Entrance of Foreign Hospitals/Doctors

KOMPAS/DIDIE SW

.

An influx of foreign workers, especially from China, has triggered prolonged debates on pros and cons. Opponents point to the expropriation of employment by foreign workers, even at the level of unskilled workers. Presidential Regulation No. 18 of 2018, which regulates this matter, is increasingly deemed to favor foreign workers and neglect local workers.

Nationwide demonstrations commemorating Labor Day on May 1 simultaneously targeted this presidential regulation. The House of Representatives even initiated the formation of the Special Committee on Foreign Workers. Meanwhile, the government argues that the entrance of foreign workers, which is related with China\'s investment,is not worrying. The number is still trivial, and they are mostly professional workers, not unskilled labor. Presidential Regulation No. 18 of 2018 essentially facilitates the licensing of foreign workers in order to attract foreign investment.

What is questioned above is the influx of foreign workers at the level of unskilled labor. What about the level of professional workers, especially in the medical sector? The ASEAN Free Trade Area (AFTA) includes the medical sector among 11 priority sectors. The professional workers mentioned in the Mutual Recognition Arrangements (MRA) include, among others, surveyors, engineers, architects, accountants, doctors, nurses and dentists.

Competition in Asia

The AFTA allows the flow of trade in goods and medical services in the ASEAN region. Countries with excess supply of goods and medical services will export them to countries that lack them. This is what the flow of and distribution and exchange of goods and medical services across countries is about. Hopefully,it will produce mutual benefits.

Does Indonesia have a surplus of physicians that need to seek work abroad? Obviously not. To this day we are still in severe shortage of doctors and supporting medical workers. So severe is that shortage that it seems to imply the imposition of the opening of new medical faculties at several universities, the idea being to reduce the inequality among regions with regard to the availability of doctors. Because of this shortage, there is a big hole that could be the target of an invasion of foreign medical personnel.

Are we ready? Let us look at the comparison of preparedness with fellow ASEAN countries. Malaysia, Singapore and Thailand successfully sell "health tourism" services to foreigners, who come to their countries. Parkway Group Healthcare, a Singaporean company, has 14 hospitals, mostly outside of Singapore, namely in Brunei Darussalam and India – with one hospital each – and in Malaysia, where there are 10 hospitals. They serve from primary health care to various surgical operations. They even operate a network of private hospitals up to the UK.

The Bumrungrad Hospital of Thailand is working with the management of hospitals in Bangladesh and Myanmar. A Thai hospital, namely Bangkok Hospital, has opened 12 overseas branches, spreading across several Southeast Asian countries and South Asia, especially in tourist destinations. This is the reason for foreign hospitals in Indonesia to follow a similar strategy.

Interestingly, at several hospitals in Singapore and Malaysia, the majority of foreign patients come from Indonesia! Our people are eager to get medical treatment in neighboring countries. This is different from Thailand. As mentioned by the CM Hall, in Medical Tourism: The Ethics, Regulation, and Marketing of Health Mobility (2012), the majority of foreign patients are Japanese, and only about 7 percent of the patients come from ASEAN countries. This is quite interesting, because Japan, which is a developed country, trusts the health facilities in  developing countries.

Able to compete

We need to see what makes hospitals in Malaysia, Singapore and Thailand so great that they become favorite destinations of foreign patients. The general perception is that the quality of hospital services in the three countries is considered to be equivalent to hospitals in developed countries, but the rates are lower. In Thailand, the quality of services has been explicitly promoted by a qualified accreditation system. Its medical personnel are of high quality and well trained, and communicative. Its services are cheap, because its hospitals are  internationally accredited. They are used to performing advanced surgical and cardiovascular actions. This is not available in other ASEAN countries, especially in countries that are not as advanced as they are in the health field.

It is clear that they are well prepared to take advantage of the current flow of goods and services in the health sector within the AFTA framework. They are ready with skilled professional human resources, reliable management and, let’s not forget, strong capital support. Even the Philippines, which is known as an exporter of unskilled labor, turns out to have been exporting medical transcript services to the US. The medical transcript is a service to translate instructions dictated by medical personnel into a text form in a structured way. Its function is to make medical documents of the patients on the instructions of doctors, which are kept at the hospitals.

On the contrary, as described by Jutamas Arunanondchai and Carsten Fink, who conducted studies on the trade in health services in the ASEAN region in 2007, Cambodia experienced an influx of hospitals built by Chinese investors. Malaysia employs hundreds of foreign doctors and medical specialists to overcome shortages. At the same time, several hundred Malaysian doctors have moved to Singapore for higher incomes.

Indonesia is left behind

How about Indonesia?

There is a big gap. The needs for medical personnel and paramedics are just not met. We are still struggling with the very basic problems of high infant and maternal mortality, an uneven distribution of immunization, family planning, low per-capita income, the increasing prevalence of non-communicable diseases besides communicable diseases, especially tuberculosis and malaria, a low ratio of doctors to residents, unequal quality of physician education, unequitable distribution of healthcare services and so on.

Based on the Human Development Index (HDI), the quality of our health care is still below that of those four countries. Indonesia still has to work extra hard to face AFTA, especially in the liberalization of trade in goods and health services. Health matters in Indonesia are gigantic affairs, covering a quarter of a billion human beings! The great challenge is to distribute evenly and improve the quality of health services.

It is common practice for our patients to travel in droves to get medical treatment in Singapore and Malaysia. One report of the World Health Summit mentions that 226,200 people go to Singapore, while 300 000 go to Malaysia per year. This data was submitted by Abu Bakar Suleiman in 2013, who discusses the subject of regional medical tourism.

Of course, the current figures are likely to be even higher. What should be encouraged is how to get overseas patients to seek medical treatment in hospitals here. That means the quality and credibility of our hospital services (such as in the aspects of reliability, guarantees, tangibles, empathy, responsiveness, care, communication) must be improved. The medical profession needs to keep itself from engaging in any scandalous spin, so as not to interfere with the credibility of our hospital services.

Djoko Santoso, Professor, Medical Faculty of Airlangga University