Where the rich get better and the poor stay poorly

Two decades ago, Indonesia's doctors used to charge according to what their patients could afford. But not now, says the president of the country's Medical Association, Dr Azrul Azwar.

'Of course we know that the cost of health is very expensive - but the high cost now is not real, it's because of malpractice. They [doctors] do what is not necessary,' he said.

'It may not be necessary to hospitalise people but they do it. We really get mad at that.' The problem is a symptom of Indonesia's growing wealth gap. According to official estimates, the poor and low-paid constitute about 90 per cent of the nation's 190 million people and the growing middle to upper classes 10 per cent.

Increasingly the needs of the two groups are coming into conflict, and health care is no exception. The problem is that the doctors, especially the good ones, go where the money is. For instance, a disproportionate number of doctors - 6,000 of a national total of 65,000 - work in Jakarta, Dr Azwar said.

Indonesia's health care achievements have been considerable. Little more than a decade ago, rural areas had few facilities - now there are 10,000 community health centres throughout the archipelago. These are manned by medical graduates who are required to do three years' government service.

But because of low wages, doctors quickly set up private practices, forcing more of the poor to use expensive non-government facilities, Dr Azwar said.