Doctors not immune to GATT

JAKARTA (JP): Indonesia's doctors should begin preparing themselves for greater competition from abroad, which is required under the General Agreement on Tariffs and Trade (GATT), Minister of Health Sujudi said yesterday.

The minister, himself a physician by training, prescribed introspection as a preparatory treatment for doctors as the era of free competition looms.

Sujudi said doctors should take a hard look at themselves. "We have to ask ourselves why patients here like to seek medical services overseas," he said yesterday.

"Patients want to know about the medicines they are told to take, and why they need surgery," he said after installing new second-echelon officials in the ministry. "Patients are getting more critical, and maybe they are finding services abroad more satisfactory."

"Medical staff must build the trust of their patients," he added.

The issue of greater foreign competition surfaced during a seminar on the impact of foreign investment in the health sector held by the Indonesian Medical Association (IDI) this week.

The association urged the government to weigh the advantages and the disadvantages of opening Indonesia's health sector to foreign investors, which is required under GATT.

Sujudi said the government advocated the use of local personnel, as far as possible, in the health sector.

He said that his ministry would be working together with the Ministry of Manpower to draw up new regulations on the employment of foreign medical personnel in the country.

The regulations would be ready before 2020, the deadline for the implementation of the GATT in the health services sector, he added.

One of the requirements facing medical personnel seeking to work in Indonesia is that they pass local examinations to ensure a minimum standard, he said. "Another criteria is fluency in Bahasa Indonesia."

The current regulations allow foreign doctors to work in Indonesia only in positions that cannot be filled by Indonesians. Under the new GATT such a broad restriction will not be permitted.

Doctors at the seminar warned that opening the doors to foreign doctors could mean that those doctors entering would be of "third grade quality."

A number of local companies have already joined up with foreign investors in building health institutions. For instance, Singapore-based Gleneagles and a local consortium, PT Nusa Medika Perkasa, which includes the Lippo City Development group, plan to build 15 hospitals in various cities.

Sujudi stressed that the main employment rules still applied for the time being, notwithstanding that the companies had been granted investment approval.

"Requests to employ foreign personnel are only allowed if they can prove that local staff with the necessary skills are not available," he said.

The chairman of the medical association, Azrul Azwar, said that one benefit of foreign investment would be better quality services as a result of "sharper competition." However, this would also lead to higher costs, he said.

"Patients will have to be prepared to pay more," he said.

Azrul said a regulation on health services rates was needed.

Sujudi said, however, that regulating rates was not yet possible.

"The possibility of regulating rates depends on insurance," he said. Only 15 percent of the population has health insurance.

An official from the Ministry of Trade, Painan Nainggolan, who also spoke at Thursday's seminar, urged the health community to show a "clear commitment" in facing the free flow of services.

"The health community must be actively involved in multilateral agreements to ensure the most benefits" for the country, Nainggolan said. (anr)