Tifa Asrianti, Jakarta – In the absence of competition and thorough supervision, the inadequate number of hospitals in Indonesia is a far cry from those convenient ones in neighboring countries.
Even at Jakarta-based Cipto Mangunkusumo hospital, which is regarded as one of the best hospitals in the country, many patients are often seen in waiting rooms lying in sick beds because of the lack of available rooms and medical workers to serve them.
Indonesian Consumer Association (YLKI) executive director Sudaryatmo said that the government should implement standards for hospitals in the country soon so that citizens would not be forced to travel overseas to find quality healthcare.
Similar cases are even more evident at hospitals in the regions, he said, as many specialists still preferred to work on Java.
"The local administrations should approach local doctors by giving them scholarships for specialization programs under the condition that the doctors return to work there after completing their training," he said.
According to a 2009 World Bank report, Indonesia, with a GDP per capita at about US$1,750, has one hospital bed per 1,000 citizens, worse than China and Thailand, which had similar per capita GDP figures at the time. Vietnam and Samoa have lower GDP per capita levels but higher hospital bed ratios than Indonesia.
The central government has been accused of not prioritizing investment in expanding hospital infrastructure. The 2009 report recorded that private initiatives and local governments were mostly responsible for setting up new hospitals from 1995 to 2006, adding that existing government facilities have not been upgraded and are poorly supervised.
As of March, the Health Ministry recorded that 42.4 percent of 1,523 hospitals have been assessed.
Four hospitals received Joint Commission International (JCI) international accreditation: Siloam Hospital in Karawaci, Santosa Hospital in Bandung, West Java, Eka Hospital in Bumi Serpong Damai, Tangerang and Premier Bintaro Hospital in Tangerang.
This year, the ministry aims to process accreditation for 914 hospitals, accounting for 60 percent of the total number of hospitals. Hospitals with accreditation are expected to reach 1,370 by 2014.
Nico A. Lumenta, head of the accreditation division at the ministry's Hospital Accreditation Committee (KARS), claimed that the low number of hospitals assessed was due to the reality that many hospitals do not yet meet the necessary requirements.
"We can't force them to apply for accreditation when they are not ready. But in the future, we will encourage them to gain accreditation," he said.
The accreditation system in Indonesia has four grades: passed; not passed; requirements; and special. The hospitals should meet at least 75 percent of the assessment criteria in order to gain accreditation. Hospitals should renew accreditation every three years.
The accreditation system assesses the standard operating procedures in each service unit in a hospital.
Indonesian Hospitals Association expert Amal M. Syaaf said that it is difficult to improve the quality of hospital care when management teams are still struggling with the deficient number of medical workers.
"When it comes to quality service, it means quality human resources. It is easy to construct a building and buy state-of-the-art equipment, but professional doctors and qualified nurses are difficult to find," he said.
Amal said that it was important to seek foreign investment to improve hospital care conditions, especially for rural areas.
"If such hospitals bring their medical workers to Indonesia, we can learn from them and they can also learn about the diseases here," he said.
Seeing the huge market for healthcare services in Indonesia, several international hospitals from neighboring countries such as Singapore and Malaysia have expressed interest in investing and expanding their hospital businesses here.
Antara reported that 20 Singaporean hospitals are planning to set up local branches in East Java.
The requirements for foreign investment in hospitals, however, is not simple. The stipulations include that foreign ownership in a hospital cannot be more than 67 percent and foreign medical workers should be gradually phased out over a certain period of time to ensure transfer of knowledge.
Prosperous Justice Party (PKS) legislator Ledia Hanifa Amaliah said foreign competition is not a good way to improve hospital care.
She said that it would be better if the government improved the quality of local healthcare services by allocating at least 5 percent of the state budget for healthcare.
"The world-class hospitals are expensive and only a small group of Indonesians can afford to pay for them. We should focus on healthcare service for the poor first," she said.