Chris Born (Courtesy of Healthcare UK)

The United Kingdom’s healthcare system, the National Health Service (NHS), has been acknowledged as one of the best public healthcare systems in the world. Launched in 1948, the service currently covers more than 64.6 million people in the UK and 54.3 million people in England alone. On Wednesday, Chris Born, a senior healthcare specialist at Healthcare UK of the Department for International Trade, talked to The Jakarta Post’s Gemma Holliani Cahya and shared his insights on Indonesia’s healthcare system run by the Health Care and Social Security Agency (BPJS Kesehatan) and what the nation could learn from the NHS.

Question: The NHS is a model for universal healthcare systems in many countries. What are the core principles the NHS upholds in managing funding and delivering medical treatment in the UK?

Answer: The key principal has always been that it is universal, free, and it’s also integrated. So, the idea is different departments in the hospitals, clinics, radiology, primary care, secondary care, social care, NGOs, all the services must work together. The idea is you bring all the expertise around the patient and you can offer a better service but also more efficient.

And really it is about effectiveness and using the research and the evidence to say that ‘these are things that work and we’re going to do it this way not that way’. Sure, there is a challenge to use the evidence but we have guidelines nationally. We have a national institute producing guidance to help with the decision on which drugs or treatments to use.

It’s all to make sure that we are using the most effective medicine. We’ve been assessed as the best healthcare system in the world so we must be doing something right.

After meeting with stakeholders in Indonesia, what have you learned about our BPJS?

To be honest I’m very impressed. I think in the short [period of] time a lot has been achieved. I know there are a lot of problems, and I can see that one of the biggest issues is the need to strengthen primary care because the hospitals cannot cope with more and more people coming to the hospitals so it needs to improve primary care. That’s the experience we have in the UK: improving the quality of the primary care to help patients who do not really need to go the hospitals. I think that is important.

Clearly, there is a need to improve the training of the staff in the public hospitals. And it’s really important to develop the information system, because unless you know who your patients are then you are not able to provide them with the best care, because the next time they go to the hospital they may find it difficult to find their records. So I think that there is a need to produce an information system for the public primary care and hospitals, and I think it will help to improve the service a lot.

There is always an increase in demand because as the population gets healthier, they also get older. So, the pressure is in the aging population, so as we get older then we have more illness and disability.

Secondly, new medical treatments, drugs and equipment are also expensive, so the pressure on the healthcare budget in any country is always increasing. I think what’s very important for indonesia is to perhaps review what treatments and drugs are available through the formulary that currently exists and has been approved. If they look at it again maybe some of the treatments are less effective and should be stopped and maybe others should be brought in. I think that’s one of the ways we control the cost in the UK too. We are very careful, especially with new drugs. It also goes with the equipment: we spend quite a long time on whether or not we should have that for the public, and we want to see some trials and see if it’s really useful and effective.

What is your suggestion to make the BPJS sustainable?

I think it has to be recognized, especially when you are starting out, that the demands will increase because more people will come forward for health care because they know they can get free health care. So, I think it should be accepted that it’s going to cost more in the beginning.

But even when it is stabilized, health service inflation is always higher than ordinary inflation because of increasing demand, especially as people get older. Secondly, because of new technology, drugs, equipment and treatments they actually put some pressure on the cost. So, there has to be a recognition that if you want to have universal health care, you have to keep putting more money in, and at the same time also try to be really efficient.

And I think some of the technologies make it more efficient, and for us efficiency includes using primary care more rather than hospitals, because it’s so expensive.

Indonesia is still struggling with making sure you get all the income you need. Because at the moment it seems that while the employees pay, and poor people may pay or don’t have to pay very much, there is a group in the middle who are not paying: the informal sector. We all have the informal sector but it is probably bigger in Indonesia. These people do not have regular salaries and they are not making regular payments. That is a big question about how do you get everyone to pay premium for their insurance. I’m not sure what the answers are, but making sure that you get your income from the insurance premium is important.

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