WORLD HEALTH ORGANIZATION STATES:
There are hardly any modern health care and treatment facilities in Indonesia available for everyone.
It is anticipated that over USD 10,000,000,000.00 in foreign currency savings and earning is lost as part of an none-taxable Organized Medical Care Export Plan from Indonesia to other regional countries caused by the negligence of the Indonesian Medical Board (Kollegium) along with a well structured undetectable opportunities for Indonesian Doctors to make quick earnings.
- Not all diagnostics are available
- Not all treatments are available
- No oncology center
- Not sufficient invasive cardiology
- Not sufficient kidney dialysis
- No transplant center
- No healthcare for the unfortunates
- No complete health care insurance
- No modern children hospital
- Not sufficient cardiac surgery
- Not sufficient plastic surgery
- No burn center
……… (This list can go on and on)
Although the above statements are hard and people can say we have an oncologist in Jakarta and we can treat cancer, the hard truth is that the type of care provided is poorly organized and relies on the hard work of often individual physicians. In the example of oncologic care, good treatment is performed by a team while keeping up with the modern treatment standards and continuously developing new treatment arms for different kind of tumors.
The health care organization has not changed much since the Dutch left Indonesia. There are old hospitals with poor hygienic standards and very old equipment and poorly trained staff. A good medical
school and further specialization is not available for the young ambitious student. Although difficult to prove, many physicians have made statements such as
“to become a doctor or a specialist, selection is not done on the merits of qualities but on the amount of money paid by the applicant”
There are generally five groups of people in Indonesia that use health care facilities:
- The Rich Upper Ten,
- The Foreigners,
- The Middle Class,
- The Lower Working Class,
- The Lower Non-Working
1. The Rich Upper Ten
The rich can afford private clinics and healthcare in other countries at a huge cost for Indonesia.
They use the private clinics in Jakarta for diagnostics and treatment of simple diseases. For their surgery and more complex diagnostics they go to other countries in the region. Originally it was Singapore but Thailand, Malaysia and Australia are becoming more popular. The Chinese community also seeks their care in Hong Kong and China.
There are no exact economic data available for the loss of foreign currency savings and earnings caused by this type of Renegade Capital. However, low estimations indicate that it is exceeding the USD 10,000,000,000.00 level per year. A devastating amount of USD 40 per capita, being 20 times more than the current government spending on health care. This money is lost for the Indonesian economy but most important lost for the further development of the health care in Indonesia.
It is also bad for the rich people, as they have to travel in sick conditions to the health care destinations abroad, which is not
advisable but impossible in acute cases. This means that there is a high level of mortality in cardiac patients with acute coronary syndromes. Acute PCI techniques are unavailable in Indonesia and that means that those that survive their coronary event have poor chances for the future with a higher incidence of chronic heart failure and earlier death.
Although the rich think they are better off getting their health care abroad in the long run they and their children will suffer the same consequences as all the people of Indonesia.
The mission here should be to keep that money inside the country to be used for improvement of the health care system. It is a challenge for DHC to try to develop a health care system that uses this money and will eventually create a modern medical environment in Indonesia.
Foreigners seek their healthcare outside Indonesia.
The lack of good healthcare scares away investors and multinationals. Many expatriates, businessmen and tourists come every year to Indonesia. They rely on the health care as provided. Tourist experienced after the Bali bombing not only too many body bags but also a complete chaos in the local hospitals and the incompetence accordingly. The pictures on CNN and other broadcasting channels of the wounded were more traumatizing as the fact that the bombs went off. The bombings we regrettably get used to in our modern society, the poor health care was more of a trauma to many. One of the reasons that tourists evade Bali now is not only the chance for bombings but also the lack of health care.
Foreigners have high insurance policies for healthcare outside of Indonesia. For annual check-ups most of them go to Singapore and Kuala Lumpur. Pregnant ladies most of the time leave Indonesia while still allowed to fly to deliver their babies at home and not in Indonesia. The maternal care and pre-birth care is highly underdeveloped. Large amounts of possible health care fees are lost
for the Indonesian economy and health care system.
It is also a fact that many multinationals are fleeing to the so-called low-wage countries. Indonesia is such a country. Many companies decide not to come to Indonesia because of the lack of good health care for their employees. Resulting to high insurance costs for them. For Indonesia many billions of dollars are lost every year by losing the companies to start their business in Indonesia.
3. The Middle Class
The middle class is the main consumer of the healthcare system and is often insured.
This is the group that can afford the healthcare in Indonesia. They are the consumers of the current health care system. Some of them can afford insurance while others can barely pay the bills and medicines. The group complains about the old fashion style of health care but have no choice and therefore no other place to go.
The average low cost insurance policy currently on the market for healthcare is USD 700.00 per person per annum, and for most of the average Indonesians a fortune. This insurance covers basic healthcare and doesn’t cover healthcare in other countries.
Insurances for high level care exceed western prices and can range up to USD 5,000.00 per person per annum.
4. The Lower Working Class
Sparsely use of healthcare and no money for expensive treatment.
They cannot afford insurance and hardly ever go to hospitals for care. When ill they try to fix the problem with herbs and alternative so-called local black magic rituals. When a doctor is needed they go to the local kampong doctors and can hardly pay their bills. Often the doctor gets paid in chicken and rice. For expensive medicine as antibiotics and anti malaria drugs the people have no money. This is one of the main reasons why infectious disease is the number one
cause of death in Indonesia. There is no low cost insurance policy for the lower class on the market. Most of them rely on charity and religious organizations for their health care. Local hospitals often get needy patients that they cannot help because of lack of funds.
5. The Lower Non Working Class
No money, no care and no long life.
These are the real victims. A social plan is non-existent and people are not able to survive on the streets. This particular group is even far too poor to go to the basic health care providers.
They have barely enough money to keep themselves alive. If they encounter an accident or catch a disease they are literally in the hands of “the gods” and must struggle for survival.
This is in every country the most difficult group to provide healthcare. The first priority of man is survival by having to eat and to drink and be able to have a roof over its head. Health always comes at a high but second place. In modern societies there is a social plan for those people. In Indonesia such a broad social plan is impossible due to the unbalanced and non-equal distributed wealth caused by corrupted and struggling economic growth.
WHO statement on health care in Indonesia:
However, government investment in the health system has been limited, leading to insufficient facilities and workforce needed for public services, and encouraging the growth of private health facilities. Problems of maternal and child health, nutrition and communicable diseases persist, while noncommunicable and chronic diseases are emerging as new priorities. There are significant regional disparities in terms of health status and in the quality, availability and capacity of health services. Decentralization has affected the capacity of the central Ministry of Health to maintain integration and alignment across the different levels of the health system.
Health care vicious circle
1. No Doctors
During our studies of the Indonesian health care system we developed the above-mentioned vicious circle of health care in Indonesia.
It’s a very simple economic principle combined with human characteristics. We are convinced that trying to solve one part of this circle will never lead to the full solution of the health care problem. Without investing in an integral solution it will be impossible to make a functional healthcare system and generate sufficient cash to care also for the financial and social unfortunate Indonesians who are in need of a real operating healthcare system.
2. No Hospitals
There are hospitals in Indonesia but as we mentioned before poorly staffed and equipped, resulting in incomplete healthcare. For physicians it is not attractive to work in a hospital where they cannot give better treatments to patients because of the lack of funds.
It is not appealing to use a knife for surgery when you have learned all the minimal invasive endoscopic techniques. This leads to the outflow of doctors and doesn’t create an atmosphere for investments. The declining funds and reserves of the hospitals will create major health care problems in the next decennium. Already very poor international indices will probably get worse.
The neonatal death rate at birth is among the highest in the world and totally not acceptable for a modern country that Indonesia is aiming to become sooner or later.
The educational system for physicians is similar to other places in the world. First the student has to attend medical school to become a basic physician. After that it has to specialize to become either a family doctor or a specialist. In Indonesia many students have to work for 5 years in the kampong after their studies to pay for their government paid education. After that period they have to start their further training. They will learn their specialization in Indonesia in poorly equipped hospitals and often have to go to other countries to become a more experienced and modern specialist. Most of the time, they are not paid during the specialization period and even have to pay the specialist that trains them. At the end of their training they have to appear for a board called the “Collegiums” to do a final exam. After that they can call themselves a specialist in Indonesia and after that they will be allowed to treat Indonesian patients.
Many students that go abroad don’t return to Indonesia. When they return they have to do the exam at the collegiums to be able to practice medicine in Indonesia. Some people doubt the objectivity of this exam at the collegiums. It is certainly only a knowledge and not skill based evaluation of the candidate.
3. No Patients
As mentioned earlier, many Indonesian patients know of the poor quality of the hospitals and specialists that work there. So many people that can afford health care will seek it abroad. This leads to a negative cash flow.
4. No Money
The lack of funds leads to a climate where hospitals and other health care facilities barely have enough funds to survive and are not able to invest in modern equipment and education for their staff. This leads to a not to interesting environment for physicians to work in.