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.