The Indonesian Government has the bold and admirable ambition of implementing the world’s largest universal health care system by 2019 to provide better health care services for its more than 250 million residents.
Challenges of fulfilling the ambition are complex. To highlight one area: increased incidents of non-communicable diseases (NCDs) – including cardiovascular disease, cancer, chronic obstructive pulmonary disease, diabetes and mental health condition — pose challenges to Indonesia as well as all health care systems across the world.
The growing middle-class, urbanization, changes in lifestyle and aging populations are among the reasons for the rise in NCDs. WHO estimates that NCDs will cost Indonesia $4.47 trillion from 2012 to 2030.
By engaging in innovative partnerships, Indonesia can benefit from the experiences of other countries, including Denmark, in countering the challenges arising from NCDs. A partnership in the health sector has just been formalized by Indonesian and Danish ministers in Geneva a few days ago.
Cost-effective Health Care
Providing universal health care is about making the demand for health care services meet the supply in the best possible way. Since demand almost by nature will exceed supply, cost-effectiveness becomes absolute key to health care providers everywhere.
The Danish model does not constitute a silver bullet, but we can share our lessons learned to inspire Indonesian stakeholders. The Danish model is characterized by a strong focus on the primary sector and general practitioners, and how they link up to both prevention at the municipality level and to hospital treatment.
Prevention and early diagnosis and treatment at the lowest care level is key to controlling costs both in the short, medium and long run. For instance, the cost of identifying patients with diabetes and the right treatment in the primary sector is far lower than the cost to individuals and society of complications from non-treated diabetes.
Another important parameter to reduce health care costs is prevention strategies: How public institutions at different levels are addressing the risk factors related to patients getting NDCs, such as nutritious diet, exercise, reducing smoking and intake of alcohol.
Similarly, telemedicine enables an optimization of the expertise of scarce specialists by linking them up to general practitioners and their patients in clinics in remote areas via IT-solutions.
Another essential element for strategic decision-making in the health sector is data. Denmark has built a Diagnosis Related Grouping system (DRG) that combines diagnoses and the costs of these diagnoses. This enables decision makers to improve planning, monitoring and comparisons across hospitals and regions as regards costs. The system can be contextualized to any country by making use of country specific clinical practice.
The areas of mutually beneficial collaboration in the health care sector are numerous.
Innovative Health Partnership
On 24 May, in Geneva, the Indonesian Minister for Health and the Danish Minister for Elderly Care signed a memorandum of understanding on health. At the other side of the world – in Jakarta on May 23 – we conducted a joint roundtable with the Ministry of Health and the Health Care and Social Security Agency (BPJS Kesehatan) on cost-effective health care.
During the roundtable, we shared Danish experiences from focusing on primary care to reduce costs while ensuring the links to both prevention and hospitals in the secondary sector. During the seminar, we also shared our lessons learned regarding the benefits of the DRG system.
Innovative partnerships between health care institutions and professionals, universities, patients and private companies have been key to cost-effective, patient-centered health care innovation in Denmark.
A Cross-sectoral Exercise
As is clear from the 2017 presidential instruction about the public "Healthy Living Movement," achieving public health is about more than the organization and funding of health care services to everyone, everywhere. In fact, it is a cross-sectoral exercise involving sectors such as water and sanitation, energy, agriculture, infrastructure and city planning.
Increasing public health is about reducing the risk factors to the health of citizens. A cross-sectoral approach is for example about reducing air-pollution be it from fossil fuel based power plants or an excessive number of cars that have an impact on respiratory diseases.
Of equal importance is the supply of clean water and sanitation as well as wastewater treatment. It is about food-safety and nutritious diets for both children and adults – to reduce the average stunting levels of 27 percent that will irreversibly affect the capabilities of the next generation. And it is about creating infrastructure for livable sustainable cities, in which citizens have spaces to exercise.
Evidently, all the areas mentioned are high priority to the Indonesian government and included in the president’s call for a Healthy Living Movement. Denmark and Indonesia have already formed innovative partnerships in many of the areas where Denmark have valuable experiences to share. With the new cooperation in health care, we are now upscaling and broadening our innovative partnership for the 21st Century.
Dorthea Damkjær is the head of trade at Embassy of Denmark in Jakarta