TheJakartaPost
Please Update your browser
Your browser is out of date, and may not be compatible with our website. A list of the most popular web browsers can be found below.
Just click on the icons to get to the download page.
Taking digital health forward in Indonesia
Delivery of health care in Indonesia faces myriad challenges: shortage of trained manpower, infrastructure deficits and fiscal challenges to name a few.
Change Size
D
elivery of health care in Indonesia faces myriad challenges: shortage of trained manpower, infrastructure deficits and fiscal challenges to name a few. These challenges are compounded by the arduous task of delivering health care to almost 300 million people across some 17,000 islands, many of whom are afflicted by non-communicable diseases requiring continuous medical management. Rising to the challenge, both the government and private sector have taken bold steps, particularly driving digital health care as a game-changing solution. These changes have been further accelerated by COVID-19 over the last few years.
On its part, the government has laid out a bold vision for digital health transformation – including the integration of health data systems, the integration of healthcare application systems and the strengthening of health technology ecosystems. This is expected to lead to more informed health policies, more efficient health services and the development of digital health ecosystem involving government, industry and the public.
At the same time, private players have been building out ecosystems of digital health services to cater to an ever-growing population seeking greater accessibility and convenience. While digital-first players like Halodoc and Alodokter have been scaling up tech platforms to offer a growing portfolio of digital health services, traditional brick-and-mortar providers have been digitizing their existing processes to enhance patient experience and minimize inefficiencies. Together, this has led to Indonesia leading the way in digital health disruption in the region.
Great early strides have been made, but the question now is how we scale up these solutions to ensure that the benefits of digital health can be sustainably delivered to reach a wider population.
Five pillars to drive digital health in Indonesia
Digitized medical information is the foundation
Digital patient information is an important foundation to deliver digital health services. With less than 25 percent of Indonesian healthcare facilities utilizing electronic health records today, access to portable, digitized patient information to deliver care, or, take health system level resource decisions remains a challenge. Introducing unified electronic medical record systems, addressing the interoperability of systems and data protection and security are critical issues to be addressed as a priority.
The government has taken bold steps in this direction. The vision to create an integrated health data warehouse under the Indonesia Health Services (IHS) provides a strong foundation to digitalize the health sector. Integration of health data systems across stakeholders, the creation of a centralized national health data platform and leveraging big data and analytics provides the necessary framework to implement patient-centric healthcare services as well as to take policy-level decisions.
Successfully implementing this vision will require infrastructure investment to digitize patient information, strong policy interventions and collaboration across stakeholders.
Regulatory clarity is key
Among the various digital health segments, only telemedicine and online distribution of medicines (e-pharmacy) today have clear regulations. For both telemedicine and e-pharmacies, regulations clearly outline the scope of services and recognized providers for these services. As a result, these segments have witnessed active private sector participation and rapid growth.
While these are important initial steps, broader regulatory clarity across the spectrum of digital health services including data protection, promotion and marketing of digital health services, and wider e-commerce regulation for digital health offerings is vital in enabling broader adoption of digital health. A case in example is Singapore, with national guidelines for telemedicine, for using software as a medical device, for artificial intelligence in healthcare and for personal data protection regulating healthcare data storage and transfer by providers.
Reimbursement needs to speed up
Approval by regulatory authorities and subsequent reimbursement of digital health services has been a critical enabler to drive digital health uptake in many countries. Globally, digital behavioral therapy, chronic disease management and telemedicine are all digital health segments that have benefited significantly from reimbursement.
In Indonesia, digital health services remain largely non-reimbursed. Even the most widely adopted digital health service – telemedicine – is largely paid out of pocket, or in some cases, covered by private insurance. Reimbursement of digital therapeutic solutions is uncommon. These barriers to reimbursement dramatically limit the uptake of digital health services, which can often be equally effective and potentially more efficient than physical services in improving patient outcomes.
Regardless, health insurance coverage for physical services also remains limited in Indonesia, and it remains to be seen if Indonesia can leapfrog beyond physical access to deliver wide insurance coverage that incorporates digital health services.
Multi-stakeholder collaboration ensures success
Healthcare systems are complex and adoption of digital health at scale requires careful orchestration across different stakeholders.
This is particularly true for Indonesia – with a decentralized public healthcare system, multiple stakeholders spread across public healthcare delivery, private providers and policymakers and limited coordination mechanisms to orchestrate system-wide transformational initiatives.
Successful delivery of digital health given Indonesia’s unique landscape will require structural mechanisms to drive collaboration. This will necessitate a clear supportive policy setting and regulations to drive adherence and adoption of guidelines. It will also entail financial or tax incentives to ensure private sector cooperation, further supported by establishing tight governance and project management.
Driving adoption with healthcare professionals is crucial
Doctors are the beating heart of health care, and empowering their digital shift is critical. Although the pandemic has accelerated adoption of digital health services in younger, tech-savvy doctors, adoption of digital tools among the broader physician community remains low, particularly among veteran clinicians.
It is important to change the perception of health professionals around digital health solutions, addressing attitudes that telemedicine may be a temporary, stop-gap measure to cope with a surge in patient numbers. This mindset shift and digital adoption requires a multipronged approach. It requires educating the broader medical fraternity about digital health benefits and hands-on training and support during adoption. It also requires engaging key opinion leaders to help build trust and encourage fellow physicians. And finally, it requires addressing uncertainties in regulations, legal security and malpractice liabilities.
Digital health care offers an invaluable solution to address Indonesia’s health care challenges. Delivering on that potential will require a challenging mix of technology investment, enhanced regulation, improved reimbursement, vital collaboration and shifting mindsets in clinicians. That is by no means an easy transition. However, if it is delivered, the rewards far outweigh the challenges, providing a unique opportunity to boost healthcare access and patient outcomes for the entire healthcare ecosystem.
*****
Anurag Agrawal is partner and associate director and Yishu Pi is consultant at Boston Consulting Group
