Local hospitals must fit the bill for their patients

Local hospitals must fit the bill for their patients

By Yudha Kartohadiprodjo

JAKARTA (JP): Before the monetary crisis unfolded,
Indonesians, like other citizens of booming Asian countries,
experienced an increase in living standards. They not only afford
to buy branded goods and vacation overseas, but could also travel
abroad for medical checkups.

Of course, they had their own reasons to trust foreign health
services; after all, why wait in long hospital lines when you
could afford not to? Many Indonesians, from businesspeople and
their families to the then research minister B.J. Habibie and
Soeharto, sought medical treatment abroad.

The crisis brought the trend to a grinding halt.

Indonesian hospitals are now facing a challenge to fit the
bill for local patients.

Unlike in the past, the duty of hospital management is no
longer limited to providing health services.

A.W. Boediarso, chairman of the Indonesian Hospital
Association (PERSI), said he was optimistic members of his
organization could rise to the challenge.

A former director of the Army's health service division,
Boediarso, 58, sees the need for Indonesian hospitals to put
their management in order. He ranked efficiency as a determining
factor for the institutions' survival.

Boediarso earned his MBA while still on active duty and his
medical specialty is community health. "Marketing skills and
community health knowledge are compatible for managing
hospitals."

A 1966 graduate of University of Indonesia's School of
Medicine, Boediarso now manages Sunter Agung Hospital in addition
to consulting at other healthcare institutions.

Below are excerpts from an interview with The Jakarta Post.

Question: What has been the impact of the monetary crisis on
members of PERSI?

Budiarso: On one hand, cost factors such as the price of
medicine, medical equipment and foodstuffs increased while
hospital income decreases. The impact is felt worst by hospitals
with dollar loans.

It is hard for us not to increase fees, yet we are trying to
heed the instruction of the health minister to hold off on fee
increases.

However, procedures like medical operations will inevitably
rise due to soaring prices of surgical knives and other medical
equipment.

Even so, I have not heard of any hospital which has laid off
workers.

Q: What caused many Indonesian patients in the past to seek
medical treatment overseas?

B: When asked this question, the typical answer is "to look for
better treatment". This answer, however, does not provide the
whole picture (of our medical system).

Overseas medical treatment usually provides excellent service
quality. Most health services or checkups could be done within
one day since the patient's arrival in the hospital due to the
hospital's efficiency and professional administration system.

From the medical expertise side, however, (doctors in) our
hospitals are not far behind. Various surgical procedures, from
appendectomies to heart surgery, are done with high success
rates.

Harapan Kita Hospital has performed thousands of heart surgery
operations, yet we rarely hear of people dying.

Q: Beds in Singapore hospitals are empty since Indonesian
patients could no longer afford the cost of having overseas
medical treatment. How are Indonesian hospitals anticipating
this?

B: To weather the crisis, increasing efficiency is a usual
reaction. However, we need to maintain the quality of service.
Overseas trips (for medical treatment) would be too expensive for
people (who once could afford it), so they are forced by the
condition to seek treatment here.

Hospitals must still provide sophisticated medical treatments,
as they did before the crisis occurred. This is actually a great
opportunity for us to prove that we are not inferior to foreign
hospitals.

I have not heard of any complaints from those who used to seek
medical treatment abroad about local medical services.

Q: What should be prioritized in order to develop our hospitals'
management standards?

B: The development of standardized accreditation system is a
must. Then, there is the need for hospital's service provider to
have total comprehension of what they are doing.

So the management paradigm needs to focus on service to
consumers, in this case, the patients.

Q: In the past, there was an assumption that even without any
improvement in service, patients would just come to the hospital.
Does it still hold true?

B: Hospitals with such an attitude will only attract those who
have no alternative. If hospitals only depend on this, they would
not be able to improve and survive.

In order for any hospital to survive, it needs to attract
those who are able to pay, without forsaking its social
obligation.

Q: You mentioned marketing earlier. How do you impart marketing
into an institution like a hospital?

M: Marketing is identical to selling and promotion, unsuitable
for hospitals.

In reality there are six functions of marketing that should be
implemented in a hospital.

These functions are research on consumer needs, in this case
the patients; product development, where service is continuously
improved and communication, where hospitals communicate their
ability to prospective patients.

Pricing is, of course, crucial because it defines the
hospital's market target.

Other functions are distribution, where the hospital creates
an efficient system to distribute services within the hospital.

Then there is service. In a good hospital, the patients should
feel that they are in good hands.

Q: How does this affect consumers?

B: The needs of consumers also increase, especially the upper
class. They would not mind paying more to get better treatment
and to have a thorough explanation of their disease. In return,
they will cross subsidize lower-income patients.

Q: To what extent can a hospital market its services?

B: I consider this a very important point.

The purpose of hospitals evolved from social to social-
economy. Now it has taken the shape of health industry.
Economical paradigms started to become significant factors and
were adopted by hospitals into their management system.

However, many of this paradigms collide with medical ethics.
The rule of thumb is: any effort of hospitals that do not inflict
any harm to patients and against the law do not violate ethic.

Q: What are the factors that trigger hospitals to lean from its
socio-economic role to economy?

B: I think this is actually a natural process.

I remember when I was a boy I did not have to pay to go to
hospital, yet I had to wait for hours before being treated.

Limited ability of the government and donators causes
hospitals to look for alternative sources of income. Facing these
challenges, hospitals started to think in economical terms.

Q: What is the role of private hospitals here?"

B: I think it is an excellent way for the private sector's
participation in providing health services. More than 50 percent
of hospitals in the future will be run by private institutions.

The government's contribution will be to provide general mass
health services.

Q: What contributes to the lack of interest in health insurance
here?

B: The success of health schemes depends on the people's level of
education and economy as well as the supporting infrastructure of
the insurance system.

Now, the Ministry of Health is developing People's Health Care
Security System (JPKM). People will be educated that they should
be responsible for their own health.

Q: Does the current system contribute to the unpopularity of
health insurance?

B: Appointed hospitals will accept subscribers of Askes as long
as the patient brings his or her insurance card and a referral
from community health centers. In most hospitals, the subscriber
will be assigned a third-class room, even though government
officials would be admitted depending on their ranks.

I feel that the system has improved considerably, since it
used to take four months for hospital to receive their
reimbursements.

Q: Is the government decree requiring hospitals to dedicate 10
percent to 25 percent of beds to lower income patients still
relevant to the present situation?

B: At present there is no alternative. This is already an
agreement between hospitals. In practice, however, hospitals do
not have to provide those beds but could pledge an equal fund to
a (lower class) hospital that they patronize.

This is more practical since low-income people would be
reluctant to go to luxurious hospitals anyway.

Q: What is the social obligation of luxury hospitals?

B: All hospitals should always stick to their social obligation.
The fundamental implementation of the social obligation is
through the hospital's emergency room.

During an emergency situation, an emergency room should admit
all critical patients without asking any questions. No emergency
room is profitable.

Q: How do you see the future of Indonesian health services?"

B: We should look to countries that succeed in covering a large
number of their citizens efficiently. What we are looking for is
an insurance system where the healthy ones help the ailing ones.
The system should also takes care of the lower class.