu per month, per person). The reason why many people don't choose class 1 is because everyone on your KK has to have the same class, of course the amount of money being paid every month stacks up.

Officially all classes get the same quality of medical treatment, only the rooms are different. And the higher your class the more " "Extra" benefits you get. For example, every 1 or 2 years (i forgot) you can get new glasses (not fully paid though, only subsidies). Class 1 gets a higher subsidy for new glasses.

Still medical treatment is the same.
 
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mas_dam

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I think class 1 is " Only" 150 ribu per month, per person

For employees:
5% of salary, the calculation is capped at max. 12,000,000 IDR (this amount will surely increase in future). That makes 600,000 IDR for the higher salaries and around 220,000 IDR on Jakarta minimum wage and covers dependents.
 

MamangDudul

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For employees:
5% of salary, the calculation is capped at max. 12,000,000 IDR (this amount will surely increase in future). That makes 600,000 IDR for the higher salaries and around 220,000 IDR on Jakarta minimum wage and covers dependents.
Right and thanks for the reminder. That depends on her situation. If she is a employee with a contract then this applys. Although this form of BPJS should at least partly be paid by her employer.
Everything else goes into BPJS Kesehatan and there class 1 is 150 ribu.
I dont know about her situation. Thats why the most important advice is to figure out how it works and whar are your rights. What gets paid and what not. No matter how much she pays or what form of BPJS she has, you should have the same treatment and rights. Except for rooms and maybe a few other "extras'.
Ps: iam also no expert on this and maybe Iam missing something here. Thats why people have to check directly with BPJS if they are not sure.

For example this came out with a quick search only:
 

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fastpitch17

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Overall sounds like a strike against socialized medical care. I have to ask though, how do they determine your "class"?
Not sure if it's the system that fails some or the personnel the system utilizes to maintain it. To me it more looks like some of the doctors involved steer patients into things they have to pay cash for at a higher rate to oad their personal pockets. I have talked with a number of people who told me their doctors have steered them or tried to steer them in stopping clinic visits and visit them at their private practices where the cost is much higher and in cash.

I question the professionalism of many of the doctors I have come across. If I or my wife visit a doctor, I immediately cross check the diognosis and any medications received. I have received perscriptions for medications that were harmful if taken while I continued other medication. Other medication that the doctor had a list of right in front of him. Doctors don't seem to look at causes and key on effect. Oh, you have this happening to your body, we will give you this to make you feel better. Ask what causes that and they are clueless.

My housekeepers was told by her doctor that her son shouldn't attend school because he will have no need for it. He wouldn't clarify his reasoning for that assessment.

BPJS has three classes. Class 3 is what the low income normally choose since it is the cheapest. While the care is supposed to be the same for all classes, the doctors get paid higher amounts for the higher classes. As do the approved facilities.
 

Nimbus

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Overall sounds like a strike against socialized medical care. I have to ask though, how do they determine your "class"?
I still remember the alternative before BPJS, which was “pay upfront or die”.

Socialized medicine isn’t perfect, but at least you have a chance fighting a bureaucracy, like squatting in the facility or going to social media. Back then when you didn’t have several million Rupiahs they required, you were SOL.
 

pantaiema

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The things were much worse before BPJS was introduced. In the past you might get rejected if you could not pay in advance in term of deposit. Certainly many low income family could not effort medical treatment paying by themselves. But now by paying less than IDR100,000 which work like an insurance, people could get expensive medical treatment, major operation that might cost a few hundred millions rupiahs.

I personally heard a few good stories of people get hospitalised and treatment in ICU. Some people are getting long term medication. All paid by BPJS. The cost might close to hundred of million rupiahs which many Indonesian might not be able to effort it.

BPJS might not be perfect if you compare it with social heath security in the developed Wold, especially in Europe with its free healthcare system. But at least it is much better then what it used to be. In the past when a person got accident on the street, and in need of hospitalisation, not many people would dare to approach him. Once you take care of him, take him to a hospital the burden will be on your shoulders. You would be asked who would be paying for the treatment.

What this family has gone through might be an isolated incident ???
These Son and mum are fighters. Wish them all the best and hope the son to get better and recover soon.
 
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fastpitch17

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Mother was filled in by nurse at the hospital who actually sat down and explained things. She explained that there was one failed kidney and ine good kidney. Yes, it can and probably should be removed but it would have to be at a different hospital. Said if that was their wish she would help with a transfer. Family feels it may be best if they would have to pay for dialisis. Nurse explained that no, while the doctor who told the mother 6 juta isnincorrect and that according to the hospital records it will be 2.5 juta. This because BPJS had said they would not cover that.

Mother doesn't understand all the BPJS stuff so my wife sent her to the BPJS office to sit with someone who can explain it all converning her circumstance. She was told that the Class 3 is so overwhelmed that the cash paid in is used up and they are taking some from Class 2 and 1. My understanding isnthat it all goes into one kitty and paid out where needed, but that is my take on it. Class 2 and 1 has always supported Class 3. According to BPJS the mother has reached a point where they don't pay all because, her son has had so many doctor visits that she has used up so much funds. They will cover the surgery at the other hospital. My wife asked her if she told them that the funds were used up because she had taken her son to Puskesmas so many times and nothing ever being done and getting no referrals to a hospital and never seeing an actual doctor, just nurses. No, she didn't mention that to her.

The lung us better now. It was drained and told it must be drained every 2 years. No actual name for the problem or treatment, just drain the green stuff out every 2 years.

The bleeding from nose and ears they say was caused by a bug in the ear and dying. Infection set in. Removed, treated and fixed.

Hospital will transfer once she pays the 2.5 juta and she said she was going there to pay Saturday afternoon. Surgery is scheduled for today, Sunday. We shall see how it all goes.
 

fastpitch17

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My beef with the BPJS program all lies in it's management and structure. Right now there are 3 classes. The only difference it seems is that the higher the class the better room if an inpatient. Double room to ward type. Class 1 is allowed a Rp 200,000 coverage for new glasses. I feel a better program is having actual different levels of care and what is cared for at different price points. More like an insurance. If you want basic care, you pay for basic care, if you want major medical protection, you pay for it. Something like maybe 5 different catagories.

Management has failed in there process of patients at the Puskesmas's. The procedure they advertise is that you go to the Piskesmas, get evaluated, see the doctor, either get referral to clinic or get treatment there if any treatment is needed. Unfortunantly, not doesn't seem to be what us practiced. You go in, see a nurse, get some pills from the nurse, and are sent on your way because most times of the day there is no actual doctor available. Where I come from, a nurse prescribing or handing out medications without a doctor would lose their job and possibly have charges brought against them. One reason why there are so many people at the Puskesmas is they just don't fix the patients so they have to keep coming back.

We have BPJS but will only use it in an emergency. We refuse to go into a Puskesmas to get a referral. We can pay cash for a doctors visit and any lab and medication so we do. Emergencies we would go directly to an emergency room which is allowed under BPJS.

Class 1 and 2 are not big users of BPJS. The system is primarily Class 3. Why not, it's a lot cheaper and you are supposed to get the same care. You just have to go into a ward if admitted or pay for a room upgrade which for some reason hospitals seem to always say the room you qualify for are full so you need to upgrade or wait. Looking at Puskesmas and many times clinic clients, there seem to be a lot of people there with problems they could have stayed home for. OTC medication would do them good. No, the have BPJS and will seek medical care for the most minor of things. Scratched finger, see the doctor. Headache, see the doctor. Sniffles, see the doctor. Maybe BPJS should use some of their funds for a better education program to teach people some self care. Doing that could reduce the traffic at Puskesmas.

They are planning to put a single rate for all BPJS members. This will reduce the Class 1 rates for sure. Raise the Class 3 rates. While this class is what is carried by the low income evidently it has been decided that the government will cover partially to fully this amount. As for class 2 and 1, the rooms will be downgraded they are allowed so the hospitals love the idea of that because they know they will get more cash for all the upgrades.
 

MamangDudul

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The things were much worse before BPJS was introduced. In the past you might get rejected if you could not pay in advance in term of deposit. Certainly many low income family could not effort medical treatment paying by themselves. But now by paying less than IDR100,000 which work like an insurance, people could get expensive medical treatment, major operation that might cost a few hundred millions rupiahs.

I personally heard a few good stories of people get hospitalised and treatment in ICU. Some people are getting long term medication. All paid by BPJS. The cost might close to hundred of million rupiahs which many Indonesian might not be able to effort it.

BPJS might not be perfect if you compare it with social heath security in the developed Wold, especially in Europe with its free healthcare system. But at least it is much better then what it used to be. In the past when a person got accident on the street, and in need of hospitalisation, not many people would dare to approach him. Once you take care of him, take him to a hospital the burden will be on your shoulders. You would be asked who would be paying for the treatment.

What this family has gone through might be an isolated incident ???
These Son and mum are fighters. Wish them all the best and hope the son to get better and recover soon.
I agree with what you said, only would like to add that most health systems in Europe are not free. A part of your salary gets cut for it, your boss pays the other part. For example my cut was 150€ a month and not 150 ribu (yeah, for employees it's more of course)😉. If you have no job the government pays for you, with taxpayers money of course(that comes from people who actually pay into the health system). Sorry, I didn't mean to be a smartass but more or less it works almost the same way as in Indonesia, it only works better and with higher quality and doesn't have too many things to jump over. Something we might also see in Indonesia in the next 10-20 years.
 
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MamangDudul

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My beef with the BPJS program all lies in it's management and structure. Right now there are 3 classes. The only difference it seems is that the higher the class the better room if an inpatient. Double room to ward type. Class 1 is allowed a Rp 200,000 coverage for new glasses. I feel a better program is having actual different levels of care and what is cared for at different price points. More like an insurance. If you want basic care, you pay for basic care, if you want major medical protection, you pay for it. Something like maybe 5 different catagories.
In my opinion this is not how a social health system should work. Why do you need BPJS then? You can get private insurance anytime or just pay for your bills as you do it.

What is basic healthcare then and what does it cost? A few pills and be send home to die? Such a system will only lead to the same conditions we already had.

A good social healthcare is a balancing act that is hard to pull off in a country with this many people, relatively low income but high medical costs. Let's see how far we get in the next decades.
 
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pantaiema

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I agree with what you said, only would like to add that most health systems in Europe are not free. A part of your salary gets cut for it, your boss pays the other part. For example my cut was 150€ a month and not 150 ribu (yeah, for employees it's more of course)😉. If you have no job the government pays for you, with taxpayers money of course(that comes from people who actually pay into the health system). Sorry, I didn't mean to be a smartass but more or less it works almost the same way as in Indonesia, it only works better and with higher quality and doesn't have too many things to jump over. Something we might also see in Indonesia in the next 10-20 years.
Well, I know the European and Developed World Healthcare and welfare System quite well. Some people never contribute (never pay a penny) in their whole-life yet they have the same right and treatment from the state when come to the State Healthcare.
Some people instead of contributing to social security, welfare system they even get paid from the state benefit system while never contribute a penny to the system in their entire life.
That is where I am referring to in my previous post when contrasting the Indonesian BPJS with developed world healthcare system. However BPJS in Indonesia is an improvement of the previous system.
 
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pantaiema

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My beef with the BPJS program all lies in it's management and structure.
BPJS system is collecting money and redistribute it back where it is needed. Other thing that need to be considered is the cultural element that rooted in Indonesian people who consider the collective money collected from public as the inheritance they inherit from their ancestors (their "engkong"). Just look at the case of Menara Jamsostek, Asabri, Jiwasraya, Century Bank, Bank Bali,etc. All of them have the same feature treating the money collected from public as the inheritance they inherit from their engkong. The regime changing might lead to lack of supervision to the system, lack of supervision on how the money collected from public have been or will be used.
But I think BPJS is less vulnerable than other forms of state insurances, pension schemes, public Banks as the money is not in the system for the prolonged duration of time, there is not much money left in the system each year.
 
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Nimbus

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I’m actually amazed that this single-payer insurance somewhat works in Indonesia. On paper I don’t see how the system can work, considering the number of people covered and the small premium collected. To be viable they have to raise the premium, but like every other government-controlled price in Indonesia, that tends to make people angry.

BPJS is an expansion of Askes, an insurance program mostly for gov’t employees. My parents aren’t thrilled because Askes used to give them more benefits, as they have paid into it their whole life. They think the current administration is a little too ambitious, at the cost of previous Askes payers.

I generally think that single payer insurance is the way to go, but the system has to collect enough money to be sustainable.
 

Samoerai

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I’m actually amazed that this single-payer insurance somewhat works in Indonesia. On paper I don’t see how the system can work, considering the number of people covered and the small premium collected. To be viable they have to raise the premium, but like every other government-controlled price in Indonesia, that tends to make people angry.

BPJS is an expansion of Askes, an insurance program mostly for gov’t employees. My parents aren’t thrilled because Askes used to give them more benefits, as they have paid into it their whole life. They think the current administration is a little too ambitious, at the cost of previous Askes payers.

I generally think that single payer insurance is the way to go, but the system has to collect enough money to be sustainable.
I heard that BPJS has already a debt of a couple of trillions Rupiah. Because of that BPJS is very slow in paying the bills of the hospitals. Or not able to pay the bills at all. That's why some (not all) hospitals and doctors are very reluctant in taking in and helping new patients.
 

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