Can Indonesia Learn From UK Healthcare System?

I have experienced healthcare systems in Indonesia, Singapore, and the UK. After living in the UK for ten years, I am converted into a staunch supporter of the National Health System (NHS) of the UK. Of course I admit that the NHS is not without its failings. For one, its cost keeps on ballooning, and the NHS has been under the threat of bankruptcy right from her inception 60 years ago.

'Cradle to Grave'

However, the UK spends much less money per capita on healthcare compared to the USA. Countries that rely on private healthcare system provide a rather cruel treatment to certain segments of the society. If one has money, one can receive the best treatments on the planet. However, woe befalls those with empty pockets for they will not receive a decent service. This is why I adore the NHS; a system that allows both princes and paupers to receive equal healthcare treatments. I do have to give a disclaimer as I currently work for the NHS so please expect a rather biased view.

It would be desirable if the Indonesian healthcare system is able to adapt some basic ideas from the NHS. As you are aware, both in Jakarta and the rest of Indonesia, there has been a recent change to improve access to secondary healthcare by making it free for those who earn below certain levels of income. Understandably, this initiative has resulted in overcrowding of these secondary healthcare centres, that is, the hospitals, and led to some tragic consequences such as deaths due to delay in initiating treatments.

'Gatekeepers' of the system

Remedial works have been tried, especially in ensuring that referrals from Puskesmas are required to have services provided in the hospitals. This is where, I believe, we can learn from the NHS. The structure in the NHS is quite similar to the Indonesian healthcare systems. The function of Puskesmas is delivered by General Practitioners (GP) here. Every patient would need to be seen by the GP before being referred to a specialist in the hospital. Thus, GPs act as 'gatekeepers' in the NHS.

To be able to perform their duties fully, GPs in the UK are trained further for 5 years after they graduate from medical schools. Therefore, GPs in the UK are experts in managing chronic diseases. They are also given economic power to enable them to buy services from the hospitals. Subsequently, these GPs will tend to buy high quality services from hospitals.

Function of the Puskesmas

We may be able to do the same with our Puskesmas system. The Puskesmas doctors and nurses can also have the function as those 'gatekeepers'. Their knowledge and skills should be upgraded so that not only doctors who have just graduated from medical schools are able to deal with complicated illnesses. These new doctors should receive supervision from more experienced doctors so that chronic diseases can be managed in Puskesmas and only difficult cases are referred to the hospital. This is because hospital care is expensive and resource-intensive.

Furthermore, Puskesmas should also be given more financial power and they should be able to manage their own budgets. The gravest medical problems in Indonesia are still due to malnutrition and infection. Non-communicable diseases, such as heart attack and diabetes, are catching up quickly. These problems are preferably treated in Puskesmas, hence we should strengthen the Puskesmas system to deal with these fundamental problems.

source: www.globalindonesianvoices.com