Low-income people still rely on RSCM

By Stevie Emilia and Dwi Atmanta

JAKARTA (JP): Despite the mushrooming of hospitals in the city, the state-owned Cipto Mangunkusumo Hospital (RSCM) in Central Jakarta still serves as the primary medical facility for many Jakartans.

A 49-year old mother who had brought her daughter to RSCM for medical treatment said she chose the hospital because she could not afford treatment at more expensive medical centers closer to home.

"There is a private hospital in my neighborhood but I think medical treatment there would be very expensive," said Rodiyah, who lives in North Jakarta.

She admitted she had never actually entered the private hospital. "I just think I can't afford it," she said.

RSCM director M. Ahmad Djojosugito acknowledged there are many hospitals established on economic profit considerations alone. He lamented that business motives often overrode many hospitals' obligation to serve poorer people.

He praised the cross-subsidy scheme that enables a state-owned hospital such as RSCM to seek profit from higher-income patients to use the money to help the majority of the patients, namely the poor.

The hospital reserves around Rp 2.4 billion (US$1 million) of its annual subsidy for the needy, but in return it receives Rp 24 billion a year from the government.

Ahmad said the government subsidy is used to cover the hospital's operational costs, including the salaries of the almost 6,000 employees.

"The cross-subsidy method is simply aimed at increasing funds reserved for patients with lower incomes. We barely make money from that," Ahmad said.

He said that RSCM, the oldest hospital in the country, continues to have trouble breaking even 77 years after its establishment.

A Jakarta hospital breaks even if it makes an average of Rp 25,000 per bed per day.

"You can imagine how difficult it is for RSCM to make a profit if 85 percent of the beds are reserved for people who can only afford to pay Rp 7,500 a day," Ahmad said.

RSCM has 1,305 beds with an average daily occupancy rate of 66 percent (858 beds).

Medical expenses at the hospital range from Rp 7,500 to Rp 235,000 per day (See diagram).

Ahmad, however, has a reason to smile despite the hospital's downward-looking mission. "We have the country's best medical experts and technology," he said.

The hospital employs 991 doctors, 90 dentists and 760 specialists. They receive support from more than 1,800 medics and more than 2,000 nonmedical employees.

However, like other state-owned hospitals across the country, quality of service remains a challenge at RSCM. Ahmad said: "We admit that we are not giving the best possible service. Neither do we have a totally clean hospital.

"But it's difficult to meet the two demands because we deal with a staggering 12,000 patients every day."

While not directly speaking specifically of RSCM, Samsi Jacobalis, chairman of the Indonesian Hospitals Association, lamented the general standard of hospital services, saying that they are simply "inadequate".

"Medical services providers should set new standards that put customer, or patient, satisfaction first," said Samsi who is dean of the Tarumanegara University School of Medicine.

He said hospitals must also keep up with both changes in medical technology and customer expectations.

"If we neglect changes in the medical world, patients will abandon us," he said.

Questions of quality and service aside, the vital role of hospitals like RSCM cannot be neglected.

As Ahmad Djojosugito pointed out, RSCM serves as a referral hospital; thus it cannot refuse any patients.

"This is the patients' last resort, we cannot refuse them even though they cannot always afford to pay," he said.

Table: Hospital Occupancy and Rates Rates (Rp) ------------------------------------------------------------------------- No. Hospitals Beds III II I VIP Super VIP Executive

Deluxe Royal VIP ------------------------------------------------------------------------- 1. RCSM 714 7,500 25,000 45,000 65,000 -- -- 2. Medistra 129 30,000 75,000 150,000 275,000 700,000 -- 3. Mitra Keluarga 250 45,000 75,000 125,000 250,000 350,000 -- 4. Metropolitan 177 30,000 90,000 160,000 250,000 375,000 400,000

Medical Center 5. Pluit 191 35,000 50,000 125,000 250,000 400,000 800,000

75,000 6. Pondok Indah 307 40,000 75,000 125,000 200,000 350,000 -- 7. Siloam 328 30,000 75,000 125,000 250,000 400,000 600,000

Gleneagles 8. St. Carolus 400 22,000 45,000 75,000 200,000 275,000 --

60,000 85,000 225,000

250,000 9. Jakarta 122 40,000 80,000 140,000 210,000 350,000 --

100,000 250,000

** Rate for Siloam Gleneagles Hospital' Suite rooms is not being determined yet.

RSCM : Cipto Mangunkusumo General Hospital