RI needs coordinated system to provide inexpensive healthcare

Ridwan Max Sijabat, The Jakarta Post, Jakarta

The idea of a hospital as a social-oriented institution took a beating when the sad case of Sumaryono was recently exposed.

Sumaryono, a poor resident of Bendungan Hilir district in Central Jakarta suffered from a shocking lack of care or concern for his health, despite his obviously dire situation with his intestines protroding from his mid-section.

The 24-year-old man went to the city-managed Tarakan Hospital in May and was told that he had a problem with his appendix, which was wrong, as it turned out to be a tumor in his stomach.

Surgery was performed to remove it, but the doctors did not adequately stitch up his stomach and shortly after that discharged Sumaryono without any medication nor follow-up treatment. Later, the doctor recommended him to the Cipto Mangunkusumo General Hospital for follow-up treatment, but the government hospital refused to admit him without clear reasons.

In another case, Henry Altriansyah, a jobless father of three children, sold his own organs for money that he needed to pay for his ailing youngest son' medical bills amounting to more than Rp 20 million in a hospital in Tangerang.

It is common for hospitals to require patients to pay a certain amount of money in advance, called the "admission fee" and for preliminary treatment service.

To the majority of people in urban and rural areas, health care at state and private hospitals remains a luxury. A recent survey conducted by the medical school of the University of Indonesia showed that following the economic crisis that hit the country in 1997, the number of hospital in-patients dropped by an average of 30 percent because of people's decreasing purchasing power.

Many people have moved to public health centers while many others have turned to cheaper traditional and herbal medicines or visited traditional healers for alternative treatment.

Only those working in major private and state companies have easy access to a relatively high standard of health service in hospitals since they are insured.

Drugs, doctor services, room facilities and medical equipment are the only four components that contributed to the expensive health care service but simultaneously have been "manipulated" to support hospital businesses.

Pondok Indah private hospital's director Muis Aida acknowledged that the poor payment-based system had denied the poor access to modern healthcare.

Drug prices, she said, were set by pharmaceutical companies while the prices for diagnostic equipment usage was set by the hospital management in line with their purchase price and import and income taxes, all of which is passed on to patients.

"Our hospital cannot do much to make the brandname drugs cheaper. We have set a standard medical service and diagnostic equipment usage for all patients regardless of their economic background or job and provide rooms with varying facilities depending on patients' economic situation," she said.

Aida declined to comment on different prices set by hospitals for doctor fees and consultation or for diagnostic medical equipment usage.

"But many people who used to go overseas for medical checkups in the past, have visited the domestic hospitals after they reduced their prices," she said.

Aida said the diagnostic equipment charges were relatively expensive because they were all imported and unfortunately this government treats imported medical equipment as a luxury item, which is therefore subject to very expensive import tariffs as well as a luxury tax.

Director of Income Taxes at the Taxes Directorate General I Made Gde Erata confirmed that they did tax hospital equipment "because it has been regulated this way."

"But not all imported medical equipment is subject to tax collection," he said without elaborating.

Chairman of the Indonesian Doctor's Association (IDI) Farid Anfasa Moeloek said the expensive health care service had a lot to do with the absence of a comprehensive, universal health care system in the country.

"We have committed a fundamental mistake by developing a payment-based health care system. A fundamental reform of the system is absolutely needed to improve people's social welfare," he said.

Moeloek, also former health minister, insisted that people had a right to receive easy access to affordable healthcare because being healthy was a human right and the government was obliged to provide cheaper healthcare in compensation for the taxes people pay.

"It is very easy to make the healthcare service cheap if the government has a political will to do it," he said, citing that the pro-people healthcare systems in Britain, France and the Netherlands were several good models Indonesia could imitate.

According to him, the government should develop a national healthcare system for which it and the people have to co-pay to finance the healthcare service for all so that any service a hospital provies would be based on a patient's ability to pay.

"Patients must enjoy health care service not because of their economic condition but their actual need," he said.

Moeloek said IDI had discussed the issue with the House of Representatives and both sides agreed to work on two bills on national health care system and on cross-subsidy funding.