regulating the professional - aarhus universitet · 2007-09-03 · regulating the professional :...
TRANSCRIPT
![Page 1: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/1.jpg)
1
REGULATING the PROFESSIONAL :The Dilemma in Medical & Health Practices
for the Poor in Indonesia
Soenarto Sastrowijoto & Nur Azid MCenter for Bioethics & Medical huamities
School of Medicine, Gadjah Mada UniversityYogyakarta, Indonesia
2007
![Page 2: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/2.jpg)
2
Background :In Indonesia Morbidity & Mortality rate and Human Development index rank is Lower compare to ASEAN Countries.The history of medial / health care system and judicial product = Colonial – Orde Lama – Orde Baru– Economic Crisis – Reformation Era, related to health statusMedical / health care system, based on
Welfare stateSocial (security) state Free market / Market driven direction.
The medical health services / education / financing is not developed integratedly.Act and regulation related to medical health / education / financing
![Page 3: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/3.jpg)
3
Objectives of the study
The identify feasible regulatory mechanisms and strategies to address iatrogenic health problem in medical & health practice. To describe and analyse the existing regulatory mechanisms, ethical codes and legislation with direct implication for medical & health practice.
![Page 4: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/4.jpg)
4
Questions of the study
Is the medical & health practice could be covered by the existing rules and regulation ? Which type of ethical consideration and cases of ethical problems are handled by relevant regulatory body / court, argument’s constitutes, and the outcome ?
![Page 5: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/5.jpg)
5
Methods :
Desk – study of documents (Act and regulations, text books, articles, internet, newspaper, and Court), and Key individuals, professional associations, Center / Provincial / Districts MoH offices, NGO; and All will be analysed, based on the relevancy to the objectives of the study.
![Page 6: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/6.jpg)
6
Results :
Five levels Hierarchy of Law and Regulation in Indonesia
1) the Constitution of the Republic of Indonesia,
2) Act or Government Regulations replacing Act,
3) Central Government Regulation, 4) Presidential Regulation, 5) Provincial and District Regulation.
![Page 7: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/7.jpg)
7
The Extent of the Regulation
1. Regulating Capacity and distribution of Health Care Practitioners (HCP)
2. Regulating Competency of HCP3. Regulating quality of Healthcare
service4. Regulating Financial system5. Regulating the Ethico - legal Aspects6. Regulating Penalties
![Page 8: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/8.jpg)
8
Some Type of ethical cases
1) Unpaid insurance on doctors’ fault 2) Advertising3) Patients’ miss-management (including miss
diagnosis and treatment)4) Quarrel between doctor and employee (nurse
and midwife)5) Neglecting patients’ who are unable to pay
approval or court request6) Sexual harassment
1. From The Medical Ethics Honorary Committee(MKEK, 2005)
![Page 9: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/9.jpg)
9
Type of ethical cases……..cont
1) Wrong medical intervention 2) Failure on certain medical intervention3) Leaving operation instrument in
patients’ body 4) Illegal abortion 5) Medication error 6) Miss-diagnosis
2. From the Newspapers
![Page 10: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/10.jpg)
10
Ethical cases in the Court
1. Obgyn, Private Hospital (2002)2. Surgery, Private Hospital (2004)3. Surgery, Private Hospital (2004)
Why ? Small number
![Page 11: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/11.jpg)
11
1) Obgyn, Private Hospital (2002)Failure to install contraceptive devicepregnantInformed Consent sufficiently givesCurettage – careless – neglecting patient
Court : granted the plaintiff's demands
![Page 12: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/12.jpg)
12
2) Surgery, Private Hospital (2004) Patient injury Information was gives not directly by the surgeryThe right of the patient To have second opinion – rejected.Alleged negligence
Court : granted the plaintiff’s demands
![Page 13: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/13.jpg)
13
3) Surgery, Private Hospital (2004) Necrotizing ileocolities Medical standard procedure – fulfilled First and second operation – no causal link Courts : - refused defendant’s exceptions
- Denied plaintiff’s demands completely
![Page 14: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/14.jpg)
14
• Act related to Health system
1. National Education systemNo. 20, year 2003
2. Medical PracticeNo. 29, year 2004
3. Decentralisation / Provincial –District autonomy (2004)
![Page 15: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/15.jpg)
15
• National Education system, Act (2003)
In developing standards in Post (Medical) Education, - college of medicine/surgery –coordination with Professionalism Assoc, School of medicine, Teaching Hospital, Department of Education, and Department of Health.All kind of higher education and training vocational & professional, under / managed by the university system. The needs and demands of the society, particularly the poor (disadvantaged group)- no consideration.
![Page 16: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/16.jpg)
16
• Medical Practice Act. No. 29. 2004
1. Medical Profess standards of Education / Training
- generals – school Med. Assoc - Post graduate – college of medicine / surgery
2. Medical / health service legislation CertificationRegistrationLicensing
Regulating – Medical Practice Nursing & alternative
(not covered)
![Page 17: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/17.jpg)
17
• The integration of Health system development
Population HEALTH status
HEALTH Servicessystem
HEALTH Education
System
HEALTH Financing
system
![Page 18: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/18.jpg)
18
Formal Providers
![Page 19: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/19.jpg)
19
DISSCUSSION
MMR and IMR – higher comp. to ASEANThe Number of Health Professionals
( Doctor-Sp ; Nurse; others)- Very limited – the number of
Population
![Page 20: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/20.jpg)
20
Health Financing (Economic) Systems
Goverment
Private
Goverment
Private
Govt
P
1.
2.
3.
Welfare – State
Market – driven – system
Social – security system
![Page 21: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/21.jpg)
21
Medical / Health Practice, and New Regulation (Needs)
Privatepractice
Govt.
The Rich
The Poor
HealthInsurance
System
FamilyMed. / Healthcare
Primary
PublicMed. /health
ServiceMDs
New Reg.
![Page 22: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/22.jpg)
22
The current Act & RegulationsPrimary health care
(Private & public)GP / FM – RegulatedNurse - Medical care
- Nursing careAlternative health care
The Poor choice !Secondary health care
The condition is the same for the PoorMost / many Medical / Health practice(particularly Private sector) – the choice of the Poor – without license.How to monitor/ Control / Develop : A Dilemma
Not covered by Regulation
![Page 23: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/23.jpg)
23
Primary care - Nursing / Medical Second care - Generalist / Specialist
Tertiary care - Specialist / sub specialist
Professional Training
JobOrganization
Professional OrganizationGrey Area
New Regulation
![Page 24: REGULATING the PROFESSIONAL - Aarhus Universitet · 2007-09-03 · REGULATING the PROFESSIONAL : The Dilemma in Medical & Health Practices for the Poor in Indonesia. Soenarto Sastrowijoto](https://reader033.vdocuments.site/reader033/viewer/2022042300/5ecb991e9d0d2c34515c80ea/html5/thumbnails/24.jpg)
24
RECOMMENDATION
Health sector reform in services, education, and financing should be considered, developed integratedly.New Act and Regulation is needed, even though need time.Privilege Regulation in transition (Provincial & District level), as Model development should be developed urgently.