By Ahmad Pathoni, dpaJakarta - The plight of a woman who was jailed briefly after sending an email to friends expressing her dissatisfaction with a hospital's service has turned the spotlight on Indonesia's healthcare system.
Prita Mulyasari, 32, was detained for three weeks in May after a hospital about 30 kilometres west of Jakarta filed criminal charges against her for accusing it of denying her access to her medical record and laboratory test results in the email that later ended up on mailing lists and popular social networking site Facebook.
Prita, a bank clerk with two young children, was earlier fined 30,000 dollars under the civil code for defaming the hospital.
She was cleared of criminal defamation charges by a court last month following an outpouring of support from the public and politicians campaigning for the July 8 presidential election, including a Facebook appeal signed by more than 150,000 people, but the case has highlighted concerns about the country's health sector.
Hundreds of thousands of rich Indonesians prefer to seek medical treatment overseas, reflecting their distrust in local healthcare standards.
But the majority of Indonesians are not covered by health insurance and poor people often have no access to medical treatment, despite efforts by the government to provide low-cost healthcare for them.
"Indonesia doesn't have a healthcare system at all," said Kartono Mohammad, a senior doctor and former chairman of the Indonesian Medical Association.
"There is no institution that controls the quality of healthcare and hospitals are not regulated," he told a discussion with foreign correspondents.
Even patients who can afford treatment have very little protection from medical malpractice or poor service, he said.
Unlike Singapore, Indonesia does not have a medical council that governs and regulates the professional conduct and ethics of medical practitioners, he said.
"In the event of a dispute between a patient and a healthcare provider, the patient has nowhere to go and the notoriously corrupt legal system doesn't help," Kartono said.
Last year the government launched an ambitious scheme to provide universal health coverage for Indonesia's population of 220 million and the World Bank said so far the country has already provided coverage to an estimated 76 million poor and near poor.
But the World Bank, in a report released in May, said the full impact of the programme had not been assessed or felt and the shortcomings of the health system could make the implementation of the scheme ineffective.
Ajriani Munthe Salak, a campaigner for the Legal Aid Institute for Health, an organization acting as an advocate for victims of medical malpractice, said the health scheme for the poor was too complicated because patients have to produce various letters certifying they are poor.
"People could die before they get treatment. We have to change the situation. The system is appalling," Ajriani said.
Ajriani said her organization had handled about 500 cases of malpractice since it was founded in 1999, but the number was "a tip of the iceberg" because many cases went unreported.
She said people were also discouraged from taking legal action, or following through cases, because it often took years for cases to reach settlement.
Kartono said in many cases, patients made deals with doctors or hospitals and were given cash compensation in exchange for not filing lawsuits.
Another problem is that doctors often testify in favour their colleagues embroiled in malpractice cases by saying that they had followed proper procedures, Kartono said.
Farid Hussain, the Health Ministry's director general for health services, declined to comment.
Mariani Akib Baramuli, a legislator from a House of Representatives' commission dealing with health affairs, said lawmakers were currently discussing bills on medical practice, hospitals and patient protection.
She said legislators had difficulty in coming up with a satisfactory definition of medical malpractice but hoped the legislature could pass the bills before its term ends in October.
"We realize there are problems and we are trying to address them," she said.
