Battling Chronic Diseases to Win the Healthcare Revolution
    Category: Health is Wealth By : Suryo Suwignjo, Philips Indonesia Read : 865 Date : Tuesday, August 11, 2015 - 20:46:36

    The national health insurance scheme is revolutionizing Indonesia’ s healthcare. A much needed and very useful government program, the scheme is improving access to healthcare for millions. However, the high number of patients seeking treatment for non-communicable diseases (NCDs) is overwhelming the program—if not numerically, then financially. Fortunately the right policies can win the battle.  

    Recently the Health Ministry revealed that a significant portion of claims through the Jaminan Kesehatan Nasional (JKN) scheme are for treatment of NCDs, which are essentially chronic diseases that originate from our own bodies. Besides cardiovascular disease and strokes, NCDs include conditions such as cancers, diabetes and hypertension.

    The government organization that oversees the program, the Healthcare and Social Security Agency (BPJS Kesehatan), reported that the value of claims it reimbursed in 2014 was 103% of the value of the premiums received. Lowering the cost of treating NCDs is crucial to make the scheme sustainable.    

    Between 2008 and 2014, according to the Health Ministry, the incidence of mortality caused by diabetes mellitus rose to 2% from 1%; by hypertension, to 10% from 8%; by stroke, to 12% from 8%. These three NCDs now account for almost one-quarter of deaths in Indonesia. We cannot expect the government to overcome NCDs through direct patient care alone. Stakeholders need to work together to fight them, especially in three areas:   
    1) Improve access to healthcare and medical advice;
    2) Raise awareness of NCDs and how people can take responsibility for their own health;
    3) Work with hospitals and insurers to lower treatment costs and relieve the financial pressure on the JKN.

    One way to improve access to primary healthcare is the Ministry of Health’s Nusantara Sehat (Healthy Archipelago) program, where mobile eight-person medical teams bring basic healthcare to remote areas. Another way to increase access is to enable medical professionals’ use of technology. For example, in one tele-health project in West Sumatra, two doctors have been able to track the pregnancies of more than 600 mothers. An extension of such tele-health solutions is at-home self-screening, with patients doing their own monitoring.

    However, one big step is patients making better lifestyle choices. NCDs are linked to poor nutrition and physical inactivity, as well as tobacco and alcohol abuse. Finally, one way to contain costs is to use new ways of charging for health services, with initiatives such as pay-per-use. In this model, the hospital pays the equipment provider based on actual usage—an approach in line with how patients are billed and the government reimburses. Thus pay-per-use can be a model for equipment.  

    The healthcare revolution can be won, if we apply the benefits of technologies in science, communications, and medicine with age-old wisdom: Mencegah lebih baik dari pada mengobati or “prevention is better than cure.”  We all—government, medical professionals, private sector, and you and me—must help make the healthcare revolution succeed.