Interview: Dr Grace Frelita
What challenges is Indonesia facing when trying to improve its health care system?
DR GRACE FRELITA: The main challenge at present is the quantity of medical personnel compared to other Asian countries. The shortage of doctors is particularly acute outside of Java and Jakarta. Even a few km outside of Jakarta medical facilities are of poor quality and have limited offerings. The number of skilled and expert doctors and nurses is not sufficient compared to the rest of the region, and the number of beds per capita is extremely low. A significant number of people therefore opt for medical treatment in Singapore, Malaysia or Thailand where the health care industries are characterised by greater accessibility and are perceived to have a better level of care.
How is the industry attempting to overcome the aforementioned challenges?
FRELITA: We have to improve the overall quality of health care. International standard accreditation is the first step to ensure quality standards are met locally. In 2007, for instance, Siloam Hospital received global accreditation from Joint Commission International, becoming the first hospital in Indonesia to be internationally accredited. It was hoped that other hospitals would follow suit and that the standard quality of care would improve. In 2010 Siloam Hospital was reaccredited and at the time four additional hospitals were following in its footsteps pursuing certification. We now have five internationally accredited private hospitals. The public sector hospitals have been mandated by the Ministry of Health to become accredited as well, with eight public hospitals pursuing international accreditation. This is undoubtedly a positive development.
What role is the private sector playing in developing the industry and how can this be enhanced looking toward the future?
FRELITA: There is a necessity to improve both human resources and funding. Private hospitals can be more flexible in regards to improvements due to the bureaucracy and regulations that exist within the public health care system. The private sector must therefore take the lead in developing the industry.
The introduction of public-private partnerships (PPPs) would help to further drive the industry as a whole. As the private sector has the facilities, and the public sector the human resources, there is a significant opportunity to combine expertise in sub-specialties with advanced equipment and facilities.
A working group within the Indonesian Chamber of Commerce and Industry is currently exploring viable schemes for the development of PPPs in the health sector. This project will be the first step to future cooperation between the private and public sectors.
What is the rationale behind the limitations of foreign involvement in the health care sector, and is it a hindrance to development?
FRELITA: It is not clear whether foreign ownership restrictions are hindering development, as the regulations were recently changed and now permit foreign investors to own up to 67% in a number of specialities or services. The issue remains, however, of laws prohibiting foreign doctors to practice in anything other than a consulting capacity.
From the perspective of the private sector, foreign experts are highly sought after, particularly in management. They would undoubtedly complement the system. They can offer different practices, technical expertise and a management style that is not necessarily present in Indonesian culture. If quality is to improve, we must be willing to learn from our peers and implement the architecture to facilitate innovation and operational performance. Indonesia is currently losing a large volume of patients to regional countries which are seeking out foreign specialists in areas like cancer treatment and plastic surgery. Acquiring more foreign talent is ultimately a very important step for helping to move our health care industry’s development forward.
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