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Indonesia healthcare system failing millions JAKARTA - Indonesia's health system is failing to provide even the most basic care to vast swathes of the population, say specialists. Many who cannot afford doctors' fees often receive no treatment at all, while the wealthy fly abroad for a check-up. The system is plagued by under-funding, decentralization, lack of qualified staff, rising medical costs and outdated medical equipment, say insiders.

"The health system desperately needs improvement," said Kartono Mohammad, a senior doctor and former chairman of the Indonesian Medical Association (IDI), adding that it is hard to even speak of a healthcare system since there is no regulation or quality control. "There are no laws that protect the patient," he said.

In June, the system's failures were the focus of nationwide debate when a patient was sued by a hospital after her complaints about poor treatment were published on the internet. Omni sued Mulyasari for damaging its reputation, but after an outpouring of public support, including from parliament, the lawsuit was dropped. "Doctors are very protective of each other. It is a conspiracy of silence," says Mohammad. "Doctors here don't want to testify against their own colleagues."

And though it is unclear how many patients are misdiagnosed each year, many disputes are believed to be settled under the table. Those who have a choice fly to Singapore, Australia, Malaysia and even the United States or Europe in search of better care. According to Fahmi Idris, chairman of the IDI, at least one million Indonesians are estimated to seek medical care oversees each year.

But for most of Indonesia's more than 250 million inhabitants, even the lowest quality healthcare is often inaccessible. Access to health facilities across Indonesia's 6,000 inhabited islands varies greatly. While cities usually offer a range of services for most medical problems, in remote areas such as the easternmost province of Papua it can take several days to reach a doctor.

Some islands or remote mountain villages can be inaccessible for months at a time during the monsoon season. In addition, many low-income earners or the unemployed avoid going to a doctor, explained Ajriani Munthe Salak, from the Legal Aid Institute for Health (LBH). "They stay at home, hoping the illness will disappear. They are afraid of bills and the bureaucratic system."

Critics say a new health insurance scheme for the poor, Jamkesmas, launched by the government in early 2008 is too complicated, requiring a patient to provide documentation on income, identity, hospital registration, family records and a doctor's referral notice. The Health Ministry has spent seven years drafting an ambitious new universal healthcare bill, but it has faced delays, budget problems and technical hurdles, such as a lack of a common definition for malpractice, said Mariani Akib Baramuli, a member of parliament.

"The country still faces significant challenges in developing and implementing effective and sustainable health-financing reform," according to Joachim von Amsberg, World Bank country director for Indonesia. Lawmakers hope the bill will pass during the current term that expires in October, but there is a huge backlog of other work.

Meanwhile, as politicians debate the bill, the problem of affordable care is becoming more entrenched. Indonesian hospitals are even known to keep patients "hostage" until family members can settle their bills. Since 1999, Salak's organisation has handled almost 500 cases, mostly in Jakarta. "But that is just the tip of the iceberg. There are probably millions of people who don't have real access to healthcare," she said.

With the vast distances involved, it is impossible reach everyone, she said. "We get calls from Papua, but we don't have money to fly over there, it is just too costly," she added.



Posted in Health @ 07 August 2009 06:17 CET by Jeroen · 'Blog' RSS feed · permalink





hobo1
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Every country must be careful not to let their humanitarian instincts to ruin a system that works. Indonesia is a third world country and no one should expect it to provide top-of- the-line medical care.

Consider the end-game of providing the best health care coverage for all the people - it would mean the population would grow older and larger (but certainly not happier), many people who God intended to die would be kept alive by machines. Furthermore, it would drain the nations resources that should be used to improve the lifestyle of those with the vigor to truly enjoy life. Death cannot be avoided so why bankrupt the country trying to prolong life?

Having been treated by unlicensed health healers, called dukun, they do have healing skills passed down from generation to generation. They can set bones and heal wounds with natural herbs and plants. They are poor doctors who care for the poor people. Traditional massages are also effective where Western medicine is often not - Indonesia is famous for that.

The needs of the many outweigh the needs of the few. Indonesia has a health care system that fits the needs of its people. Let's not think about improving (and paying for) high class health care while a large percentage of the people still live in abject poverty.



Yerun
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On 08 August 2009 15:34 hobo1 wrote:
The needs of the many outweigh the needs of the few. Indonesia has a health care system that fits the needs of its people. Let's not think about improving (and paying for) high class health care while a large percentage of the people still live in abject poverty.
It does not, that is what the article is all about. Tens of millions without proper access to a doctor or further medical care if needed.



FredB
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Indeed, it does NOT. And it is probably concerning closer to HUNDREDs of millions of Indonesian people lacking the BASIC healthcare.
This hobo dude must live in another, long passed, century, is why he's tucked away in his bunker. Thinking that the people of Indonesia are or should be satisfied having their traditional medicine men is proof enough for me that he is in need of a mental doctor. Go to a traditional one that chops off limbs to heal a criple!
It is about corruption and illegality, that's why all those people lacking the basics in healthcare; and they are not happy about what they have got now. Far from it.



hobo1
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You have pinpointed the problem.. If hundreds of millions of Indonesians lack basic healthcare in a country of 240 million, then virtually the entire population is lacking what you define as "basic healthcare". I live in a remote island and can clearly see the quality of health care received by the poorest of the poor.

Take the example of a cripple. A traditional healer can treat broken bones - even my German born grandmother could set broken bones. That doesn't require special treatment. Now let's assume the cripple is suffering from torn ligaments or something that requires surgery and follow-up physical therapy. The price of such an operation, and follow-up treatment would be at least US$2000 - much more if "modern techniques" were used. Do you expect the government to pay for that operation for a hundred million people? Unlike Western countries, Indonesia has a very low tax base and such a program would sap the resources from the central government. How do you propose the government pay for such a system? Stop the rice subsidies to the poor? Or stop construction of infrastructure projects which are the key to a more prosperous future?

A population must live within its means. You would have one person being treated in a modern hospital while his brother is on the brink of starvation? If Indonesia wants modern health care, its residents must work collectively as a nation to lift up the entire social support structure. That must include not only health care, but adequate food, clean water, healthy sanitation, good education, sustainable, clean environment, and a moral structure free from corruption. A rising tide lifts all boats. And the quality of health care must rise along with the development of the entire country.



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