How can health care really care for the people?

C.G. Moghe ,  Jakarta   |  Mon, 09/08/2008 10:53 AM  |  Opinion

Last month, a peculiar incident highlighted shortcomings in the health care system of Indonesia -- a country of several thousand islands, far flung over several thousand square kilometers and populated with people of diverse economic means.

A group of patients from various outlying islands, being treated on an outpatient basis in a major government hospital in Jakarta, were forced to occupy some unused part of the hospital because they had no money to commute every day from their homes.

The group were evicted, but were saved from disaster when volunteers accommodated them in a private residence.

For a country of this geographical size and population, the incident highlighted several major inadequacies in the government controlled health care system (supposedly available to the poor throughout Indonesia at affordable prices). These shortfalls included the gross inadequacy of several hospitals, infrastructure and practicing doctors.

Had Indonesia been more active in following "best practices" (not just management jargon, but a way of life in the current competitive world), a lot more could have been done within the same budget constraints.

A number of countries now have "telemedicine" infrastructure, whereby lab test results, X Ray pictures and other relevant patient data can be electronically transferred to doctors/specialists in distant locations, instead of patients having to first be sent to distant places for testing, and then waiting there during treatment.

A doctor/specialist who receives patient data electronically can direct and monitor others for treatment at the place where the patient is located. This way, Patients would only need to be at the place where the doctor/specialist is located as a last resort.

While this system is eminently more efficient, where large distances separate patients and medical facilities (as was the case with patients evicted from the Jakarta hospital), it could also be useful over short distances, where fast decision making by doctors/specialists, ensured with the quick transfer of data for their study and direction, can save lives in emergencies.

In Jakarta, patients are known to have been taken in screaming ambulances from one end of the city to another, involving several anxious hours fighting worsening traffic. In at least some such cases, the emergency treatment at their own location could have been directed by specialists who got to know the patient's medical details via telemedicine infrastructure (saving them the trip).

A large proportion of patients from outer islands seeking assistance of specialists in Jakarta/large cities need not move from their place if specialists available in Jakarta/large cities can direct treatments, making the overall medical care more efficient and/or more evenly distributed.

Granted, the development of telemedicine infrastructure may also require investment, but it will also provide more bang for the budget with a more efficient usage of medical facilities outside major cities.

Limited availability of specialists is another major reason why patients suffering from specific medical conditions overload the hospitals/health care facilities with the required expertise, resulting in delays and extra costs.

If medical practitioners throughout Indonesia could upgrade their knowledge and skills easily and regularly, the availability and distribution of expertise throughout Indonesia would improve and make medical treatments more efficient and therefore less expensive.

In their desire to protect their own turf, the Indonesian medical profession have made it so difficult for foreign medical experts to share their expertise, that most end up visiting Indonesia only as tourists -- instead of sharing their valuable expertise and knowledge, which can they do more frequently and easily in Australia or Singapore.

As a result, many Indonesians end up being refereed to Singapore or Australia for medical treatments, due to a lack of availability of local expertise, and in the process spending much more than whatever costs would have been involved in Indonesia.

We are told of a program to extend free health care coverage (People's Health Insurance: Jamkesnas) to some 76.4 million people, for which the government has allocated Rp 4.6 trillion (US$500 million) this year. The move, however, may not answer how to prevent patients from Aceh or Papua being forced to land up in Jakarta (despite risking being thrown out at the mercy of generous Jakarta residents) because they lack the means to find accommodation in Jakarta while receiving treatment.

The system should be oriented towards treating patients where they are -- and letting Jakarta-based experts deal with them digitally.

The Corporate Terminology for these steps would be "optimization of resources" and "upgradation of capabilities of human resources". Everyone will grow to love these words, if they can improve the availability of health care for low-income earners in every corner of Indonesia.

The writer has more than 35 years experience covering several industries including financial services, and can be contacted at cmoghe@indosat.net.id

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