DOI: https://doi.org/10.14710/dmj.v12i5.40503

Ethical and Professional Dilemmas encountered by Doctors in the National Health Insurance System

*Tuntas Dhanardhono  -  Department of Forensic and Medicolegal, Faculty of Medicine, Universitas Diponegoro, Indonesia
Wian Pisia Anggreliana  -  Division of Forensic and Medicolegal, Sunan Kalijaga Hospital, Demak, Indonesia, Indonesia
Intarniati Nur Rohmah  -  Department of Forensic and Medicolegal, Faculty of Medicine, Universitas Diponegoro, Indonesia
Sigid Kirana Lintang Bhima  -  Department of Forensic and Medicolegal, Faculty of Medicine, Universitas Diponegoro, Indonesia

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Abstract

Background: The implementation of the National Health Insurance System in Indonesia has not only increased access to medical services but also raised various dilemmas among doctors. 

Objective: This study aims to analyse various ethical and professional dilemmas among physicians in the National Health Insurance System (NHIS).

Methods: This is a cross-sectional descriptive study with a purposive sampling method. A questionnaire was distributed online between June to December 2019 to physicians practicing in Indonesia.

Results: Of the 87 doctors who participated in this study, 60.92% were general practitioners and 39.08% were specialists. The inability to maintain professional independence (63.41%) is the most common ethical dilemma faced by doctors with 65.38% of them experienced in advanced level health facilities. Meanwhile, the limitation of adequate medical care in an emergency (25.45%) is the most dilemmatic situation experienced in terms of professionalism with 85.71% occurring in advanced level health facilities.

Conclusion: Physicians in Indonesia were deal with various dilemmas while practicing in the NHIS. The high rate of dissatisfaction and the various ethical problems and professional disciplines require a review of the health system to improve the quality of services and maintain the professionalism of doctors.

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Keywords: dilemma; ethical; professional; National Health Insurance System; Indonesia
Funding: Faculty of Medicine, Universitas Diponegoro under contract 68/UN7.5.4/HK/2019.

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  1. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi, Achadi EL, et al. Universal health coverage in Indonesia: concept, progress and challenges. Lancet. 2018;393. https://doi.org/10.1016/S0140-6736(18)31647-7
  2. Social Security Agency for Health. Program Management and Financial Report Year 2018. Jakarta: Social Security Agency for Health; 2018
  3. Marzoeki P, Tandon A, Bi X, Pambudi ES. Universal Health Coverage for inclusive and sustainable development: country summary report for Indonesia. 2014
  4. Wu TY, Majeed A, Kuo KN. An overview of the healthcare system in Taiwan. London J Prim Care (Abingdon). 2010;3(2):115–9. https://doi.org/10.1080/17571472.2010.11493315
  5. Fusheinia A, Marnochc G, Gray A marie. Implementation Challenges of the National Health Insurance Scheme in Selected Districts in Ghana: Evidence from the Field. Int J PUBLIC Adm. 2016;40(5):416–26. https://doi.org/10.1080/01900692.2015.1127963
  6. Unnikrishnan B, Kanchan T, Kulkarni V, Kumar N, Papanna MK, Rekha T, et al. Perceptions and practices of medical practitioners towards ethics in medical practice - a study from coastal South India. J Forensic Leg Med. 2014;22:51–6. https://doi.org/10.1016/j.jflm.2013.12.001
  7. AbuAbah F, Alwan A, Al-Jahdali Y, Shaikh A Al, Alharbi A, AL-Jahdali H. Common medical ethical issues faced by healthcare professionals in KSA. J Taibah Univ Med Sci. 2019;14(5):412–7. https://doi.org/10.1016/j.jtumed.2019.09.001
  8. Indonesian Council of Physicians. Indonesian Medical Code of Ethics. Jakarta: Executive Board of the Indonesian Doctors Association; 2012
  9. Ministry of Health Republic of Indonesia. Regulation of the Social Security Agency for Health number 7 year 2016 regarding fraud prevention system in the implementation of the health insurance program. Jakarta: Ministry of Health Republic of Indonesia; 2016
  10. Indonesian Medical Council. Indonesian Medical Council regulation number 4 year 2011: the professional discipline of physician and dentist. Jakarta: Indonesian Medical Council; 2011
  11. Istiono W, Claramita M, Ekawati FM, Gayatri A, Sutomo AH, Kusnanto H, et al. Physician's self-perceived abilities in primary care settings in Indonesia. J Fam Med Prim Care. 2015;4(4):551–8. https://doi.org/10.4103/2249-4863.174286
  12. Raharjo RA. Diagnosis and treatment patterns of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia in Murjani General Hospital, Central Kalimantan, Indonesia. Prostate Int. 2016;4:65–9. https://doi.org/10.1016/j.prnil.2016.02.001
  13. Breslin JM, MacRae SK, Bell J, Singer PA, University of Toronto Joint Center for Bioethics Clinical Ethics Group. Top 10 health care ethics challenges facing the public: views of Toronto bioethicists. BMC Med Ethics. 2005;6(5). https://doi.org/10.1186/1472-6939-6-5
  14. Mira JJ, Nebot C, Lorenzo S, Pérez-Jover V. Patient report on information given, consultation time, and safety in primary care. Qual Saf Heal Care. 2010 Oct;19(5):e33. https://doi.org/10.1136/qshc.2009.037978
  15. Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017 Oct;7(10):e017902. https://doi.org/10.1136/bmjopen-2017-017902
  16. Petek Šter M, Švab I, Živčec Kalan G. Factors related to consultation time: Experience in Slovenia. Scand J Prim Health Care. 2008 Jan;26(1):29–34. https://doi.org/10.1080/02813430701760789
  17. Maharani C, Djasri H, Meliala A, Dramé ML, Marx M, Loukanova S. A scoping analysis of the aspects of primary healthcare physician job satisfaction: facets relevant to the Indonesian system. Hum Resort Health. 2019;17(38). https://doi.org/10.1186/s12960-019-0375-3
  18. Secretary-General of the Ministry of Health of the Republic of Indonesia and President Director of the Social Security Agency of Health. Joint regulation of Secretary-General of the Ministry of Health Republic of Indonesia and President Director of Social Security Agency of Health number 2 year 2017: technical instructions for implementing capitation payments based on fulfilling service. Jakarta: Ministry of Health Republic of Indonesia; 2017
  19. Mahmood MA, Mufidah I, Scroggs S, Siddiqui AR, Raheel H, Wibdarminto K, et al. Root-Cause analysis of persistently high maternal mortality in a rural district of Indonesia: role of clinical care quality and health services organizational factors. Kuate Defo B, editor. Biomed Res Int. 2018;2018:3673265. https://doi.org/10.1155/2018/3673265
  20. Budijanto D, Astuti WD. Adequacy of strategic health center in Indonesia. Heal Syst Res Bull. 2015;18(2):179–86. https://doi.org/10.22435/bpsk.v18i2.4318
  21. Meliala A, Hort K, Trisnantoro L. Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations. Soc Sci Med. 2013;82:30–4. https://doi.org/10.1016/j.socscimed.2013.01.029
  22. Somanathan, A., Tanod, A., Dao, H., Hurt, K., & Fuenzalida-Palma H. Moving toward Universal Coverage of Social Health Insurance in Vietnam. Washington, DC; 2014
  23. Marjadi B, McLaws ML. Rural Indonesian health care workers' constructs of infection preventionand control knowledge. Am J Infect Control. 2010;38(5):399–403. https://doi.org/10.1016/j.ajic.2009.11.010
  24. Hemorrhoids R, Irawati S, Makady A, Postma M, Goettsch W, Buskens E, et al. Use of medicine pricing and reimbursement policies for universal health coverage in Indonesia. PLoS One. 2019 Feb;14(2):e0212328. https://doi.org/10.1371/journal.pone.0212328

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