In 2007, Indonesia introduced this system for paying the third class government owned hospital. According to the former Health Minister, Siti Fadilah Supari, from 2009 all hospitals in Indonesia which serve the public health insurance should apply Indonesia Diagnostic Related Groups (INA-DRG) system.
Diagnosis Related Group (DRG) is a payment system in which benefit payments are based on the individual diagnosis of a patient instead of the actual medical service received. This system categorizes medical cases into groups and assigns weights to each group that indicates the amount of resources necessary to treat patient with a given diagnosis. The aims of this system are to reduce costs, increase benefits, and increase quality of healthcare system. DRG are based upon the patient’s principal diagnosis, ICD diagnoses, gender, age, sex, treatment procedure, discharge status, and the presence of complications or co morbidities.
For example, if a patient suffering from dengue fever, the payment to the hospital has the same amount for every case of dengue fever, regardless of how many days the patient was treated or hospitalized.
When DRG applied, all rates of medical services, including nursing, doctor visits, the treatment itself, should be in the same amount regardless the patients were in VIP or third-class. If extra resource is used, the extra cost will be paid by the hospital.
It sounds like good news for the patients.
But… is this really good news?
The reality in Indonesia tells otherwise. When the financial incentive is removed, some of physicians become less interested in treating patient of the social insurance (such as Askeskin). One of the reasons is due to the vast difference in income derived from the Askeskin patients and the private patients. For example, a doctor will be paid 5,000 rupiah for one consultation with Askeskin patient while the private patient would pay 50,000 rupiah. The different is about 10 times. So it can be understood why doctors don’t give same level of service to the patients. Less time is spent for each consultation and perhaps less smile on the face.
We might blame the physician for that biased behavior. Aren’t they supposed to treat every patient exactly the same? Yes, their doctor vow and medical ethics says so. But in the reality, it is a bit difficult when money comes into the play. Doctor also a human-being that still need to live and paying their needs.
But with all my respect, there’s still a lot of doctor that has a high-integrity, treat people like they should be treated. Frankly speaking, a root of the problem is not in the doctor itself but on the government, because a decent health care is the government obligation. The question now is whether the government really wants to increase the degree of public health or not?
References
http://ariefknp.wordpress.com/2007/10/06/ina-drg-case-mix-solusi-menuju-pemerataan-pelayanan-kesehatan/
Yusmainita.Indonesia Diagnostic Related Group.2009.ppt
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