Jakarta health card pits doctors against poor patients

Jakarta health card pits doctors against poor patients Tommy Dharmawan  ;   A Medical Doctor

JAKARTA POST, 07 April 2013

“Doctors should not steal money from poor patients,” said Jakarta Deputy Governor Basuki “Ahok” Tjahaja Purnama when responding to public complaints about health services last month. For most doctors, the statement hurt them as it was only based on assumptions.  Ahok did not seem to realize that since the inception of the Jamkesmas health insurance program, the government has paid medical bills for the poor, including doctor’s fees. Such a statement is dangerous as it comes from a public leader and will sow distrust of hospitals and doctors. Since Governor Joko “Jokowi” Widodo and Ahok launched the Jakarta Health Card (KJS) program, hospitals and doctors have fallen victim to unbalanced media reports. The case of a child who died after 10 overcrowded hospitals denied him access due to lack of medical facilities is just one example. Following the launch of the KJS, Jakartans have flooded government hospitals. The problem is that the Jakarta administration initiated the program without knowing the capacity of the hospitals. So how come the hospitals and doctors were blamed for this? Jakartans should blame Jokowi and Ahok for not carefully preparing the program in detail. The system for the populist program is basically not ready yet. Often people simply regard hospitals as the assets of doctors, so if a hospital commits a mistake doctors are held responsible. In fact, in many hospitals the management is run or owned by persons without medical backgrounds. Another flaw of the KJS program is the Jakarta administration’s demand that doctors serving in public hospitals and community health centers work professionally. The administration disregards the fact that the doctors have to see 150 patients over eight working hours, which means that each patient only receives an average four minutes’ consultation with the doctor. How pathetic is this? Doctors must grill their patients about symptoms, examine them and write up laboratory examinations and prescriptions in only four minutes. The process normally takes 10-15 minutes to complete. Governor Jokowi has stated that this situation will only last a couple of months and that the number of patients attending healthcare establishment will decline in the future. Was that statement accurate and based on evidence or merely assumptions?  Another mistake concerns doctors’ salaries. Jokowi and Ahok want doctors to work professionally but they do not think about the doctors’ salaries. Jakarta’s leaders should know that most civil service doctors in Jakarta earn only Rp 1.9 million (US$195) in basic salary per month, which is less than minimum wage and even Transjakarta bus drivers who receive Rp 7 million.  This fact should straighten out public misperceptions that all doctors are rich. Many young doctors who were angered by the way the Jakarta administration dealt with healthcare shared on social media their intention to hold a demonstration.  First and foremost, if Jokowi and Ahok wish to provide the best healthcare for all, they should stop making statements based on assumptions. They should admit that the KJS has many drawbacks and was not fully prepared. Therefore, they should revise the scheme.  The administration needs to boost primary healthcare and fix the referral system, so that Jakartans will go to primary healthcare providers first if they fall sick. They will be referred to hospital if doctors at the primary healthcare centers cannot handle their cases. As a result, patients will be distributed according to the level of their ailments and hospitals will no longer be overwhelmed. The Jakarta administration cannot rely solely on the KJS program. It should promote preventive and family doctor programs as the basis of healthcare. A free-of-charge health service like the KJS will prompt people to make health their last priority. They will think it is okay to fall sick because the government will cover the medical fees anyway. They will not feel guilty if they smoke or skip exercise.  Preventive programs would make people feel that health is their top priority, therefore, fewer people will get sick and the health budget would automatically be reduced. The government should force people to live a healthy life, for example by excluding smokers from the KJS scheme. Preventive measures also require sanctions. A tuberculosis patient who does not consume the medicine appropriately for six months should face fines or perhaps jail because his or her ignorance may endanger others and society. Lastly, despite the advantages of the KJS, there are still many loopholes that need improvement. Jokowi and Ahok cannot just stop at blaming doctors and hospitals, but rather rearrange the scheme so that it benefits all stakeholders in the health sector. ●