Indonesians prefer costly private clinics for TB care
A preference by Indonesians to seek initial care for tuberculosis (TB) at private clinics rather than public facilities is resulting in diagnostic delays and escalated costs, says a new study.
According to the WHO, Indonesia ranks next to India and China with the highest TB burden in the world. Other high-burden countries include the Philippines, Pakistan, Nigeria, Bangladesh and South Africa. These eight countries account for two-thirds of the total burden. Nearly half (44 per cent) of the new TB cases in 2018 occurred in South-East Asia.
“Visiting a private clinic as the first contact also led to more visits… and higher costs than first visiting a PHC”
Ahmad Fuady, University Medical Center Rotterdam
In 2014, Indonesia implemented universal health coverage through
Social Security Agency for Health or
Badan Penyelenggara Jaminan Sosial Kesehatan (BPJSK)
to provide insurance coverage for essential health care
services, including diagnostic tests for TB, conducted by
primary health centres (PHC) and designated private
clinics.
However, according to the study, published this month in
BMC Health Services Research, patients prefer private
clinics owing mainly to a perception that they offer better
service and accessibility than government-run primary
health centres, Muchtaruddin Mansyur, an author of the study
from the
Universitas Indonesia, Jakarta, tells SciDev.Net.
Patients approaching private clinics that are not covered by
BPJSK’s insurance facilities end up paying from their
pockets, Mansyur says. In the pre-diagnostic phase, the average
direct medical cost incurred by each patient seeking care in a
private clinic was US$21 against US$5 in a primary health
centres.
Preference for private clinics was substantially higher in the
rural districts and among those with low educational levels.
“Visiting a private clinic as the first contact also led
to more visits… and higher costs than first visiting a
PHC, both in terms of direct costs… and total
costs,” according to the study led by Ahmad Fuady of the
University Medical Center Rotterdam, Netherlands.
Rural patients’ preference for starting care at a private
clinic may have been influenced by the greater distance they may
have to travel to reach a primary health centre. The number of
PHCs in these areas is limited, the cost of transport to them is
higher, and the waiting time can be long, prompting patients to
seeking a private health care provider or facility that is
closer home.
Fihiruddin, a researcher affiliated with the department of
medical laboratory technology in Politeknik Kesehatan Mataram,
Indonesia, explains to SciDev.Net that TB patients
infected with HIV also usually visit a private clinic rather
than a primary health centre.
“High-income people are usually not only infected by TB
but [also] are infected by HIV… [and] the stigma of HIV
in Indonesia is still so bad that they keep it a secret from
everyone, including their families,” says Fihiruddin who
is not involved in the study.
Mansyur says patients with TB and the larger community
“should have sufficient knowledge of national health
insurance, including their rights and responsibilities”.
They also need to know that those living below the poverty line
have a right to get a full subsidy of the membership premium
from the government, he says.
The researchers suggest that in order to reduce diagnostic
delays and minimise costs to the patient, it is essential to
strengthen the public-private mix and reduce the fragmented
system between the national health insurance scheme and the
National TB Programme.
Source:
SciDev.Net
