Zubaidah Nazeer – Straits Times Indonesia
Indonesia wants to improve medical services and access to medical insurance for its citizens, especially the poor, but the tight budget for health care means it will not happen overnight.
In the meantime, the Health Minister hopes that private investors – including foreigners who can now hold a bigger stake in specific hospital projects due to liberalized investment laws – will build more hospitals.
Dr Endang Rahayu Sedyaningsih told Reuters recently that she hoped at least a quarter of the beds in these hospitals would be reserved for poorer patients, with the central or provincial governments picking up the tab.
The Harvard-educated scientist said the free hospital treatment could cost 10 trillion rupiah (S$1.45 billion) a year. She admitted there were constraints in the Health Ministry’s budget of 26.2 trillion rupiah this year, although it was already a rise of 10 per cent from last year’s figure.
The health-care budget adds up to only 2.3 percent of Indonesia’s gross domestic product, lower than the 3.7 per cent in Thailand and 6 per cent in Vietnam.
The amount also pales in comparison to the 14 percent of government spending allocated for fuel and electricity subsidies that economists have urged the government to convert into direct cash subsidies for the poor.
Indonesian property firm Lippo Karawaci and the Mayapada Group are building hospitals in Indonesia, she said, and this can help solve some of the woes.
Beyond greater access to basic medical care, activists and politicians want the government to look into the quality of treatment, which they believe is necessary to help reduce the number of complaints against doctors or prevent malpractice claims.
Yuna Farhan, who is with a watchdog that tracks the government’s budget spending, said the small health-care budget has resulted in insufficient medical facilities and a severe shortage of qualified doctors, especially in public hospitals.
Dr Fahmi Idris, former chairman of the Indonesian Doctors Association, estimates there is only one doctor for every 4,000 people when ideally, he said, the ratio should be 1:2,500.
In addition to the severe shortage, complaints against doctors and reports of misdiagnosis or mistreatment by doctors have been making the headlines.
Last month, an eight-month-old baby girl lost her finger from an infection caused after doctors inserted an intravenous drip to reduce her high fever. The child’s parents have filed a police report and are suing the hospital in West Jakarta for 3.5 billion rupiah for malpractice.
Last December, independent film-makers released a documentary called The Conspiracy Of Silence, which focuses on three victims of alleged malpractice. One was a woman who lost her voice as a result of a botched surgery.
In another case in 2009, housewife Prita Mulyasari was wrongly diagnosed with dengue when all she had was mumps.She was later jailed and dragged into court when she complained publicly about hospital maltreatment
The medical council that looks into disciplinary issues said it had received a spike in complaints – 46 between January and October last year, up from 11 over the whole of 2007.
Indonesian Doctors Association chairman Prijo Sidipratomo said the council found that allegations of malpractice were sometimes prompted by a “lack of communication and the patients’ high expectations.”
“The perception of doctors in Indonesia is bad and patients don’t realize that complications can happen,” he said.
But activists claim the low number of complaints does not tell the full story. Sometimes patients are not interviewed by the council or are pressured to keep their case under wraps, noted Nurkholis Hidayat, director of Jakarta’s Legal Aid Foundation, which provides legal services to the poor. “We’ve had patients who have been intimidated by hospitals for taking on cases, or simply paid off to preserve the hospital’s good name.”
Legislator Nova Riyanti Yusuf, who sits on a parliamentary health-care commission, said better training for doctors should focus on communication skills, which would raise the standard of medical care. “We need our doctors to be trained to show empathy… and communicate better with their patients so they can forge a better relationship.”
The Health Ministry has said it will conduct a 100 billion rupiah nationwide survey of more than 10,000 medical centers to assess the level of health care before coming up with improvement schemes.
Reprinted courtesy of Straits Times Indonesia. To subscribe to Straits Times Indonesia and/or the Jakarta Globe call 2553 5055.