AngloInfo Text_Indonesia: Health, Doctors, Hospitals & the Medical System

Indonesia: Health, Doctors, Hospitals and the Medical System

Structure of Indonesia’s Healthcare System

Coverage
Social Security programs are governed by the Social Security Act of 1992. Indonesia spends 1.5% of the GDP on social security programs, 95% of that is spent on old age benefits (eligibility begins at age 55). The program covers establishments with 10 or more employees and/or a monthly payroll of Rp.1 million (1USD = Rp.8950) or more. A special system of social insurance is available to public-sector employees and military personnel. Though not yet available, coverage is being extended gradually to employees of smaller establishments and to organized informal-sector worker, including persons in family employment, fishermen and those employed in rural cooperatives. The social security system is managed and administered by the Employees Social Security System (Jamostek). The Ministry of Manpower provides general supervision.
Civil servants receive social protection through a special social security program (Government Civilian Employees’ Savings and Insurance and Pension Plan). The benefit, which includes a life insurance scheme, is paid at retirement or death and is about 19 times the final monthly salary.
For the military, there is the Armed Forces Social Insurance Plan. The retirement provision for private sector workers is through the compulsory provident fund called Jamostek which was established under the Social Security Act of 1992. This act covers 10% of the population or one-fifth of the total labor force excluding the remaining four-fifths of the labor force involved in informal sector employment.
Taken together, medical and retirement benefits for select groups include:

Jamostek- social insurance fund for private sector employers and their employees. Services include: Employment Injury, Death, Health Insurance, and Old Age Benefit.
Taspen- the civil servant fund. Provides lump-sum retirement and a pension program.
Askes- provides health insurance for public sector employees and some others.
Asabri- a combination of Taspen and Askes but for the armed forces and police. Lump-sum retirement, pensions, and health care programs are included. The armed forces have some of their own hospitals.
JASKESMAS/ JASKESMAS- these are companion health insurance programs that cover the cost of medical services for the country’s poor. (See below for more information)

Indonesia does not currently have a national health insurance program or retirement system that serves the population outside of the select groups listed above. Indonesians who aren’t covered will be expected to pay for medical services out-of-pocket. As mentioned, the Indonesian government invests in health with public expenditures at around 1.5% of GDP. This is one of the lowest rates in South East Asian countries. Overall, less than 25 Euros per capita is spent on health annually in Indonesia, and nearly half of that is borne out-of-pocket by Indonesians themselves. The other half comes from mainly from government programs, with foreign aid accounting for some of it.

COVERAGE for the POOR

Amendments of Article 28H and Article 34 (2) and (3) to Indonesia’s 1945 Constitution states that the health of all Indonesians, including the poor, is assured by law.

With the rise of democratic institutions in 1998, the Indonesian government has implemented a few health programs that serve the disadvantaged. Half of Indonesia’s population of 240 million lives on less than two American dollars a day and cannot afford medical costs.

JASKESMAS/ JASKESMAS – Indonesia’s largest Health Insurance program

Because this group of people is so large, JASKESMAS/ JASKESMAS health insurance constitute the largest government health care programs.

Currently, Indonesians who carry JASKESMAS (Kartu Jaminan Kesehatan Masyarakat- Community Health Insuarnce) or JASKESMAS (Jaminan Kesehatan Daera- Regional Health Insurance) are entitled to medical service that is provided free or at greatly reduced cost. In order to be a recipient, an individual’s poverty status must first be confirmed “official”. Upon request, the village chief, or Kepala Kelurahan issues a poor family of the community a SKTM (Surat Keterangan Tidak Mampu- Certificate of Disadvantage), declaring them “impoverished” as determined by the local standards. Determination is subjective- that is, subject to the village chief’s discretion.

The individual applies for the new program at the local general public hospital. Parents apply for their children. Documents needed:

Surat Keterangan Tidak Mampu (Certificate of Disadvantage)
Surat keterangan dari pihak sekolah (proof children of family attend local schools)
Kartu Keluarga (KK) (Family Registration Card)
Kartu Tanda Penduduk (KTP) (National ID Card for those 17 years of age and older)
Photos of each family member (2 x 3 cm)

PUBLIC HEALTH FACILITIES

There is a substantial private health care system in Indonesia, but most people are served by the public sector.

Indonesia’s health care system is controlled by a nationwide, hierarchical bureaucracy. Doctors, for instance, are civil servants and paid relatively low wages. National law sets forth all rules and regulations concerning health service delivery and the responsibilities of its medical professional ranks.

The organizational chart flows down through the political units:

Minister of National Health- DEPKES (Departemen Keseahatan)
Provincial Level Health Office- DINKES (Dinas Kesehatan Propinisi)

(Tingkat Propinsi)

District Level Health Office – Dinas Kesehatan Tinkgat Kabupaten

(Tingkat Kabupaten dan Kota- i.e., includes cities within the district)

Public Hospitals

Public hospitals (RS or rumah sakit) are found at both the provincial and district levels. The best equipped of those hospitals are found in urban districts and provincial capitals. There are very few specialist hospitals that are publically funded. Many of those are only found in the very largest cities, with the majority located in the capital of Jakarta.

Village Health Clinics

The next level is the sub-district level (Tingkat Kecamatan), or PUSKESMAS (Pusat Kesehatan Masyarakat). These are best described as village health clinics. PUSKESMAS breaks down into three categories. Sometimes the three functions serve under one roof, other times not:

Sub-Health Center (PUSTU- Puskesmas Pembantu)
Village midwife clinic (POLINDES- Pondok Bersalin Desa)

Integrated Health Post (POSYANDU- Pos Pelayanan Terpadu)

As found at the village level, the PUSKESMAS is a very important medical provider. For many villagers, it is the only medical access available. A PUSKESMAS is like a very small hospital. All PUSKESMAS are supposed to be open 24 hours a day. Better funded PUSKESMAS have general practice doctors on site 24 hours a day as well as nursing staff. Specialists call in on schedule perhaps once or twice a week, as does a dentist. Most have some in-patient facilities and a pharmacy on-site.

As mentioned, a broad decentralization plan has been in effect in Indonesia since 2004. That plan details the responsibilities for each level listed above are presently as follows:

Regional development has to be performed by the districts and cities, while the provincial level attends to those the lower levels haven’t covered. Meanwhile, the central government performs the role of policy formulation, standards and providing guidance to all levels of government under them.

RESTRICTION on DOCTOR PRACTITIONERS

Only Indonesian doctors are allowed to treat patients. This pertains to all health care facilities in Indonesia. Expatriate physicians can be hired and kept on site only as a medical consultant.

MENTAL HEALTH

Indonesia has a developing mental health service, but there are comparatively few practicing psychologists and psychiatrists in Indonesia. Psychotropic medications are not generally available.

PRIVATE HEALTH SYSTEM

Government Act on Health No. 23/1992 states that “Health Systems” should be implemented by the community with government as facilitator. Private sectors are encouraged to perform an active role in the nation’s overall health care system. Government is to provide guidance, appropriate regulation, and supervision.

Indonesians who choose to use the private health system seek higher quality care, more specialized care, better facilities, and more comfortable accommodations.

General and specialist medical practices, clinics, laboratories, and hospitals as privatized exist in great abundance in Indonesia’s urban centers, but to a much lesser degree in rural areas. Because doctors are paid low wages for their government practices, they are allowed to practice privately. A doctor’s office as located outside a government facility will most likely be a private practice. This includes both general practitioners as well as specialists.

Some hospitals are run by non-profit and religious organizations. Most are for-profit businesses owned by Indonesians. In 2010 a new law was put into effect that allows foreign investment in the privatized health sector. Over time this will substantially increase health care offerings to consumers.

Those who use private medical services will be expected to pay for them in cash when services are rendered or carry private insurance.

MEDICAL CARE FOR FOREIGN RESIDENTS & TRAVELERS

What health services are available to foreign nationals?

Foreign nationals who travel or live in Indonesia do not need to carry any form of insurance in order to enter the country. Nor are they eligible to receive government sponsored health care. If they are working for a company in Indonesia, they may have as part of their employee benefits package private health insurance. Most foreign nationals travelling or living in Indonesia aren’t foreign workers. They must either carry some sort of private insurance from their home country (such as traveler’s insurance), buy into an insurance program in Indonesia or perhaps more regionally, or pay out-of-pocket.

Foreigners who buy quality health insurance often pay extra for emergency services. MEDIVAC/MEDEVAC helicopter evacuation is one good example. This applies, for instance, to those who may be planning for potentially dangerous guided treks into remote areas.

Indonesia is considered to have the highest rate of natural disasters in the world. For those who travel or live in areas prone to being cut off due to floods and landslides, medical evacuation can become a serious issue when an injury or illness occurs. Trapped in a flooded area poses added risk of contact with water-borne disease. This is compounded by Indonesia’s poor sanitation practices.

In short, accidents that would otherwise be considered relatively minor can become serious or life threatening in isolated parts of Indonesia.

OVERALL QUALITY of INDONESIAN MEDICAL CARE

Indonesia’s medical care facilities and the competence of its medical professionals are ranked much lower than that of developed countries. Though Indonesia’s health care system has improved greatly over the past two generations, its progress has stalled recently. For serious illness, most foreigners seek medical treatment outside the country. Singapore and Bangkok are popular destinations. The same is true for well-off Indonesians. Most Indonesians visiting nearby Singapore, for example, do so for medical reasons.

There have been many documented cases of misdiagnosis as occurs under a doctor’s care in Indonesia. This sometimes relates to human error on the part of the doctor, but also reflects the lack of hi-tech diagnostic equipment and procedures available in the country.

Ambulance Service
Ambulance services are individually run by hospitals and clinics. There is no reliable emergency ambulance service in Indonesia. Indonesian ambulance attendants lack paramedical training equivalent to standards in most of the developed world. Ambulances themselves are relatively under-equipped as well. Foreigners living in Indonesia are recommended to investigate private ambulance services in their area. Expect traffic to increase transportation time in metropolitan areas, sometimes significantly.
Ambulance services are non-existent in most of rural Indonesia.

GENERAL AVAILABILITY

Urban vs. Rural

Foreigners who travel or live in Indonesia’s larger urban areas or highly-developed islands such as Bali will generally find easy access to health care services and pharmacies.

The opposite is true in rural areas. These areas are generally less wealthy, have poorer health, and limited access to medical care. The island geography makes reaching remote regions doubly hard. Foreigners finding themselves in such areas will be affected similarly. Emergency services are especially scarce.

Unequal Access

The statistics are as follows: for rural areas there exists 1 doctor per 16,792 people. For urban areas: 1 doctor per 2,763 people. Doctors are government employees and receive low salaries. They top their salaries through private practice on the side. Such opportunities in rural areas are few so doctors would rather not practice there.

The same is true for medical facilities. Well-equipped hospitals especially are scarce in rural communities. The only remote areas well-served are seats of provinces, districts, and sub-districts.

ACCESS to MEDICAL FACILITIES

Both public and private medical facilities are open to foreign nationals. Any foreigner can walk into a public or private hospital, PUSKESMAS (village health center), or clinic and ask for a test to be taken or to see a doctor. Foreigners have the right to admittance as in-patients, too.

Many hospitals have ranked services, especially in terms of accommodation. General admittance-shared hospital rooms versus V.I.P. private rooms are a choice in many hospitals. V.I.P. rooms are spacious, furnished (which often include amenities such as sofas, private bathrooms, private balconies and refrigerators) and offer better food and more personalized nursing care.

Hospitals generally have their own pharmacies as do PUSKESMAS.

If insurance is not available, all services are customarily paid for in total and by cash. Payment by installment is rarely an option.

PHARMACIES & FILLING PRESCRIPTIONS

Pharmacies are found in abundance in urban areas. Some are open 24 hours a day. Some have private clinics in the back staffed with doctors and sometimes dentists, too.

Pharmacies in rural areas are often scarce. The only access to medicines found in many villages is to be found at the local PUSKESMAS. Remote areas often have no medicine stocks available if no PUSKESMAS exists. NOTE: a PUSKESMAS pharmacy is usually not as well-stocked as a commercial pharmacy as found in an urban center.

Some common drugs and medicines that would require a doctor’s prescription in a country such as the United States are freely available in Indonesia. This is especially true of antibiotics. They will simply be sold upon request by a pharmacy. Still, many drugs require a prescription.

In general, expensive, highly specialized treatments and medicines aren’t available outside of major urban areas such as Jakarta. Sometimes a trip outside the country is necessary to access them. Even common, over-the-counter drugs such as aspirin and ibuprofen can be very difficult to come by.

Finding the Proper Care

Outside of well-developed, urban areas, knowing where to find an English-speaking doctor, a 24 hour pharmacy, a qualified specialist or general practitioner, or the appropriate hospital or clinic is difficult. Even in a metropolitan area, access to information can be difficult. In rural areas many times there is simply no choice but to report to the one and only medical facility that exists.

Foreign embassies and consulates are good sources of medical information. Most are located in Indonesia’s most developed areas: Bali, Jakarta, Medan, and Surabaya.

Visiting a local hospital or PUSKESMAS and requesting information is as good an alternative as any given no prior sources. Reporting in person is usually more fruitful as compared to calling, even if you can speak Indonesian.

In general, researching the topic prior to arrival in Indonesia is recommended. Web sites that carry lists of doctors and medical facilities are cited in the Further Information section at the end of the page. Travel guides offer lists as well, but become out-of-date quickly.

Prevention and Treatment for Common Tropical Diseases

Diseases such a malaria, dengue fever, tuberculosis, typhus, polio, and rabies are serious threats to public health in many places throughout Indonesia. It is advised that foreigners planning to travel or live in Indonesia consult with a physician before arrival. Usually a physician will in turn consult with a clearinghouse like the CDC (Center for Disease Control and Prevention) for the most current information. Following an update they will offer the traveler a list of recommended vaccinations and prophylactic medicines. This should all be initiated at least two months before departure. Some vaccination regimes are multi-stage and take place over several weeks.

Preventative medicines for malaria are cause for special consideration. Malaria is especially prevalent in Indonesia. West Papua has at least twenty strains and some are extraordinarily difficult to cure. Therefore most travelers request anti-malarial medications. Many are available and some carry the risk of negative side effects.

FURTHER INFORMATION

Country Report- Indonesia
U.S. State Department
Re: Medical Facilities and Healthcare Information
http://travel.state.gov/travel/cis_pa_tw/cis/cis_2052.html#medical

Hospitals, Clinics, and Physicians

This list contains names and addresses of facilities and individuals for medical purposes in Bali:

These sites contain names and addresses of facilities and individuals for medical purposes throughout Indonesia:

http://www.pacificprime.com/countries/indonesia/hospitals.php

http://healthsharing.wordpress.com/2008/01/26/list-of-medical-facilities-in-indonesia/

http://www.indonesia.embassy.gov.au/jakt/MedicFac.html

http://jakarta.usembassy.gov/service/medical-providers-clinics.html

Bali Emergency and Rescue Numbers

http://www.balistarisland.com/Bali-Information/Bali-Emergency.htm

For the best up-to-date information on disease, disease-outbreaks, disease prevention, and treatment the world over:

CDC- Center for Disease Control and Prevention, Atlanta, Georgia, USA

http://www.cdc.gov/

Special Providers for the Expatriate Community

International SOS and Global Doctor are membership-based, full-service medical organizations and are mentioned on the U.S. Embassy- Jakarta’s web site.

INTERNATIONAL SOS MEDIKA

Operating medical clinics located in Jakarta, Bali, and West Kalimantan, International SOS serves mainly expatriates living in Indonesia. Indonesian doctors are available 24 hours a day. An expatriate doctor is on staff for consultation purposes, too. Ambulances are always on call. International SOS belongs to the medical evacuation organization, Asia Emergency Assistance which serves the greater region.

International SOS, Jakarta

SOS Medika Klinik and Jakarta Alarm Center
Jl. Puri Sakti 10, Cipete
Jakarta Selatan 12410
Clinic Tel. (62-21) 750-5980 (appointments)
Admin Tel. (62-21) 750-5973
Fax (62-21) 750-6002-3
24 Hour Alarm Center (62-21) 750-6001
Clinic Technical Advisor : Colm Benson
Email jkt.enquiry@internationalsos.com
Website www.internationalsos.com and www.sosindonesia.com
Hours of Operation:
Clinic Consultation 7am to 10pm daily
Clinic Emergency Unit 24 hours daily
SOS Medika Klinik Kuningan
Menara Prima 2nd Floor
Jl. Lingkar Mega Kuningan Blok 6.2
Jakarta 12950
Telephone (62-21) 5794 8600
Fax (62-21) 5794 8686
Consultation Days:
Monday to Friday (8am to 6pm)
Saturday (8am to 2 pm)
Sunday and Public Holiday Closed
SOS Medika Klinik Bali and Bali Alarm Center
Jalan By Pass Ngurah Rai 505X
Kuta, Bali 80221
Clinic Tel. (62-361) 720 100, 710-544
Admin Fax Fax (62-361) 710-515
24 Hour Alarm Center Tel. 0361 710-505
Email sos.bali@internationalsos.com
Website www.internationalsos.com and www.sosindonesia.com
Clinic Technical Advisor: Karen O’Keefe
Consultations : 08.00 AM to 10.00 PM daily (including Public Holidays)
Emergency Assistance : 24 Hours daily

International SOS, Balikpapan, Kalimantan Timor
PKT Office
Jl. Pupuk Raya 54, Balikpapan
Tel. (62-542) 765 966
Fax (62-542) 764 237

International SOS, Bali

SOS Medika Klinik Bali and Bali Alarm Center
Jalan By Pass Ngurah Rai 505X
Kuta 80221
Clinic Tel. (62-361) 720 100, 710 544
Admin Fax Fax (62-361) 721 919
24 Hour Alarm Center Tel. (0361) 710-505 - Emergency Assistance : 24 Hours daily
24 Hour Alarm Center Fax (0361) 710-515
Email: sos.bali@internationalsos.com
Website www.internationalsos.com and www.sosindonesia.com
Clinic Technical Advisor: Karen O’Keefe
Or call International SOS Jakarta Telephone (62-21) 750-5973 Fax (62-21) 750-6002
Consultations : 08.00 AM to 10.00 PM daily (including Public Holidays)

GLOBAL DOCTOR
http://www.globaldoctorjakarta.com/

Global Doctor offers services similar to International SOS. It is based in Perth, Australia.
Medical consultation with doctors in Perth is provided through telemedicine appointments.

Jl. Patimura 15
Kebayoran Baru, South Jakarta
Ph.: (021) 723-1121/7257962
Emergency: 7258115

Global Doctor International Medical Center (24hr)
Jalan Kemang Raya 87
Kemang, South Jakarta
Ph.: (021) 719-4565

Global Doctor Clinic – Mega Kuningan (8am-7pm)
Taman Kantor A 9 #A3-A
Mega Kuningan, South Jakarta
Ph.: (021) 576-2869

References