Health Care Reform

Health is one of the most important components of attention in the social security system. In Act No. 23 of 1992 on Health stated that the government develop, nurture and encourage the implementation of health care financing which is done praupaya. The meaning of praupaya is financing fees that were paid in advance for a certain period. Health care is meant is a series of efforts to provide health coverage for participants and consists of various types and health service activities that are improving health, prevention and cure diseases (Ghufron, 200). Health care efforts include basic health care are required to follow.

Health sector reform is no longer a new language. It's just that the agenda needs to be returned as a basis for further development. If simplified, the health reform agenda forward will be more public participation in formulating and conducting health aspects with minimal government intervention. Empowering communities to measure the success and interest of the poor become its universality acceptance requirements.
Gunawan Setiadi, a doctor and a master's in health, revealed some reasons why people can organize their health, and better than the government, among others:
(a) greater public commitment than paid employees;
(b) more people understand the problem itself;
(c) the community can solve problems, whereas professional / government simply provide services;
(d) the public is more flexible and creative;
(e) communities are able to provide cheaper services; and
(f) standards of behavior more effectively enforced by the community than bureaucrats or health professional.
The views on top appears to be reasonable enough to see the work ethic of the low tendency of bureaucrats and health professionals for this. It is time for the health organization initiated by the community itself, so the meaning of healthy living into a new culture, wherein up trust, respect for the rights of life and norms menyuburnya other humanitarian. Model-based health organization empowerment (empowerment) must be arranged in a rational way by as much as possible to involve all relevant stakeholders.
Thus, health development priorities as far as possible is more directed to the poor - the majority of their number and have many rights taken away for this. For that, the target of government subsidies in the health sector needs to sharpen the road include:
First, increase the budget for health programs related to the many poor people. For example infectious disease eradication programs, services, maternal and child health and nutrition.
Until now, as a developing country Indonesia is still faced with the problem, especially the limited access of the poor to quality health services and affordable. A study conducted by Thabrani (2005) states that 10 percent of wealthy people in Indonesia have access to health facilities in 12 times greater diandingkan 10 percent of the poor. While out of pocket expenditure is regressive, so the added weight to the cost burden on the responsibility of low-income communities.
Exemption fees for services in health centers in some areas and city districts, it did not increase the poor's access to health services. Research conducted by Susilowati (2004) found that access was more frequently used by large urban population (34.4%) compared with rural residents (26.9%). While in fact the most vulnerable groups to health care in rural areas (25.2%) than urban (17.7%). This means that injustices have occurred in health care financing as a government subsidy enjoyed by the people actually capable of.
Although the government has endeavored to develop various public health programs, increased investment there is the health service, improving service quality, decentralized health system, but public access to health services remains a major problem contributing to poverty. The main cause of this whole problem lies in the limited public access to health insurance system. The question now is how far health and social security is understood as a tool and prerequisite for overcoming the problem of poverty, economic growth and development and the extent to which this issue was held in the policy effective and coherent.

Health Insurance Policy in Indonesia
In the Universal Declaration of Human Rights, declared health a fundamental human right. It required a system that can guarantee the fulfillment of these basic rights. Regarding health insurance in the international world has been set in the UN Declaration on Human Rights dated December 10, 1948 concerning the health and welfare rights, health insurance, disability and old age. Health insurance is also regulated in the ILO Convention No.102 thn 1952. In Indonesia, Health insurance mandated by the 1945 changes in Article 28H Paragraph (1) which states that "Everyone has the right to live in physical and spiritual welfare, residence, and a good environment and healthy and are entitled to health services". Furthermore, in Article 28H Paragraph (3) confirmed again that "Every person has the right to social security in order to develop oneself fully as a dignified human being". As a form of implementation of the mandate of the 1945 Constitution, in 2001, through TAP MPR MPR No.X/MPR/2001 assigned to the President of Indonesia to establish the National Social Security System. On October 19, 2004, the Indonesian government finally set the Law No.40 of 2004 on National Social Security System.
In the Navigation Act, the social security system was built to be able to overcome the problems that can cause people to be poor such as sickness, accident, death, old age, retirement and disability. This system is also built to guarantee the basic living needs and to promote the health and social welfare. Unfortunately, the articles in the Navigation Act is not fully able to reach people who become poor because of loss of jobs or people with social welfare issues.
The implementation of social security has long been a part of real community life in local communities. Most local communities are familiar with the term rice barns, jimpitan, fees and social gathering as a way of managing social security on a small scale. but the state has a very big role to influence the availability of well-being. The role of this country due to: (1) the State has the capacity to determine the policy, which will affect the service (c / expenditure policies). State could decide who will be allowed to become a provider or not, determine their qualifications, determine how the service delivery mechanisms and regulate the quality and quantity of service., (2) The state may participate directly in the provision of services and benefits, (3) the State can play a role in planning and oversee service delivery, (4) The State can also play a role in providing direct assistance, provide fiscal support and subsidies (Thabrani, 2005).
In Act No.6 of 1974 on Basic Provisions of Social Welfare, development in the field of social welfare embodied in the government efforts that include:
1. social assistance to citizens of both individuals and groups who have lost their social roles or become victims of disasters, whether natural or other causes.
2. Social welfare standard maintenance through the implementation of a social security system,
3. Guidance, training and social rehabilitation including peyaluran into the community to citizens of the affected their ability to sustain life.
4. Development and social counseling.
But according to the identification Lindenthal (2004) the general characteristics of the social security system developed in Indonesia are:
• limited in scope and only serve minority populations, namely civil servants, armed forces and a small part of the private sector.
• Dependence on family and community in providing informal social protection is very high
. • a very limited dependence on the employer / company due to the inability of labor laws to accommodate the needs of social security for workers.
• Options are limited to social security for workers in the private sector
• Social benefits package that is relatively more comprehensive for civil servants and armed forces
• social benefits (social assitance / services) is not sufficient for poor people where the level of leakage and very high administrative costs.
• public health system is not adequately funded resulting in the inability to provide public services are also inadequate.