Free Care Plan Underpays Us: Doctors
Markus Junianto Sihaloho
General practitioners are resisting a regulation governing the new social security agency that they contend will see them earn less than barbers.
Nova Riyanti Yusuf, deputy chairwoman of House of Representatives Commission IX, which oversees health affairs, said on Tuesday that the grievances were made at a meeting earlier in the day between legislators and officials from the Indonesian Doctors Association (IDI).
Under the supporting regulation for the Social Security Organizing Body (BPJS), which in turn is meant to underpin the National Social Security System (SJSN), general practitioners will be required to offer their services for free to the public, but will be subsidized by the state.
Nova, a Democratic Party legislator and psychologist, said the reimbursement scheme was set at Rp 2,000 per patient per month, multiplied by the number of SJSN-covered residents in their area.
She said this meant that if a doctor’s area covered 10,000 patients, he or she would only be paid Rp 20 million ($2,120) a month by the government, regardless of how many free treatments and consultations they performed. “The doctors I spoke with point out that even a barber gets Rp 7,000 per customer, which is much higher than the Rp 2,000 that a doctor gets for each patient,” Nova said.
“There needs to be equitable treatment for all Indonesians, and that includes doctors, who should not be sidelined or disadvantaged by the BPJS regulation.”
She argued that the doctors’ demands for a higher premium per patient under the social security system was reasonable and should not be misconstrued as greed.
She said that although they were bound by the Hippocratic oath to provide treatment regardless of a patient’s ability to pay, there had to be pragmatic considerations made for their own economic welfare.
Nova also argued that doctors had invested a lot in their education and training and that it was only reasonable to allow them to recoup that investment.
“No one wants doctors to fall into financial straits, especially considering the high-risk nature of their work, where they run the risk of being sued for billions over possible malpractice, and the fact that they have to be responsible for the health of 238 million Indonesians under this utopian universal coverage scheme.”
Nova said there was still time to reformulate the doctors’ reimbursement calculation in the BPJS regulation before it takes effect on Jan. 1, 2014.
Currently, 117 million Indonesians have some form of health insurance but domestic workers and contract-based laborers are not covered, an issue the BPJS aims to change once it is fully operational.