Indonesia’s push to improve healthcare in a nation where life expectancy lags upper-middle-income peers is facing opposition from local nurses and doctors.
(Bloomberg) — Indonesia’s push to improve healthcare in a nation where life expectancy lags upper-middle-income peers is facing opposition from local nurses and doctors.
The proposed legislation that parliament is scheduled to discuss soon will make it easier for foreign doctors to work in the country and exempt Indonesians aspiring to become physicians from paying tuition fees when undergoing hospital residency.
The measure may also shift the burden of funding hospitals to the private sector by removing a required government spending from the budget. It also seeks to clarify the criteria by which a woman may seek an abortion.
Healthcare workers have staged protests, saying the changes could jeopardize their work and that parliament discussions lacked transparency. A number of medical professional groups “have prepared to submit a judicial review challenge if parliament passed the legislation,” said Adib Khumaidi, chairman of the Indonesian Doctors Association, known as IDI.
The country seeks to improve health services for its 270 million people, as the lack of doctors in remote areas and months-long wait for treatments keep its life expectancy at 71.3 years in 2019. That compares with the 76.3 years average for upper-middle-income countries.
Indonesia has six doctors for every 10,000 people, compared with neighboring Singapore with 25 and Thailand with nine, according to World Bank data. That has prompted many Indonesians to spend $11.5 billion a year to get treatments overseas.
Here are the key points in the bill:
Hospital Funding
The bill will remove the requirement for the state to spend at least 5% in the national budget and a minimum of 10% in regional budget for health spending. It will allow the government to tap the private sector to build public hospitals.
It’s unclear how the bill will affect foreign ownership limits in the health sector as set out by the investment ministry. The measure will also provide a mechanism for communities to provide funding to improve hospital services.
More Doctors
Indonesians wanting to become doctors will not only be exempt from paying tuition fees during hospital residency but will also be entitled to receive a salary. The bill would also simplify the process for doctors applying for a license to practice.
If requested by local facilities, foreign doctors would be able to practice onshore for up to four years as long as they pass a competency evaluation and agree to learn the local language.
The proposed changes don’t address the more pressing gap for services between urban and rural areas. The country has enough specialists, “our problem is in the distribution that is still centered in big cities,” said Khumaidi.
Abortion
The bill clarifies how abortion can be performed. Abortion is illegal in Indonesia, except when it’s done for a married woman with her husband’s consent or for victims of sexual assault. The proposed law also allows for abortions due to a medical emergency.
Any abortion done outside of those conditions would subject the woman to up to four years imprisonment, while healthcare workers performing the procedure could face up to 12 years of jail depending on whether it was done with the patient’s consent or not. The physician could face up to 15 years of incarceration if the abortion leads to the patient’s death.
(Adds comment on potential legal challenge in fourth paragraph.)
More stories like this are available on bloomberg.com
©2023 Bloomberg L.P.