When the new Social Security Organizing Body (BPJS) came into being on January 1, the government’s plan for 100 percent universal health care coverage by 2019 took a massive leap forward.

The government has predicted that more than 170 million Indonesians will be part of the new health care scheme with the introduction of the BJPS, putting health care for all in motion after a long journey that began a decade ago with the passage of the 2004 Social Security Law.

Much has been said of the impact on patients, doctors and pharmaceutical companies, but what does it mean for the medical devices industry?

AmCham Indonesia sat down with Budi Prasetio of the National Association of Laboratory and Medical Devices (GAKESLAB) to talk about medical device and laboratory equipment issues in Indonesia, and how the goalposts have been moved with the advent of the BPJS.

AmCham Indonesia: It has been said that domestic medical device companies receive preferential treatment from the government. Do you feel that multinational companies have a fair chance to thrive in this market?

Budi Prasetio: Some of the big government tenders are dominated by big local companies. However, 90 percent of the tender content is imported product. So there is no doubt that foreign companies are able to participate because those products must be bought from them. On top of that, there is still a large portion of remaining demand from the non-government private market for health care services.

Through existing regulation, the government prioritizes domestic products only when the procurement utilizes the government budget. 

I personally do not agree that there should be a double standard. All companies (manufacturers and traders) have the same responsibility for patient safety. A double standard on product quality would constitute a crime.  

There are many factors behind the slow growth of good and proper medical device manufacturing in Indonesia. Business players currently exist, and they profit from trading, basically. To move to be a true manufacturer is not easy. The business philosophy is different from trading.

Besides, to enter the manufacturing business, one requires a huge amount of investment with a longer ROI (return on investment). It is not as simple as managing an operation. Special knowledge and skills are required.

One factor for the lack of a medical device manufacturing industry is the government’s lack of attention to the firms who are purchasing on behalf of the government. Many of the purchasing authorities in municipal areas prefer to buy foreign products, although the local manufacturer has been asked to produce them. This practice continues since there are no notable instructions from the central government.

The second reason is that the government does not pay serious attention to the development of the local medical device industries. It was only in the last two years that a focus group discussion on medical device research and development was formed at the Bandung Institute of Technology.

Lastly, there is a shortage of human resources. Now there are 22 manufacturers that produce hospital furniture, which is a low-tech business. With higher tech medical device manufacturing, we need people with higher competencies, and until now there has been a shortage of those people.      

Are there any opportunities for partnerships with multinationals when it comes to health care service quality issues in Indonesia?

The provision of a quality health care service that meets standards at an affordable cost is possible but has not yet been implemented until now. SJSN (the new national social security program) has no fixed cost calculation that they can use in their claims reimbursement. Now hospitals offer what I call “escalating” fees, which they calculate with the INA-CBG (Indonesia case-based group) system. However, the existence of this calculation system has not been implemented very extensively by all health care providers in the social insurance network because of the number of debatable factors behind the pricing. Multinationals have the expertise and can help in the calculation of the fixed fees based on rational pricing for standard health service packages.

In terms of medical device and lab equipment maintenance, we face a shortage of biomedical engineers. In this case, I think there is a good opportunity to create partnerships in training. Biomedical engineers are required to calibrate, service and also to maintain medical devices in accordance with the purpose of usage, as well as other activities such as waste removal. A surgeon should not start an operation before the technician in charge does a thorough check of all the surgical equipment for function, sterility, access to adequate electrical supply, etc.

As part of the ASEAN health services liberalization agreement (2015), all health care providers must gradually pass the KARS (hospital accreditation committee) accreditation. For the international standard hospitals, health care professionals must pass JCI-A (Joint International Commission) accreditation. 

Currently the demand for biomedical engineering expertise has reached 2,069 persons if we estimate one biomedical engineering professional per hospital. The number of alumni of the biomedical engineering master’s is minimal and the majority of them work in bureaucratic administration because they lack the clinical experience to practice and coach staff. The slow development of the biomedical engineering discipline will have an impact on the quality of health care services to the entire population of Indonesia.

This shortage of bioengineering experts should be paid serious attention. One suitable solution is the establishment of a certified vocational training program. Due to the urgency of the shortage, I recommend that the Ministry of Education and the Ministry of Health immediately form a “certified vocational crash course training program” that is implemented by BNPS (the national certification agency). This training should be required for the person who is the head of IPRS (hospital maintenance installations) department in every health service unit. 

The result will be that every health service unit will have a reliable person who can calibrate, repair and maintain the hospital medical devices and laboratory equipment to ensure that the health service that is performed using that equipment meets established health care standards.

It’s difficult to attract doctors to serve in remote areas without promotions or incentives. What can companies do to ensure that their products are properly used in remote areas when there are not enough doctors?

This is an issue that has not yet been solved. Since the mandatory front line health clinic (puskesmas) service requirement of all medical doctors was placed in moratorium some years ago, the number of medical doctors in the countryside/remote areas has become minimal. 

Moreover, since the enactment of the autonomous regions policy, we have observed that many areas still do not consider health care a major priority, which is indicated by the allocation size of their health care budgets. The same thing has happened to family planning services.

Now, with social health insurance rolling out, there is renewed awareness about the importance of the rural health sector, but we are not yet able to establish good rural health care services.

Hopefully, as social health insurance creates standard clinical procedures that drive down costs and create uniform health care service quality, the rural health care sector will improve.