Private hositals try to improve image
Many people welcomed the growing number of private hospitals across the city with a hope that their presence would improve medical facilities to enable them to meet increasing public demand for better medical services.
But people have started questioning whether they favor the rich and ignore the poor.
The Jakarta Post's reporters Stevie Emilia, Ridwan M. Sijabat, Lukman Natanagara, Aloysius Unditu, Johannes Simbolon, Sri Purwati, Yudha Kartohadiprodjo, I. Christianto and photographer Oka Budhi Yogaswara discuss the issue in the following article and other related stories on Page 5 and 10.
JAKARTA (JP): For some, fiercer competition among private hospitals has brought significant changes to medical health care here as it offers more choices for the patients than it used to.
Hospital managements can no longer ignore patients. Instead, they should acquire the latest and the most sophisticated medical facilities and provide good quality services so as not to lose out to the competition.
Some private hospitals even have luxurious buildings and facilities, which remind one of five-star hotels.
But it has turned out that such luxurious buildings and facilities have scared some people, especially the poor, from even just stepping into those hospitals.
They argue that such hospitals will charge them more than necessary to rake in profits, while others have accused the hospitals of favoring the rich and neglecting their social and humanitarian roles to serve all, including the poor.
Supratno, 25, is among those who has bitter experiences with upscale hospitals.
When his wife gave birth to their first child, a premature six months old baby girl, two years ago, the baby was alive but in a sickly condition.
He was told to take the baby to a more sophisticated hospital because the one where his wife gave birth could not deal with the problem.
When he took the baby to a well-known private hospital in Kebun Jeruk, West Jakarta, which is close to his house in the Kedoya area, he had to walk out because he could not afford the expenses.
"We rushed the baby to the Cipto Mangunkusumo General Hospital. But, the baby died on the way. It's too far away from our place," sighed Supratno, a taxi driver.
He has another bad experience with private hospitals.
When his mother was sick, he took her to a private hospital, but it refused to treat her just because they would not be able to pay the expenses.
"People do not have time to choose which hospitals to go at a time of emergency.... I just don't know whether upscale private hospitals also serve poor people like me. My two experiences with them taught me well that they are only for the rich," Supratno said.
"We can never afford to pay for treatment in such hospitals. We can only afford medical treatment with written proof clarifying that we're poor to get dispensation in state hospitals," he added.
Regulation
Under the government's regulation hospitals owned by the government should set aside 75 percent of beds for the poor, while those owned by non-profit organizations or foundations should put aside 25 percent. Private hospitals, including foreign-invested ones, should allocate at least 10 percent of their beds for the needy.
Critics, however, have voiced their doubt that private hospitals have met the requirements to serve the poor.
The Ministry of Health's Director General of Medical Services, Sri Astuti, insisted that the regulation was still relevant to help the needy, saying that her office closely monitored the implementation of the regulation every three months.
But she noticed that some people were afraid to take treatment in private hospitals for fear of incurring high expenses and this after just taking a look at the luxurious buildings and facilities.
"Such an image is not always true. All hospitals should serve and are obligated to serve patients without discriminating on grounds of their status, origin and religion, especially in an emergency," Sri told the Post.
Private hospitals mostly require prospective patients, excluding emergency cases, to pay in advance a deposit worth several times the room rate before being treated. In Pondok Indah hospital, for instance, prospective patients are required to pay a down payment amounting to 10 times the room rates.
For the poor, regulation remains regulation. In reality, they are still being treated differently.
The poor, who cannot afford to pay, are obligated to show written proof from the subdistrict office detailing their inability to pay.
Sri said that the regulation was issued by the government to help private hospital managements in making their financial reports to the owners.
"But, the quality of services for the poor should not be different to that of those who can afford the expenses. The difference is in the type of the rooms, the poor are in third class," Sri said.
There are currently 1,039 hospitals in the country of which 515 are run by private operators. And according to the Central Bureau of Statistic's 1997 data, there are 98 hospitals in Jakarta alone, of which 45 including one foreign-invested hospital are privately run.
Image
The rapid increase in the number of private hospitals poses an alarming situation for some people, especially since many Indonesians are not yet protected by an insurance scheme.
They fear private hospitals will totally shift their function from that of an unprofitable social institution toward that of a profitable business. And more people have begun wondering about their social duty to the public, especially at this time of crisis.
Pondok Indah Hospital's director of business and support services, Hartono, did not blame people for having such perceptions of upscale hospitals.
"This maybe arise because we don't give much information about our services to the poor. But that's only an image and it's not true," he told the Post.
He said his hospital has provided many more beds for third class than required by the government. And room rate for the third class has never been raised for the last four years.
The hospital also did not require patients in emergency rooms to pay deposits as required for other patients.
"In the end, some of the patients cannot afford to pay," Hartono said, adding that they should show written proof from the subdistrict office.
He said that the hospital recorded bad debt from those who could not afford to pay medical expenses; Rp 200 million in 1997 and Rp 180 million in 1996.
Some hospitals face a decline in the number of patients, including in the third class. But there was an increase in bed occupancy rate at the third class in Pondok Indah hospital from 85.9 percent in 1997 to 90.7 percent from January to September this year.
"We don't give different services to our patients. If the VIP patients eat five times a day, third class patients will also eat five times a day. And the third class room is also air conditioned, provided with TV, telephone and other facilities just like a VIP room. The difference is only in the number of beds," Hartono said.
A VIP room has only one bed while a third class room has up to six beds.
Private hospital managements also denied that upscale hospitals charged their patients more than necessary as complained of by many.
"The higher costs are due to the completeness and good quality services requested by the patients or the doctors...," Metropolitan Medical Center's director and CEO, Muki Reksohadiprodjo, told the Post.
MMC, he said, even exercised rationalization of services.
For instance, he said, MMC minimized supportive examinations according to clinical significance and encouraged doctors to utilize locally made medicine only.
The hospital also provided 17 percent out of its 171 beds for the third class, he said.
"We continually have the amount of over Rp 100 million as bad debt per annum and a greater proportion due to these patients in third class," Muki said.
Some private hospitals only performed their annual social services outside their premises.
MMC, for example, has a special social project providing health care services in slum areas, while Pondok Indah hospital provides annual free medical services in different areas in the city.