Healthcare should be free… and fast.

the ER

I lost count of how many times I went to the hospital this year. I think I went there quite a lot more than before, for numerous reasons, but none of them were quite severe. One time, I went to a gynecologist because I had stopped having my period for months and got my uterus checked. Another time, I went to an internist twice because I had been struggling to eat and kept getting nauseous. Last week, I went to a clinic because I got hit by a motorbike. The doctor suggested that I get an X-ray by next week if I still feel pain in my hand and knee. And just yesterday, I twisted my knee and went to the ER to get it checked by an orthopedist.

We know that healthcare is expensive. However, in my country, there is a social security agency run by the government to provide universal healthcare to its citizens. It’s called the Social Security Agency of Health, or BPJS Kesehatan. If you’re a citizen, you must enroll in the membership in accordance with Article 14 of the BPJS Regulation, and then your healthcare needs can be provided by the government. However, employers and wealthier citizens are obliged to pay their own premiums. Basically, you can go to the doctor for free as long as you are registered with the BPJS program. If you choose not to pay for your own medical bills, the government will cover them. But if you choose to pay with private insurance or pay your own bills, well, the BPJS program won’t cover them. I don’t know much about the program, but at least that’s what I know, as I went to the hospital many times with different tracks this year.

The Bureaucracy…

So, in February, I went to a gynecologist because my period had stopped for months. I was advised to get it checked to know what was wrong. After I went back abroad, I wanted to get it checked as soon as possible, but I kind of had a problem with the insurance bureaucracy, I think. When I wanted to get it checked, I asked my parents to get it covered. Then my dad helped me with the bureaucracy. He told me that I had to go to the health facility so I could get the referral letter to see a gynecologist. So, in the morning, I went to the community health centre. I was in the queue for an hour, and then got my body checked, got asked about my condition, and then still had to wait to get my referral letter after that. I spent two hours waiting in there, I think. After I got called, I finally got my referral letter.

the community health centre

It’s that all? Of course not. I had just gotten the referral letter. Then I went to the hospital to see the gynecologist. I got enlisted with the BPJS program so I could get checked for free. I waited in another queue for hours. Literally, hours. So much time had been wasted just waiting in line. As much as I wanted to complain, I couldn’t complain much since I got the coverage. But still, it took hours to deal with the bureaucracy, and then I had to wait in line just to get checked. My mom said, “Well, that’s bureaucracy for you,” but seeing my family’s financial state as not rich, they prefer to wait in line for hours rather than cover the expensive bills, I suppose.

I waited for hours and hours. And then, the nurse called my name. And then my uterus got checked for barely a minute. The gynecologist didn’t ask me a single question about what could have led to my situation at the time. He just told me that my uterus was clean, healthy, and normal, and maybe it was just a hormone imbalance. He prescribed me one medicine and called it a day. As much as I was relieved by the answer, I was still pissed by how much of my time had been wasted when the consultation didn’t even take a minute. It basically took half of my day just to see the gynecologist and get my uterus checked. After I consumed the medicine, days later, I finally got a period then (ironically, as I’m writing this, my period is late now).

The Bureaucracy Hinders People from Getting Treatment

This is another case, but months later or so, I wanted to go to the dentist to get tartar removal by dental scaling. I’m pretty sure the BPJS program could cover it as well, but I was so sick of the bureaucracy. I didn’t want to waste my time being stuck in a queue. So I decided to go to the private clinic and paid my own bills for dental scaling. I felt better after I got my tartar removed, as I had never had tartar removal before. The price was also quite affordable. But then, the dentist noticed that four of my teeth had cavities. I was quite shocked, honestly, because I thought I had such nice teeth I wouldn’t even expect myself to have cavities, especially not plural. The dentist suggested that I get my teeth filled. Because I still had my money left at the time (I kind of miss it now), I agreed. I booked another session to get fillings.

I met the same dentist for a week or so, booked three or more sessions, from the dental scaling to the fillings. If we count it, it’s one million IDR to cover all of it. Yes, the fillings are quite expensive, especially if you have four cavities. Basically, one cavity could cost hundreds of thousands of IDR if you think about it. That’s quite a lot, especially if you’re not rich. I was grateful I did it, but I also wish it could be cheaper.

the tooth filling

I talked about it to my mom, she thought that I didn't need to get my teeth filled soon because it wasn’t urgent for her, but then I replied to her that I saw it as an investment in my own health, so my cavities wouldn’t get worse if I took care of them early. And then she told me that her tooth chipped, but she just left it as it was. I asked her why she didn’t get it treated, and she replied that it wasn’t urgent, not quite necessary, could be expensive, and she didn’t want to deal with the BPJS bureaucracy. So she didn’t get her tooth treated at all. The bureaucracy literally hinders people from seeking and getting healthcare.

Another time, I went out with my family. We had a conversation, and then it led to a conversation about a toothache. As I remember correctly, my dad had a toothache, and then I talked to him about the dentist I went to. Then he called me arrogant for seeing a dentist with my own bills instead of relying on the social agency. I don’t know if I wanted to criticize the healthcare accessibility for not being affordable for everyone, or my dad for being petty here.

The Private Track and Mental Health Accessibility

In August, I dealt with things, and it affected my digestive system, I think. I had been struggling to eat; I kept getting nauseous as I tried to eat something, even when I ate my favorite food. I couldn’t get anything into my body, I kept losing my appetite, and I vomited sometimes. As I thought this was bothering me, I decided to see a doctor. I went to the hospital, and my parents told me to use the insurance coverage. Because the system is reimbursed, I chose the private track, basically “pay my own bills,” and then the insurance covered it later.

As I walked into the third floor of the hospital building, where the line of people who chose the private track was, there were barely any people there. It’s quite spacious, totally different from the other building, where it’s full of people who chose the BPJS track. This hospital has two buildings: the first one focuses on patients with BPJS and the ICUs, I guess, while the other building focuses on patients who pay their own bills, I think. It’s kind of giving social inequality, honestly. People who choose to pay on their own don’t have to wait in line and can see the doctor as soon as possible. People who don’t pay on their own have no choice but to wait in line for hours just to get it checked for a minute. Maybe I’m still quite fortunate, but how about those patients who don’t have much free time, but then have no choice but to wait in line for hours to see a doctor? Maybe they have to work every single day to earn their daily income for a living, but then they have to empty their work schedule and spend an entire day just to see the doctor, as their body slowly deteriorates due to their sickness. Maybe the healthcare is free now, but they still have to sacrifice something else for it: their time.

When I got the consultation and told the internist about my sickness, she prescribed me a lot of medicine. As I went to the pharmacy, I was charged nearly two million IDR for the consultation fees and the medicine. That’s quite insane, honestly. Even though I got it reimbursed eventually, I still had to pay it on my own first. It was still quite shocking to me. The second time I went there, with a similar issue but with a different internist (because the last one wasn’t available), it was more affordable because the medicine prescribed wasn’t as much as the first one, but that came with a different diagnosis, so... But still, for the second one, I was charged for nearly one million IDR for the consultation fee and the medicine.

waiting for the consultation time

After I got a different diagnosis for my digestive system but was still facing similar issues — getting nauseous and struggling to eat — it made me think: maybe the pain isn’t physical, but mental. But I guess it’s still viewed as not important, or the treatment would be quite expensive, so I sought free counseling services, such as going to my lecturer — I’m a psychology student, so my lecturer basically holds a psychology title behind her name — or going to the counseling service provided by the campus.

The last time I went to counseling was a few days before my birthday. I didn’t feel much better, but I decided to stop anyway because I didn’t know what to talk about if I booked another session. My friends suggested that I seek counseling again as weeks went by, but it’s whatever, I guess.

Dealing with The Consequences of One’s Actions

I didn’t go to any healthcare units or counseling services in October, but then we never know what comes next. Last week, I got hit by a motorbike. The driver at fault was responsible for the accident and paid for my medical bills in the clinic. I didn’t have money, so it wasn’t my choice. But the thing was, the driver at fault was a motorbike ride-share driver, so he made a daily income for a living. When he got into this accident and didn’t run away, he kind of put his finances at risk. After he dealt with this whole thing, he went away with his untreated injuries. I’m not saying that he should’ve gotten away with this, but if the healthcare were free or affordable, he wouldn’t put his finances at risk just because he was dealing with the consequences of his actions.

The same goes for other “dealing with the consequences of one’s actions” things that come with physical effects, such as smoking, suicidal attempts, harming oneself, substance abuse, contraception, and so on. Do you know that the BPJS program won’t cover these? There was a rumour that the BPJS regulation wouldn’t cover treatment for illnesses caused by cigarettes. Although this rumor may seem untrue, there’s a lot of controversy regarding it. Some say they agree, so people would stop smoking, but others disagree because it could backfire on those who don’t smoke but still could get illnesses caused by cigarette smoke, or passive smokers. How does the government decide which ones get the medical coverage if they could get the same illness, whether one’s an active or passive smoker? I think any regulation that emphasizes cutting one’s actions entirely won’t make people stop doing it, even if it’s unhealthy or harmful.

There’s a guy who is an active smoker who was asked about what he thinks of the rumored regulation that won’t cover illnesses caused by cigarettes. He said he would just let it be if that happened, even though he is a beneficiary of the subsidized premium (PBI), which means that he can’t pay his own medical bills and needs the coverage entirely from the government. Even so, he didn’t say he would stop smoking if the regulation were true. He said it’s hard to stop because he’s addicted to it. This proves the point that this regulation won’t stop people from cutting off their unhealthy habits or self-harming behaviors. More so, it could lead people into desperation as they’re being punished for their actions and can’t get out of it due to a lack of resources and finances, which could deteriorate the whole situation.

I went to the Health Psychology class, and there was a guest lecture who talked about the lack of accessibility and resources in healthcare units in the city. The conversation led to the BPJS regulation. I was quite shocked when I found out that the BPJS program won’t cover the treatment bills for illnesses or injuries caused by self-harm or suicide attempts. It’s quite depressing if you think about it. Imagine if you’re going through a lot, and then you wanted to end your own life by harming yourself, but it doesn’t end you. It leads you to the hospital and the medical bills, as the government won’t cover them. And then you found out that you’re not dead, but you feel like your life is so much worse now that you’re charged with medical bills. Imagine if you have no money, resources, or safety net to help you figure it out. As if you weren’t in these shoes by thinking you wouldn’t do this, imagine it happened to you, and you didn’t expect it to lead this way. Maybe you expected yourself to be dead by then, instead of being charged with medical bills. Maybe you went through something due to a lack of finances, which led to the attempt; we never know. But it could happen to anyone, so I find it quite depressing.

i twisted my knee

I twisted my left knee twice this year, and everyone suspects that it has something to do with my habit of wearing my heeled boots every single day. I guess they were right. I should’ve learned my lesson by then, but I really love the boots. I see them as my signature style. But then my legs have grown tired from serving looks every single day. But that doesn’t mean I should be punished for twisting my knee or that I don’t deserve to get my healthcare rights. The same goes for others who deal with the consequences of their actions that come with physical effects.

I twisted my left knee just yesterday, and my mom took me to the ER so I could get immediate treatment. However, because my mom said she had quite a lot of expenses, she decided to take the BPJS track. When I entered the ER room, they checked my condition, asked my name and age, and the doctor referred me to an orthopedist to get an X-ray. I agreed. Then it took them hours just so I could get my knee checked. I waited in line for hours. So much time was wasted, and I felt unproductive because I couldn’t do my assignments. I could barely walk, so I couldn’t just cancel it and go home.

I just waited there for hours and hours. I didn’t bring my unfinished novel that I haven’t read in weeks — another regret. I brought a book I borrowed from the campus library. I decided to read it as hoping I could do something that could bring some progress for my thesis, even though I was in the hospital. After the nurse called my name, she took me to the X-ray room. It just took a few minutes there, I guess. After that, I still had to wait for the medicine for hours. God, so much time was wasted, and I couldn’t do my assignment there. After my mom went to the pharmacy, I got one medicine containing six tablets, and it was just painkillers. I stayed in the hospital for four hours just to get an X-ray and painkillers. Well, I can’t complain much since it’s free, but I wish I didn’t have to sacrifice that much time for it.

I can’t imagine what happens to those whose lives are at risk, and their illnesses put their lives at greater risk, such as a financial or time crisis. Maybe they don’t even have the money to cover their own medical bills, so they have no choice but to let the government cover them. Maybe they don’t have enough time to see a doctor, but they decided to take a day off because their condition has worsened their ability to function. Maybe they don’t have enough choice and just have to go with it.

While it’s nice that this program helped many people in need, I still think it’s open to improvement. Healthcare should be free, and I think the government has already taken note. But I think it should be accessible and fast as well. Maybe it has something to do with a lack of resources that came along with it, such as health workers and doctors. I hope it can be better for the greater good, for me, and for everyone in need. Everyone deserves healthcare rights. I hope it’s accessible, and people won’t have to sacrifice a large amount of resources to get their rights.