Geriatric health care needs funding as private clinic opens

Geriatric health care needs funding as private clinic opens

By Jules Bell

JAKARTA (JP): Geriatric patients require very specialized
health care. Couple this with the World Health Organization's
(WHO) prediction that from 1990 to 2020 there will be a 415
percent increase in the number of elderly people in Indonesia,
the fastest growth rate for this demographic group in any country
throughout the world.

Add to this, the fact that geriatric medicine has only been
taught to undergraduate medical students since 1997. Finally,
consider that in the opinion of specialists, limited funding is
directed toward geriatric health care at present; particularly in
the context of Indonesia's economic crisis.

"It's a serious problem," said Dr. Czeresna Soejono, secretary
of the Indonesian Society for Gerontology - a non government
organization established in 1996.

Geriatric health care has been overshadowed by more pressing
health problems in the past said the specialist from Cipto
Mangunkusomo Hospital's geriatric outpatient clinic - "the only
formal clinic in Jakarta".

"In the last 10 years or so we have succeeded in combating
infection and undernutrition, especially in children under five,"
he said. "That is why in the last five to seven years there has
been some growth in health care for the elderly."

Dr. Soejono's opinion that geriatric health care requires a
significant increase in funding, is strongly supported by
statistical analysis.

Data from the Ministry of Population released in 1995
estimates a 96 percent increase in the number of elderly
Indonesians, from 1980 to 2000. Forty-six percent is the
comparative increase in overall population growth for the same 20
year period. Further, WHO estimates by 2010 the number of people
over 60 will equal the number children under 5 years.

Figures and data aside, aged people experiencing illness have
very specific health needs in comparison to younger patients.
Geriatric specialist, Dr. Siti Setiati from Cipto Mangunkusomo
Hospital, defined the term geriatric.

"They are patients over 60 years diagnosed with multiple
health problems, such as urinary disease in conjunction with
heart disease associated with declining organ function," she
said.

Such patients experience degenerative diseases including
osteoporosis and related disabilities such as immobility or
instability. Also associated with the aging process, is cognitive
disease in the elderly - most commonly manifesting itself as
Alzheimer's disease or dementia.

Early assessment of geriatric patients is particularly
important stressed Dr. Soejono, because they have no "reserve" if
treated to late.

"Their presenting symptoms and signs are totally different
from the classic," he explained. As an example he cited
experiences where he had seen geriatric patients present with
pneumonia, but showing none of the classic symptoms such as
fever, coughing and shortness of breath.

"(Patients) often present with falls," he explained, "loss of
consciousness, anorexia or disabilities."

From May this year Jakarta's elderly have had an option other
than the public health system for geriatric care; Menteng
Geriatric Center.

Working at both Cipto Mangunkusomo Hospital and the new
private outpatient clinic, Dr. Setiati treats patients from both
sides of the system. She describes the Menteng Geriatric Center
as an "ideal" model for geriatric health care, whilst
simultaneously expressing frustration with the "lack of funds"
for public health system patients.

"The government's health priority is presently mothers and
young children," Dr. Setiati said, "but a focus on the health of
Indonesia's elderly will be necessary in the future."

So what is this ideal model for geriatric health care?
According to Dr. Setiati it is where patients are treated by an
integrated team of specialists in one location. This allows a co-
coordinated assessment and management of the patient with optimal
facilities and equipment.

In addition, she said, the team should have the resources and
expertise to focus on the patient and their health as a whole
person. "We focus on treating the patient with a holistic
approach," she said, "and also focus on communication and
recreation."

In her opinion, this has distinct advantages. It reduces
"polypharmacy" or over-prescription of multiple drugs to patients
she said, and fulfills patients' medical, social, family,
psychological and spiritual needs.

"We had a patient recently who was dehydrated because she was
incontinent, and was afraid that her family would get angry at
her if she lost control of her bladder," related Dr. Setiati.

Immediacy of treatment and the convenience of geriatric
specialists in one location is invaluable, she said.

Mrs. Chang would no doubt agree. The thin 85 year old is
suffering pneumonia, anorexia, a stomach disorder, problems with
her balance and some immobility due to severe leg pain. She has
walked through hot, busy passageways to queue at
separate locations in Cipto Mangunkusomo Hospital for X-rays,
rehabilitation and consultations.

For comparison, this is rather different from having a
specialist come to her whilst she rests in a quiet air-
conditioned room at Menteng Geriatric Center, having waited in no
lines nor had to visit on numerous occasions.

Premium private health care comes at a price though. A
complete first time check-up costs patients "around Rp 350,000
(about US$46)" at the private Menteng clinic, according to Dr.
Setiati. This includes consultations and examinations for 10 to
14 days. Subsequent consultations are about Rp 50,000 she said.

Menteng Geriatric Center is more expensive than government
hospitals, and does differentiate patients on the basis of
socioeconomic status said Dr. Setiati.

"We have tried at Cipto Mangunkusumo General Hospital," she
said, "but as a government hospital it has many limitations.
There is just not enough money to support (such a model)."

One thousand rupiah is what it costs patients per visit at
Cipto Mangunkusomo Hospital's clinic. A complete first time
examination including laboratory tests, X-rays and heart tests
using an ECG costs Rp 146,000. Public and private health patients
generally pay for their own medication, some of which is covered
by health insurance.

This discrepancy in cost obviously reflects the quality of the
facilities and equipment available to patients. Dr. Soejono said
the limitations of the public clinic include the lack of grouped
doctors and patients in one location, and a need for more
equipment.

From statistical and professional warnings to an "ideal
model", geriatric health care is not an island in its need for
funding. These patients are unique though, not least in their
fast increasing numbers. Will health services - particularly
those in rural communities - be prepared or will families be
forced to absorb the cost?