Healthcare in Indonesia

Indonesia has one of the largest populations in the world, with more than 278 million people. However, healthcare in Indonesia still encounters problems to this day. Up to 62.9% of the population lack access to hospitals, and 60.8% lack access to primary healthcare facilities.

Healthcare Centers

Indonesia has a mix of private and public hospitals. As of 2022, Indonesia has 1,058 public hospitals and 1,927 private hospitals. Besides hospitals, Indonesia also has 10,205 public Health Community Centers, or PUSKESMAS, which stands for 'Pusat kesehatan masyarakat,' to provide primary health care and vaccinations.

Two types of PUSKESMAS are available: facilitation of inpatient beds and provision for outpatients only. However, PUSKESMAS centers are usually managed by a General Practitioner accompanied by a nurse or midwife, as they only supply non-emergency medical care. Patients will immediately be transferred to the nearest hospital if severe illness or injuries present themselves. PUSKESMAS centers are also located in many areas, making them available in many locations.

Additionally, quality differences exist between public and private hospitals in Indonesia. Most public hospitals, especially those outside Jakarta and other major cities, need more investment, modernization, staffing, and professional capabilities. Private hospitals are usually the opposite, with cleaner and more organized hospitals, further modernization and technologies, and a higher provision of professional capabilities. Moreover, patients in private hospitals tend to spend less time waiting than those in public hospitals.

Disparities in Urban and Rural Areas

Indonesia experiences unequal development between urban and rural areas, with much more significant development experienced in urban areas. Due to this, people primarily aim for jobs in urban areas. Moreover, most people living in rural areas also have tremendously low levels of education, even in primary school. Therefore, the socioeconomic conditions in rural areas are much worse than in urban areas.

In rural areas with a significant population being poor, considerations regarding transportation and the time required for hospital visits are taken into account. The expensive transportation can be a problem, and the time needed to obtain healthcare means time for work is well-spent. Due to these recurring problems, citizens in rural areas may consider delaying their hospital visits, leading to an increasing number of chronic diseases.

Furthermore, as salaries and research opportunities are better in urban areas, specialist doctors tend to stay in cities. This needs more specialist doctors in rural areas. Additionally, the number of doctors and nurses who provide primary care in urban areas is scarce. Healthcare facilities are frequently nonexistent in remote areas.

Cost of Healthcare in Indonesia

Indonesia ranks 126th in health spending per capita in 2020 with 132.96 U.S. dollars. As a comparison, the USA ranks 1st in health spending per capita in 2020, with expenditures of 11702.41 U.S. dollars. However, the average salary in Indonesia is 4580 U.S. dollars, while the average wage in the USA is 76370 U.S. dollars in 2021.

There are several factors contributing to Indonesia's healthcare costs. To start, hospitals play an instrumental role in high healthcare costs. First, medicine costs in hospitals are high due to medicine marketing. Patent medicine in Indonesia is expensive because of the high cost of promotions and R&D costs. In addition, the production cost of a patent medicine is 30% of the total cost, while the rest is used to market the medicine. Hospitals may only receive a discount of 20% regarding the sales of these medicines. Next is the excessive inventory due to a doctor's preference for a particular brand for multitudes of reasons, including confidence in the brand or a close relationship with the manufacturers. Therefore, two patients may have similar diseases but have two different prescriptions. Since the purchasing of medicine in hospitals is mainly determined by doctors, this leads to an excessive inventory and under-utilization of medical equipment. Unfortunately, the costs of this will be charged to patients. Besides that, there is a problem with out-of-stock products from the manufacturer. As manufacturers, products that do not sell well are often reduced in production or even completely stopped, resulting in a possible problem regarding the product being out-of-stock. However, manufacturers may struggle to balance the high demand for certain products, making those products out-of-stock. Due to the high demand and low stocks, medicine prices remain high.

Besides hospitals, individual doctors also contribute to the cost of healthcare. A doctor's fees are calculated by the number of times the doctor visits the patient over the patient's stay in the hospital. However, patients may sometimes stay longer only because a doctor has not finished their diagnosis. Finally, there is a factor related to other medical personnel. A hospital must maintain standards for nurses and pharmacists, increasing operating costs.

Cost of Healthcare in Indonesia

Indonesia has two types of health insurance—private insurance and government-funded care. Indonesia's national health insurance program, known as JKN, which stands for 'Jaminan Kesehatan Nasional,' is regulated by BPJS Kesehatan, Indonesia's healthcare and social security agency. With this system, low-income citizens gain insurance that is entirely paid for by the government.

BPJS Kesehatan provides several protections. This includes essential healthcare providers, which surround choosing a preferred doctor, clinic, and dentist; advanced healthcare services, allowing access to specialized doctors or better hospitals with a reference letter from the nearest clinic; and hospitalization services.