Indonesia’s Parliament approved reforms to its healthcare sector on July 11 in a bid to improve service standards and stem the outflow of local patients. - ST
JAKARTA (The Straits Times/Asia News Network): Indonesia’s healthcare reforms are set to attract foreign doctors to practise in the country, but patients say they will continue seeking treatment abroad unless overall health facilities improve.
On July 11, Indonesia’s Parliament approved reforms to its healthcare sector, in a bid to improve service standards and stem the outflow of local patients who spend up to 160 trillion rupiah (S$14.1 billion) annually for treatment overseas, including in Singapore, Malaysia and Thailand.
The reforms include allowing foreign health professionals to practise in the archipelago of 270 million, where there were only 0.6 doctors to every 1,000 people in 2020, according to the World Health Organisation. In Singapore, there were 2.5 doctors to every 1,000 people in 2019, and in Malaysia, there were 2.3 doctors per 1,000 population in 2020.
Associate Professor Jeremy Lim from the National University of Singapore’s Saw Swee Hock School of Public Health said Indonesia’s new health law gives “a very good start” to excite and attract foreign as well as foreign-trained doctors.
“Over time, the period of practice needs to be expanded as some doctors may elect to spend their entire professional careers in Indonesia and contribute to the country,” he told The Straits Times.
Malaysian emergency medicine specialist Muhamad Syis Zulkipli, 40, said he was open to working in Indonesia, having spent five years there as an undergraduate medical student from 2002, when Yogyakarta’s Gadjah Mada University launched its international programme.
“I won’t say no... Indonesia is always very near to my heart because there are a lot of similarities in our culture,” he said.
He noted, however, that he would have to consider key factors such as salary, benefits and the country’s security and political stability.
“If you plan to work abroad, you will be interested in the offer, which you will never receive in your own country,” he added.
Under the new rules, which are expected to be in force in the coming months, foreign doctors and health professionals can initially work in Indonesia for two years after completing a competence evaluation and an adaptation process at a local hospital, with a possibility to extend their employment for another two years.
Foreign medical specialists and sub-specialists graduating from recognised overseas medical schools with at least five years’ experience, and experts in certain fields, are exempt from the competence evaluation and adaptation process.
Health Minister Budi Gunadi Sadikin said the new arrangement aims to ensure transfer of knowledge, work methods and experience from foreign doctors to their Indonesian peers, and lead to local doctors upgrading their medical skills.
The Indonesian Medical Association (IDI) has sounded caution, stressing the need for the government to impose “selective barriers” for foreign doctors to maintain professional standards, as agreed with other Asean members and through mutual recognition of medical schools.
A major step towards the recognition is verifying medical faculties in every country, said IDI chairman Adib Khumaidi.
Such barriers can also be achieved by requiring “letters of understanding” from professional associations, he added.
“There should be rules to prevent the entry of incompetent doctors, doctors who have ethical issues, bad doctors,” he said. “If the rules are set in a regulation... I think Indonesian doctors will not worry as we have made efforts to streamline standards of competence.”
Local patients ST spoke to are adopting a wait-and-see approach.
For the past 11 years, Jakarta resident Mufizar Mahmud has trusted ophthalmologists in neighbouring Singapore and Malaysia to treat his glaucoma, which was first detected when he was only 35 years old.
“Services by local doctors are good. But eye diseases are sensitive. I want the best treatment for my eyes,” said the 45-year-old. “Our doctors may be quite well trained and experienced, but (their) approach is another thing.”
He noted that foreign doctors he had consulted were willing to spend more time listening to his complaints and elaborate on procedures to be taken.
In comparison, he said, their Indonesian peers were “business as usual” – spending just a few minutes with the patient and providing minimal information on their ailments.
Many Indonesians seek treatment overseas due to the “patient-centred care” offered, according to public health expert Hermawan Saputra.
“The patient-centred care covers speed, accuracy, responsiveness, quality assurance, empathy and communication. It is usually related to satisfaction,” he said. “The comfort and satisfaction, rather than clinical effectiveness, largely affect (patients’ choice).”
The presence of foreign doctors, Dr Hermawan said, will enhance the quality of healthcare services and improve Indonesia’s healthcare system by way of increasing competition with local doctors, and this will, in turn, be beneficial to patients.
“This is good news for our people because they have options and can choose their preferred treatment, as well as (benefit from) increased quality of their healthcare choices,” he added.
When asked if he was willing to consult foreign doctors practising in Indonesia, Mr Mufizar said: “If there are foreign doctors practising here whom I can trust and I am comfortable with, I will switch to them.”
Saurma Siahaan, a university lecturer based in North Sumatra’s provincial capital Medan, whose family sought treatment in Penang in Malaysia, said she will “wait and see” if foreign doctors can offer quality services while practising in Indonesia.
She added that not only do the doctors matter, but so do hospital services and medical equipment as well.
