health insurance has not been evenly

for long-term protection for all Indonesian people are protected, the implementation of the National Social Security System (Navigation) are encouraged to be accelerated.

Similarly, the opinion of some observers red thread related to the performance of government health health field for one year, especially Jamkesmas program. Assurance is one of government's policies put forward. Coverage Jamkesmas ie 76.4 million people with a budget of Rp 5.1 trillion.

Prof Gani Ascobat of the Center for Economic Studies and Health Policy School of Public Health, University of Indonesia, last weekend, said the spirit Jamkesmas to provide protection for the poor is right, considering the 45 Constitution which mandates the poor and people can not afford the responsibility of the state. However, the service alone is not sufficient Jamkesmas. Governments should also ensure the availability of health care itself.

"Residents in remote areas and that there are no doctors and health facilities, access to health services difficult. They are difficult to use his Jamkesmas card and not protected. Particularly those outside Java, "he said. For example, about 20 percent of 8000's there was no doctor's clinic (Kompas, 10/5/2010).

Health observer and former Chairman of the Indonesian Doctors Association Kartono Mohamad said, it is difficult to assess whether successful or not Jamkesmas. "Enough of populism, yes," he said. The amount of money to JAMKESNAS continue to rise. However, targeting accuracy and accuracy of data collection is still questionable. "Still no news of poor people declined in the hospital," he said.

He looked at each other, the Ministry of Health needs to make a special audit Jamkesmas. Not only aspect of the truth of the use of funds and verification, but also the impact of treated patients related to quality of care.

Ade Irawan of the Division of Public Service Monitoring Indonesia Corruption Watch said, should not be managed Jamkesmas Ministry of Health as prone to corruption. "Ideally, managed by another party. Ministry of Health overseeing implementation, "he said.

Accelerate SJSN Ascobat said, if the government wants all citizens protected, the answer lies in the implementation of the National Social Security System which includes health insurance.

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Unreached Poor Citizens Insurance

Although the ceiling of public health insurance in North Sumatra far exceeds the number of poor people, in reality there are still poor people who are not affordable health insurance system. One of them experienced Mulyadi, a resident of Medan, Jalan Masjid Taufik, who are stuck in one hospital in Medan until now, because their families can not afford the operation cost.

Mulyadi, children aged 1.5 years, on Wednesday last week underwent a hernia operation at the hospital. Operation child and Sartini Sali pair will cost up to Rp 3.5 million. But because of Sali and Sartini unable to pay for hospital costs and did not have a card poor family as one of the requirements of public health insurance membership, Mulyadi until now still stuck in the hospital.

According to one neighbor pairs Sali-Sartini, Anton Panggabean, the family is a true one of a poor family in Medan.

"Her house is on the edge of the road, but just plot-plot inhabited by many families, one spouse Sali and Sartini. They are really poor family. But unfortunately there is no assistance from government officials to take care of their health insurance. Including the head of the environment, "said Anton in Medan, on Wednesday (20/10).

Anton said, the neighbor-Sartini Sali family had tried to help as much as possible to cover medical expenses Mulyadi. It is still not enough to pay the hospital costs.

Not recorded

On the other hand, according to Head of North Sumatra Province Health Office Chandra Syafei, the limit of public health insurance (Assurance) funded from the state budget for the North Sumatra up to 4,124,247 people. "While the number of poor people in North Sumatra on Connecticut last census only 1.6 million inhabitants. It should do all the poor people in North Sumatra have been cover all, "he said.

Chandra acknowledged, it is possible there is the poor who are not properly recorded as participants Jamkesmas or jamkesda by local governments. As a result, there could be cases like Mulyadi, poor patients who are unable to pay the cost of hospital and remained in detention at the treating hospital.

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Immediately Realize Qualified Health Insurance

Government and Parliament are called upon to immediately realize the health insurance for the entire community with the standards and quality of similar services throughout Indonesia.

According to him, the government has been proactive enough to hold social security with diverse funding sources, namely from the state budget (for civil servants and members of the military / police) and private funds (employees and private companies).

According to the universal rule, required a minimum of five years so that everyone gets the same service and easy access to basic health services.

On the other hand, the Act also states SJSN Hotbonar does have some weaknesses, but should not be revised again today.

"If the revised when implemented," he said. The most important thing that needs to be done, he said, hasten the issuance of guidelines the Act, namely to Work Accident Insurance, Death Benefit, Old Age Security and Assurance of Health Services.

He also warns, experience of implementing social security reform in other parts of the world has never touched on the existing institutional change, but more on revamping the program to be more effective. "We must strive for social security for all citizens could be done," said Hotbonar.

Therefore, he considered necessary a very deep understanding about the legal form of Social Security Organizing Body (BPJS). "To my knowledge, there is no guardian shaped BPJS mandate. That is, government agencies (Government agency) and the corporation," said Hotbonar.

In terms of the program, what has been implemented judged good enough, just need to be increased at least in the range of services, benefits and quality services to its participants.

National Social Security System Act to justify the five social security programs that already exist. If, necessary additions, required on unemployment insurance (unemployment insurance). "But that's not a social security program. So is the housing collateral," said Hotbonar.

He considered, if you want to be the compulsory savings should ideally be used as housing savings civil servants and soldiers who had run well, although not optimal.

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Community Health Guarantee Not Enough

Trouble is, each area applying different patterns to provide health coverage for its citizens. There is a local government only guarantees the disease with specific diagnosis, there is also the only bear the cost of outpatient care of its citizens, and so forth. On the other hand, RSCM must continue to provide services appropriate health procedures.

"So, although local governments concerned patients bear only outpatient care, if patients need hospitalization, yes we hospitalization," said Eka. Due to this limited guarantee, the difference in cost is not paid by local governments be borne by the RSCM.

Every day, RSCM receive an average of 2,000 patients. Of that amount, most of the medical uses such as letters of guarantee Jamkesmas (27.61 percent), Health Service Assurance Poor Families (JPK Gakin) DKI Jakarta (38.79 percent), and health insurance (32.16 percent). Jamkesda Assurance Program and are paid directly by the government to the hospital. Every month, claims billing RSCM Jamkesmas Rp 6 billion and USD 9 billion to JPK Gakin.

In fact, there's more of patients who have difficulty medical expenses but does not have any warranty letter. Because the funds held is insufficient to pay the hospital, the patient was owed to the hospital. On average, each month the RSCM has receivables amounting to Rp 300 million from the patients who are unable to pay medical expenses.

Limited facilities

Inequality and health care facilities in the area becomes its own burden when the government appointed the RSCM as a national referral hospital.

The hospital was overwhelmed to receive the patient because the hospital in the area is not optimal in terms of health facilities and medical personnel. Many local hospitals are not able to treat patients despite the severity of illness was not too high.

According to the RSCM Director Akmal Taher, referral of patients who come to the RSCM most have a level of severity that is not too high. "It should not be too severe patients could be handled solely by local hospitals if adequate facilities," said Akmal.

Because patients come abundant while RSCM limited capacity, many patients who can not be served at the hospital. As an illustration, every day there are 30-40 patients in the Emergency Room waiting to be served.

To access the facility with a CT scan examination, the patient RSCM must wait an average of 1-2 weeks. "If at another hospital a CT scan only serve 10 patients per day, in the same tool RSCM forced to serve about 60 people per day," said Eka.

Guarantee in Jakarta

Unlike the national referral hospital, district general hospital in Jakarta, for example Tarakan Hospital, the implementation of the JPK Gakin found no obstacle.

According to the Head of Public Relations Theryoto Tarakan Hospital, all claims billing JPK Gakin fully borne by the city administration. Since the claim process until the withdrawal of funds took a month.

The obstacle, says Theryoto, is a matter of administration, especially for women who give birth. In order to get the facility JPK Gakin and certificate can not afford (SKTM), women who give birth must include a marriage license.

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Handling Children Paralyzed constrained Costs

Salam Doc, our second child, male aged 6 years by doctors convicted Cerebal Palsy. During this time we accept what the state of our children, but after a long time because we felt sorry for grown-development of not just like any other normal kid, he could not anything, day-to-day can only lie in bed, unable to speak can only be heard, we could not do anything because of limited economic problems  hit. How should we Doc ..?

Madlani, Cirebon

ANSWER:

CP or cereberal palsy is a condition where neuromotorik and sensory function and cognitive impaired children usually as a result of infectious sequelae in the brain before or because of congenital abnormalities from birth. This condition does carry a considerable impact, including reduced growth ability, his endurance and ability to eat / drink.

Management of the case of CP usually includes various aspects of prevention and supportive. Prevention of transmission of infectious diseases, especially respiratory infections, diarrhea, and supportive therapy with physiotherapy to train the muscles of his body in order to function optimally, the intensive interaction of other family members and so forth.

But managing it is to most people in costly, but it is not impossible can be done by parents at home with a referral from a doctor.

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Elegant girl is left Paralyzed

Point Fatmawati (13) citizens of the Village District Kenduren Wedung Demak Regency, Central Java is one of the millions of Indonesian children who do not obtain from the government health facilities as appropriate.

Due to limited funds, berparas lovely girl for years suffered paralysis and did not get medical treatment. He could only lie helplessly in bed. In fact, a young girl her age should have been in junior high school.

With his physical condition is weak, the poor girl could only receive a fate resigned. Almost impossible for him to go to school like other children in his village. To take care of themselves only, points can not do anything, because he must rely on help from others.

Since childhood, the daughter of the couple Muasmi (43) and Jambari (50) was allegedly already suffering from paralysis. Hands and feet can not function like normal people. In fact, the physical disruption that has affected other organs.

As a result, weak points can only lay helpless. At mealtimes, she must be fed. To simply watch television or look at the circumstances surrounding his house, had to be at the point of carrying his mother.

The poor girl can only look at the doings of his friends who were playing and joking. Her adolescence was spent against the paralysis which only knows how long will befall him.

According to the mother, Muasmi, the point seemed normal at birth like a baby in general. But the lapse of a few days later accompanied his son suffered symptoms of heat cramps and continued to cry. Muasmi was immediately checked into a local doctor. By doctors, Point diagnosed only ordinary fever.

Almost as long as six months old, never point the condition improves. And the havoc it finally came. At the age of one year, his friend was able to walk, but the point can not be anything including a crawl.

Even toddlers have also usinya went to walk and to this day. Various ways have been done to cure her child, either a doctor or a smart person, but to no avail.

"I go to traditional and the paranormal in Semarang, Jepara, Purwodadi but still like this, there are no signs of improving" he said.

Muasmi claim can only be resigned to the fate suffered by her daughter. His property was discharged for medical expenses first daughter, even now also accumulate debt.

To make ends meet and pay off his debts, her husband Jambari must earn a living until the East Timorese. Although flawed, fixed Muasmi menyanyangi eldest daughter, and treated the same as two younger siblings Irmawati (4) and Riskiah (2) which grows normally.

In the village Kenduren Demak district, cases of children paralyzed like Point was relatively quite a lot. According to the Village Head Kenduren, Muanam, this time at least there are 10 residents who have physical disabilities in their area.

There's even one family in Kenduren, in which two children suffered paralysis, namely Saefudin and Sabiatun, sons and daughters of Patriamah.

Muanam admitted, the village can not do much to help the fate of its citizens who suffered paralysis. He can only hope there are parties who terketuk his heart to help ease the burden of suffering citizens.

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