Indonesians who can afford it still go abroad for medical treatment

Country has one of the lowest doctor-patient ratios in Asia - 4 doctors for 10,000 people

After a Jakarta doctor told him in September that his heart palpitations were the result of stress, and handed him a script for low-dosage anti-anxiety medicine, Mr Aldi Purnama wanted a second opinion.

Despite a resting heart rate of 180 beats per minute and an irregular rhythm to boot, the IT entrepreneur braved a flight to Singapore to visit a heart specialist at Mt Elizabeth Hospital, where he was immediately admitted. The 28-year-old was diagnosed with ventricular tachycardia - a rare condition where misfiring electrical impulses cause the heart's lower chambers to beat out of sync. Mr Aldi's condition was so acute that the hospital staff readied a defibrillator should his heart fail.

The bill at the end of five days in hospital: $37,829. But it was worth it. "He said 'I'm going to fix your heart problem' and I started to cry," Mr Aldi said of the specialist. "That was the best part."

Getting top-notch medical treatment in Indonesia is complicated, even though universal healthcare covering everything from physiotherapy to cancer treatment reaches 80 per cent of the country's 260-million population. Premiums are also modest, and a married couple with a child pay on average 240,000 rupiah (S$24) a month.

Universal healthcare is expected to add 2.9 years to average life expectancy from 71 years now when it is fully rolled out. It saves 1.2 million from penury every year because the less well-off will no longer need to exhaust their savings or rack up debts to pay hospital bills.

However, most people who can afford to still either use their private insurance or travel abroad for care.

"The perception of care is bad," said Mr Hasbullah Thabrany, who helped draft the 2005 law on universal health insurance benefit.

And while private hospitals are considered a safer bet than the public option, they pale in comparison to care in Malaysia or Singapore.

"If the rich are paying for a service they don't use they will have the incentive to seek cuts in funding," he said.

Resentment among the moneyed classes could rise as early as January when premiums double to help close the US$2 billion ($2.7 billion) deficit the insurance programme is expected to run this year.

While BPJS Kesehatan, which administers the insurance plan, is expected to be able to close the gap with the higher premiums, it leaves little to improve services, Mr Hasbullah said, and Indonesians will still continue to go abroad.

"That's money going overseas that could be spent here," he noted.

Indonesia has some of the lowest doctor-patient ratios in Asia. There are on average four doctors for every 10,000 people, according to the World Bank. That is slightly behind Laos, which has five, and well behind Malaysia, which has 15.

A visit to a doctor in Indonesia involves long waits culminating in a brief consult with an overstretched physician. Errors are common.

During the 10 years to 2016, there were 317 malpractice suits levelled against Indonesian doctors, according to data collected by the Indonesian Honorary Council of Medical Discipline and media reports.

And while the government of President Joko Widodo is courting investment in the healthcare system, its ranks of doctors face little competition from foreign practitioners. Foreign doctors must get local accreditation, speak Indonesian and be admitted to the Indonesian Doctors Association.

Richer Indonesians seek treatment elsewhere. The country is the biggest source of medical tourists for Malaysia. Last year, half of the 1.2 million or so expatriates travelling to Malaysia to see a healthcare professional were from Indonesia, data from the Malaysian Healthcare Travel Council shows.

Medical services offered in Malaysia, Thailand and Singapore were worth US$9 billion last year, according to consultancy Patients Without Borders.

"Universal coverage has made care available to the bottom of the pyramid that did not have access to healthcare. However, this has not translated into preventing medical tourists from travelling abroad," said Dr Milind Sabnis, a healthcare consultant at Frost & Sullivan.

Nevertheless, many are happy with the calibre of care they get at home. Ms Dewi Komala, a Jakarta-based interpreter, sought a second opinion in Singapore to ensure a lump in her breast was benign. The Singapore doctor was so aloof and brusque that Ms Dewi came back to Jakarta to consult another doctor.

"This was the biggest concern of my life and he didn't seem to care," said Ms Dewi.

Mr Sabnis said Indonesian hospitals are lifting their game and will eventually do a better job holding on to their moneyed clients.

But Mr Hasbullah said it is only when the flow of patients is reversed that Indonesia's medical sector will be on a level footing. "When the Thais come here, then we'll know we've got a good system."

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A version of this article appeared in the print edition of The Straits Times on November 29, 2019, with the headline Indonesians who can afford it still go abroad for medical treatment. Subscribe