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Prof. Dr. Zubairi Djoerban, Sp.PD, FINASIM, Consultant Hematology Medical Oncology

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Zubairi Djoerban

The ASEAN Economic Community

Opportunities for Progress - Part 2

The ASEAN health market now consists of 10 countries with an estimated value of 84.479 billion euros or 90 miliar billion US dollars. From that amount, the largest market share comes from Indonesia, Thailand and Singapore, followed Malaysia which is considered as one of the hotspots for health investment and business.[1] One can see many international hospitals established by foreign investment in Jakarta and other major cities of Indonesia.

The developing health industry and market in the ASEAN region comes with a number of challenges and interesting opportunities. The ASEAN Common Market (also known as the ASEAN Economic Community or AEC) was officially launched two years ago. This not only allows individuals to have more choices in buying goods and services, but also the opportunity for professionals to offer their expertise beyond the boundaries of their own country. What is happening is the internationalization of health services. This is not only about health products (medicines and medical equipment), but also health professionals such as doctors, nurses, and therapists, that need to be qualified and receive certification applicable in all AEC member countries. Wherever possible the agreed qualification and standardization should be the same or at least close to global standards applied in other developed countries. For your information, the Cipto Mangunkusumo Hospital in Jakarta and the Dr Sardjito Hospital in Yogyakarta have already passed the accreditation process conducted by the Joint Commission International (JCI), a guarantor of the quality of health care institutions based in the United States.

In the ASEAN region health tourism has already developed particularly in Thailand, Singapore, Malaysia and recently Indonesia.[2] For quite awhile we have often heard stories of Indonesian patients being treated in Singapore or Penang because they consider these places as offering better, comprehensive services at a competitive price compared to treatment in Jakarta, for example. It is also common knowledge that some hospitals in neighboring countries have their own helicopter runways used to transfer patients from Jambi, Riau, Medan and surrounding areas to their places. There are also quite a few private hospitals in Jakarta that have collaborated with hospitals in Singapore, China or Thailand, so the referral process from Jakarta to Bangkok, for example, becomes much easier. Patients and their families do not need to go through the inconveniences to take care of various certificates and  required copies of their medical records. Everything will be taken care of neatly by appointed agents, including arrangements for passports and roundtrip transportation. In other words, patients just simply need to prepare their personal suitcases, then sit quietly waiting for their pickup and treatment.

Among the most popular services and outlets are in this region are related to examination or treatment for cardiovascular diseases (angioplasty, CABG / bypass surgery, and transplantation), orthopedics (treatment to support the joints and spine), cancer (advanced stages or terminal), reproductive health (fertility, IVF, and other women’s health issues), weight loss (including gastric bypass), cosmetic surgery, and some supporting treatments such as CT scans and others for the purpose of medical check-ups.[3]

Increasing public awareness on the importance of health makes many people, especially those who can afford it, pursue what they perceive as the best quality services. And because personal comfort is increasingly being considered as more important, many patients equate quality of service with personal convenience.

But things have changed since the launch of JKN/BPJS (public health insurance scheme) these days. I can observe this phenomenon on a daily basis in my office. There is a shift among patients who used to have the tendency to go abroad are now beginning to look at options within their own country. Some of my own cancer patients would go to Singapore or Malaysia to get more assurance about their condition. But once the diagnosis is established, they undergo chemotherapy for one cycle, and then return and continue and complete their treatment in Indonesia. The economic principle applies here, namely to pay as cheap as possible to get maximum or optimal results. These patients see an opportunity to use BPJS to get chemotherapy drugs for free and they only need to pay for the cost differences of rooms when they choose VIP or VVIP rooms.

We do not have to respond to this matter by being cynical. In fact, on the contrary, we should be grateful that there is an increasing trust among clients towards doctors and health care whithin our ow the country. Each patient we take care of is actually increasing our own skills as medical doctors, and this means we are being more in competition with doctors from abroad. Some colleagues have proved this from testimonies of their patients.

Another example I observed is among patients with HIV and AIDS. It has been a long time, even before the launch of BPJS, that the government provides free medication for line 1 and some types of line 2. Patients who are admitted to Kramat 128 Hospital, for example are not only Indonesian citizens, but also citizens of Japan, Korea, Australia, Nigeria and others, who get access to free medicine provided by the government of Indonesia. We also need to note that many of them mention that the quality of services in Kramat RS 128 Hospital is equivalent to those in their own home country. Free medication is another advantage that makes them look for treatment in Indonesia as the best option available.

Again we do not need to be cynical. Our capacity to treat HIV has grown rapidly in the past decades since the first case was found. The fact that the current Faculty of Medicine fo the University Indonesia-RSCM have become one of the global study sites for HPTN 074 indicate that our skills in HIV case management and laboratory infrastructure are now recognized in the international community. The quality and increased life expectancy of people living with HIV (PLHIV) is another evidence. The economic principle for HIV therapy, therefore, is not the only factor. Quality of service remains the most important factor.

BPJS coverage is gradually becoming better. Heart patients who used to take the option of being treated in Penang, Malaysia for stent, are now choosing to receive treatment in Indonesia because the stent is covered by BPJS. Total treatment costs become zero, or at least much cheaper. Medication for lupus has also began to be covered by BPJS. The latest news I heard about is that even the expensive drugs for renal lupus is now approved to be covered by BPJS. The government has officially made that decision and so the mortality rate of patients with lupus can be decreased and their quality of life is improved.

Again, BPJS has given us greater opportunities to develop the skills of medical doctors. Our homework now is to find ways to improve the quality of continuing medical education. We have that opprtunity now and it is facilitated by BPJS. Public confidence is rapidly increasing and it now depends on how faculties of medicine, the Indonesian Medical Association, and other professional associations accept this challenge. Lastly, the rapid increase of BPJS patients have not been complemented by a more reasonable remuneration for physicians. There is  still much work yet to be done by the government if we want to reach universal coverage and continue to improve it quality.

Article translated by Danny Yatim, Angsamerah Networking Expert

References

1. http://www.tforg.com/how-we-think/sweetspot-blog/2015/11/30/the-asean-economic-community-and-the-healthcare-market-in-thailand/
2. http://www.pacificbridgemedical.com/target-asian-markets/singapore-medical-market/
3. http://www.tforg.com/how-we-think/sweetspot-blog/2015/11/30/the-asean-economic-community-and-the-healthcare-market-in-thailand/

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