Can a Hospital Refuse Emergency Services for Patients Without Insurance or Inability to Pay?

Question:

If a patient in an emergency situation comes to the hospital but does not have insurance (BPJS/Insurance) or cannot afford treatment, can the hospital refuse services?

(Andina***, 089*****)

Answer:

1. To answer this question, it is necessary to first understand the definition of an emergency in the context of Indonesian health law. Based on Article 1, number 2 of the Minister of Health Regulation Number 47 of 2018 concerning Emergency Services in Health Care Facilities, an emergency is a clinical condition that requires immediate treatment to save a life or prevent disability. Therefore, patients in an emergency situation are required to receive medical services without administrative or financial barriers.
2. This is emphasized in Article 29 paragraph (1) letter f of Law Number 44 of 2009 concerning Hospitals, which requires hospitals to provide emergency services to patients according to their service capabilities. That further explained in Article 29 paragraph (1) that emergency services are provided without asking for advance payment. This is in line with Health Law Number 16 of 2003, namely Article 174 paragraph (2) which explains that in Emergency conditions, Health Service Facilities owned by the Central Government, Regional Governments, and/or the community are prohibited from refusing Patients and/or asking for advance payments and are prohibited from prioritizing all administrative matters that cause delays in Health Services.
3. That Article 438 paragraph (1) of the Hospital Law stipulates that the Head of Health Service Facilities, Medical Personnel, and/or Health Workers who do not provide first aid to Patients in Emergency conditions at Health Service Facilities as referred to in Article 174 and Article 275 paragraph (1) shall be punished with imprisonment of up to 2 (two) years or a maximum fine of Rp200,000,000.00 (two hundred million rupiah).
4. The principle of salus aegroti suprema lex (patient safety is the supreme law) affirms the obligation of healthcare workers and hospitals to prioritize saving lives over administrative considerations. The public’s right to healthcare services is also a human right under Article 28H paragraph (1) of the 1945 Constitution and Article 4 in conjunction with Article 5 of the Health Law.
5. After the emergency phase has been resolved, the hospital may verify insurance claims (BPJS/insurance), assist with JKN membership management if eligible, coordinate with the hospital’s social services/CSR department, or collect follow-up care fees based on an agreement. This mechanism ensures patient safety is protected and the hospital’s right to financing is maintained.
6. Hospitals are not legally permitted to refuse emergency care for reasons of lack of financial security or inability to pay. Assistance must be provided without a down payment, and refusal of care can result in criminal, administrative, ethical, and civil consequences.

This Legal Opinion is presented based on the limited initial information we have received. For further details, please schedule a consultation with our lawyer.