CITIZEN JOURNALISM

Medical Tourism and Inequality in Health Access

Amanda Tan
Monash University Indonesia Master of Public Policy Student and COVID-19 Report Volunteer

Yemiko Happy
Head of the COVID-19 Report Study Division

“Indonesia wants to become a medical tourism destination and prevent people from seeking treatment abroad.
Access to health services is still problematic.”

Tuesday, March 14 2023 – President Jokowi has just inaugurated an international scale hospital in Bandung. Through a tweet on Twitter, Jokowi said that building this international hospital was the right policy to ensure that not many Indonesian citizens would seek treatment abroad, such as Singapore and Malaysia, to get better health services. According to him, around two million Indonesians leave the country every year and lose IDR 165 trillion in foreign exchange.

The government's ambition is to make Indonesia a "medical tourism" destination (medical tourism) the future to rival Malaysia and Singapore is nothing new. According to Tempo reports, in 2022, DI Yogyakarta Province has the ambition to make its region a health tourism destination (wellness tourism). The Banten Health Service has designated six private hospitals in its area as medical tourism hospitals. Together with the Ministry of Tourism and Creative Economy, the government also has the ambition to build the Bali Medical and Wellness Tourism Special Economic Zone with an investment value of IDR 10.22 trillion. The hope is that Indonesia can compete with the two neighboring countries in the health tourism sector.

On the same day, news began to go viral about the death of the mother and her fetus as a result of being rejected by the Subang Regional General Hospital, which is only 60 kilometers from Bandung. This incident occurred on February 16 2023 and only recently has it emerged and received criticism from various parties. But this is not the first time this has happened this year. In Pinrang, South Sulawesi, a mother and her fetus died while being carried on a stretcher seven kilometers to the Lasinrang Regional Hospital last January.

These two incidents illustrate the significant gap between providers of adequate health services and recipients of services, namely people whose rights to health are ignored. It is not surprising that people criticized Jokowi's tweet and stated that the government should focus on improving public health services that are affordable for all levels of society.

Right to Health

The government's decision to open international class services is considered inappropriate because the capacity of public health services is still not able to serve the community adequately. Many believe that the medical tourism policy is not a wise policy, and that the state should mobilize its capacity to strengthen public health services. This policy is a manifestation of the process of privatization of health services which is so excessive that it contradicts the principle of the right to health based on human rights and social justice.

The right to health, including the right to adequate, safe and affordable health services, is, according to the UN Office of the High Commissioner for Human Rights, a human right. This principle has also been regulated in the 1945 Constitution and the Health Law.

It cannot be denied that access to health cannot be fully supported by the public sector. The private sector also needs to be present to ensure that access to health services is widespread. However, privatization often leads to destructive competition between service providers (Bali & Ramesh, 2021). This competition actually causes health costs to become wilder in the market and makes people have to pay expensive fees for basic health services.

Inequality of Access

The potential for medical tourism in Indonesia is indeed quite large, but equitable health practices, namely in accordance with the principle of the right to health in Indonesia, is a much bigger task that the government must pay attention to. Therefore, prioritizing equal and fair access to health is very important.

In fact, medical tourism in Malaysia shows inequality in access to health, such as the stratification of private-public services due to the large number of highly qualified health workers moving to private hospitals. Experience in Thailand shows that the quality of health services close to the community is lagging due to the movement of health workers, and this has an impact on the health rights of local residents (Ormond, Mun & Khoon, 2014; Wibulpolprasert & Pengpaibon, 2003).

The ambition to develop a special economic zone for medical tourism needs to be balanced with equal distribution of health access to all corners of the country. Furthermore, it is not only access that must be made easier, the quality of service in health facilities must also be improved, especially for government-managed facilities. Don't let the ambition of a special economic zone for medical tourism become an irony in your own country.

DISCLAIMER

This article was published in the Opinion column of Koran Tempo with the title Medical Tourism and Inequality in Access to Health
more details at https://koran.tempo.co/read/opini/480857/wisata-medis-dan- jasa-kesehatan