Competing for Power in the Health Sector

8 hours ago 1

TEMPO.CO, Jakarta - The dispute between doctors and the health minister continues after the omnibus health law was passed. Claims of authority are being challenged.

THE conflict between Minister of Health Budi Gunadi Sadikin and doctors has yet to be resolved. Members of the Indonesian Medical Association (IDI) challenged the omnibus law, Law No. 17/2023 on Health, with the Constitutional Court, arguing that the government had intervened in the independence of the medical association.

In a kind of retaliatory move, Minister Budi Gunadi transferred doctors who harshly criticized his policies. Budi Gunadi’s decision resulted in a wave of protests by professors and deans of various universities’ medical faculties. This heated relationship has only moved the health sector’s many problems farther away from their solutions.

The conflict only proves one thing: medicine has turned into an arena for power struggle as it involves businesses as well as public affairs. In the name of science, doctors claim power over their patients. They have the right to diagnose illnesses and decide upon the course of action as well as treatment.

Their power is augmented by the authority of medical organizations. IDI has the power to determine the requirements for health treatments as well as to recommend medical practice licenses. The Indonesian Health Council, comprising representatives from professional medical institutions and medical associations, has the authority to issue practice registration letters for doctors.

It has been difficult for doctors educated overseas to obtain practice licenses and registration letters in Indonesia because of IDI’s regulations. Consequently, we are lacking doctors, who are not evenly distributed throughout the country. According to the Health Ministry, we still need 153,000 general practitioners as well as specialists in order to achieve the ideal doctor-to-population ratio.

Through the health omnibus law, Minister Budi Gunadi restricts the excessive power of medical organizations, among others, by eliminating the provision of IDI’s recommendation in issuing medical practice licenses as well as changing the five-year registration period to lifetime. Budi has transferred various health affairs from these organizations to under the control of the Health Ministry for the sake of making administration processes more efficient.

Budi Gunadi’s move may seem heroic at a glance, but this de-bureaucratization has resulted in centralization by giving too much authority to the government. Centralized authority is just as bad as uncontrolled distributed power. Minister Budi’s solution will not necessarily resolve the chronic issues of the health sector.

In the case of licensing, the Health Ministry does not guarantee that they will have a more effective process compared to IDI. The transfer of authority to bureaucracy also leaves room for corruption, collusion, and nepotism. If it comes to this, the issues of inequality and distribution of doctors, which require fast solutions, will never be resolved.

The withdrawal of the Indonesian Health Collegium (KKI), which determines competency standards and medical education, from universities to the Health Ministry may also provide a loophole for intervention into the independence of science. Minister Budi is creating “guided medicine,” which is as bad as “command economy”, or guided politics meant to disguise authoritarianism.

To end the conflict, both sides must sit together with clear heads. The distribution of power through regulations must still prioritize the interests of the public, patients, and the future of quality, trusted, and independent medicine. Without these three substantial elements serving as a foundation, doctors and Minister Budi Gunadi are simply burying the quality of Indonesia’s public health services.

Read the Complete Story in Tempo English Magazine

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