Rising medical costs take heavy toll on public health
By Rita A. Widiadana
JAKARTA (JP): The now familiar term monetary crisis is taking on a tragic meaning in the cost to public health.
Four patients suffering from kidney failure died in Bali, reportedly after medical supplies ran out.
In Bekasi, east of Jakarta, half of the 130 health clinics have stopped providing services due to the lack of medicines. Supplies in hospitals and public health centers elsewhere are also running out.
Suyatno, 67, a kidney patient from Cibubur, West Java, is opting for alternative medicine in a desperate bid to treat his illness. "I have already sold all my possessions, and it is still not enough to pay medical bills."
He formerly spent between Rp 300,000 and Rp 500,000 monthly on treatments. After the crisis hit last July, his bills reached almost Rp 2 million a month.
"It's impossible... I would rather buy food for my family," he said.
Reports of dwindling medical supplies are making patients nervous. "I feel so scared that those doctors will inject me with used needles," one said.
Samsi Jacobalis, a member committee of the Indonesian Hospital Association (Persi), downplayed the fears.
"As far as I know, no hospital would do that," he said. Medical staff would worry about transmission of viruses such as Hepatitis B or HIV even if used needles were sterilized, he added.
"It's not the needles which are expensive, it is the medicine which is injected," said Samsi, former Persi's chairman and dean of the Tarumanagara University's School of Medicine.
Askobat Gani, dean of the School of Public Health at the University of Indonesia, said recently the medical community was suffering the most from this crisis because almost all materials for medicines, hospital equipment and related devices were imported.
"We have been too fascinated by high-tech medical equipment and have relied heavily on imported items, until we could not even produce basic and vital equipment like disposable needles."
Samsi said efficiency measures should be implemented in diagnosis, starting with an end to the practice of using sophisticated, expensive equipment for diagnosis in cases where simple procedures would suffice.
Data from the Bureau of Statistics shows imports of medicines and medical equipment reached US$35.04 million between January and September of last year. But with the current exchange rate of around Rp 9,000 to the U.S. dollar, the cost of imported medicines has surged by almost 300 percent.
High costs
Prices of individual hemodialysis units have reportedly jumped from between Rp 120,000 and Rp 140,000 last year, to Rp 572,500.
The cost of X rays and CT scans rose from Rp 150,000 to Rp 1.6 million. Insulin needed by diabetic patients rocketed from Rp 300,000 to Rp 500,000 up to Rp 1.2 million.
The scarcity of supplies was worsened by the inability of local companies to open the Letters of Credits (LCs) needed to import medical items.
Last month, Minister of Health Sujudi said an LC worth $58 million had been issued to cover needs for several months ahead. This is in addition to a government subsidy of Rp 700 billion for imported generic drugs and vital medical equipment.
"This crisis seriously afflicts low-income patients and those who need regular medical treatment, such as patients with kidney failure, heart-related problems, diabetic and cancer-related diseases," Askobat said.
Unless the government intervenes, there are fears thousands of chronically ill patients will lose their fight for life.
The government, Askobat said, should pay serious attention to the problem and effect measures to help the most affected.
Sujudi had said hospitals and other medical centers should not increase costs of services.
A recent survey by the Hospital Management Study Center of the University of Indonesia of 19 hospitals in the capital found his advice was not heeded.
It reported that medical fees at general polyclinics, specialists, emergency units, intensive care and intensive cardiac treatment centers had increased between 42 percent and 100 percent.
Laboratory services have also soared between 58 percent and 182 percent. Rates for hospital rooms rose between 12.5 percent and 33 percent.
Samsi commented that an increase in medical fees was inevitable, but big hikes should be the last resort.
"This is the time for both public and private hospitals to carry out their humanitarian mission to help ... the poor in particular.
"It seems we're experiencing a 20-year setback. The most important thing is to save patients' lives."
He also urged hospitals and doctors to cooperate in handling the purchases of medicines and equipment. This would cut the cost involved in making purchases through distributors by between 30 percent and 40 percent.
Several hospitals in Jakarta are cutting down on expenses to survive.
Director of state-owned Cipto Mangunkusumo Hospital (RSCM), Ahmad Djojosugito, reportedly said the hospital trimmed its overhead costs by utilizing more generic drugs and using less expensive medical equipment.
The general hospital is now concentrating on purchasing life- saving drugs needed in anesthetization and dialysis. Second priority is for drugs like influenza medication, antibiotics and vitamins.
Despite efficiency steps, the hospital's expenses for medical equipment such as X rays, surgical equipment and anesthetics increased about 29 percent in January.
Food expenditures also rose about 19 percent. Fortunately, several anonymous donors contribute funds to RSCM.
Rumita S. Kadarisman, director of Isak Salim (Aini) Eye Hospital in Kuningan, South Jakarta, said surgical thread, silicon oil and disposable surgical instruments were difficult to come by.
Treatment of most eye conditions required patented medicines, produced by domestic or overseas pharmaceutical companies, and generics usually could not substitute, Rumita said.
She added that the cost of medical supplies soared "irrationally" by at least four times since September last year.
"I have met with drug and medical suppliers. We discussed ways of eliminating price problems and securing our distribution of vital medicines and equipment."
With the hike in prices of imported medical supplies, she said it would be hard to meet the hospital's operational costs.
"So far the hospital has just made limited adjustments in its medical services related to the use of imported medicines and medical equipment. We have not raised doctors' fees."
The hospital has been efficient in usage of its imported medicines, medical utensils and electricity.
"We have also set up a joint cooperation with other hospitals in waste management to reduce processing costs, " she said.
Despite scarcity of basic medical supplies, Rumita said the hospital pledged to maintain the quality of its services.
Modern facilities like Pondok Indah Hospital are also vowing to maintain their current rates.
Hospital director Zakiah Risyad confirmed there would be no rise in doctor fees. In an earlier interview, Zakiah said Pondok Indah, which recently expanded its medical facilities, promised to provide quality services at reasonable prices.
"With some new facilities, like the brain center and heart department, we provide international-standard medical services like those provided by foreign hospitals. Indonesian patients would save quite a lot of money if they were treated in local hospitals," Zakiah said.
Walter Kmet, president of PT Putramas which manages Mitra Keluarga Hospital in East Jakarta, said the crisis was battering hospitals in what could be the worst year in their modern history.
Like other hospitals, Mitra Keluarga is trying to maintain its medical fees. "We have increased the rates of hospital rooms by only 10 percent based on an annual basis," he said.
"We have to work a bit harder to make cross-subsidies to help patients of all income groups receive high-standard medication."
Some medical procedures, including surgery, require use of a lot of imported medicines, he said, and the hospital made slight adjustments in prices.
It was also reusing some medical equipment.
"Patients should not be afraid about this because we reuse them after sterilization in international health standards," he said.