Tag Archives: healthcare reform

Straight, No Chaser: Contrasting Healthcare Reform In the U.S. and Halfway Around the World

 Thoughts from a crowded Starbucks in Jakarta, Indonesia

Over my career, I’ve been fortunate to have studied and assisted healthcare systems all over the world. This past week, Sterling Medical Advice had the pleasure, privilege and outright honor of being invited to spend a week in Indonesia with the U.S. Department of Commerce on a healthcare mission in what will be a recurring role. By way of introduction (in case you weren’t aware), Indonesia is the fourth most populous country in the world (right after the U.S.) with a population of approximately 252 million people. It is approximately the same size as the United States, and it is a democracy and a member of the G-20 (with the 17th largest world economy).


More relevantly, Indonesia is in the midst of becoming the largest country in the world to implement a system of universal healthcare for its citizens. That’s right: by 2019, Indonesia will have enrolled their entire population in a universal healthcare system that is not owned or run by the government. This is a living rebuttal to those who insist that universal healthcare is necessarily socialist medicine.
There are some interesting observations to be made and contrasts between the system design and our own healthcare system. The U.S. currently spends over $8000 per person on healthcare per year; in Indonesia the average spend will be $60/person. This translates into Indonesia spending approximately $15 billion annually on health care after implementation of its new system, compared with over $2 trillion spent in the U.S., inclusive of Indonesia’s goal of doubling its current contributions toward its citizens’ health as part of its healthcare reform.


Dr. Sterling with Dr. Hasbullah Thabrany, professor of health policy at the University of Indonesia in Jakarta and architect of the world’s largest healthcare system

Access will be the foremost priority in the new system of Indonesia, whereas in the U.S., choice is the core component. Still, reform efforts of both systems are prioritizing access; unfortunately in the U.S., access still usually means utilization of the emergency room as a last resort as opposed to having everyone connected to a primary care physician.
Both systems suffer from dramatic physician shortages. In the U.S. this shortage has been addressed by the expansion of numbers and responsibilities for physician assistants and nurse practitioners. Indonesia has yet to permit non-physicians to obtaining status as independently licensed practitioners. In Indonesia, medical schools are opening in an attempt to address the shortage over the long-term; this is not a policy priority in the U.S.
These comments aren’t meant to suggest one country’s approach is better or worse. Such opinions are best addressed by review of objective data. Prior to the implementation of the Affordable Care Act in the U.S. and the current effort in Indonesia, both countries were performing less that either would have wanted. The World Health Organization’s (in)famous rankings of various countries’ systems (based largely on access and outcomes) placed the U.S. system #38 despite being the most expensive and Indonesia’s #92 while being #154 in costs. On the other hand, the U.S.’ ongoing spending of $2 trillion annually on healthcare does wonders for our economy.


As much as anything, the successful implementation of a universal healthcare system in a country the size of Indonesia should encourage those in the U.S. who have long advocated for such here, meaning if the political will ever existed, it could be accomplished. Unfortunately, the ingrained financial interests here continue to outweigh the desires of the public health community.
In the meantime, appreciate that the basics of a country’s ideal healthcare system should be the tools you utilize as your personal healthcare system. Embrace prevention through diet, exercise, screenings, immunizations and healthy life choices. Obtain information and advice to help guide your health decisions. Find a primary care physician. Get prompt treatment when you need it. The benefits of good health are worth the effort at every level.
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Straight, No Chaser: This is What Change in Healthcare Looks Like…


In case you hadn’t noticed, the delivery of healthcare is undergoing a “Wild West” transformation. Although it’s been several decades (circa 1970s) since physicians actually controlled the healthcare system, a law called “The Corporate Practice of Medicine” prevented non-physician owned entities from practicing medicine (or influencing the practice of medicine enough to affect your care). With the contribution of $2.7 trillion dollars to the U.S. Gross National Product (GNP), perhaps it was inevitable that corporations would find a way to control all aspects of healthcare and reconfigure it as a business. Indeed, perhaps the single biggest reason the Affordable Care Act took its final form was because of the clarion call to repudiate socialized medicine (read as “embrace our capitalist system of healthcare”). Undoubtedly, the prominence and influence of insurance companies combined with the satisfaction most of the population has with its current care (“You can keep your doctor if you want!) played a major role in this.
What wasn’t as predictable was the influx of new entrants into the healthcare market. Perhaps we should have seen it coming, because anytime you’re offering one-sixth of the U.S. GNP – almost $3 trillion – you should expect major corporations to seek a piece of the pie. An early notable hint could have been detected in Wal-Mart’s decision in 2006 to begin offering generic drugs for $4. This was initially thought to be a tool to get folks into the stores (e.g., come for the generics, stay for the shopping). However, the move has proven to be much more ingenious than that.

  • If you’re a company as huge as Wal-Mart, you can make a profit off $4 items if your volume is high enough. They’ve proven that with many other products.
  • Most physicians write for more than one prescription at a time. Odds are, money is being made on some portion of your total prescription.
  • The innovation in offering transparency in pricing was a new and welcome development and created a level of trust and credibility to the Wal-Mart brand.

Let’s take a minute to explore that last bullet point. If you’re the world’s largest corporation, looking for new markets, have some credibility in healthcare and find barriers being torn down for healthcare delivery, wouldn’t the opening of one of the largest components of the American economy be an exciting opportunity? In short, it shouldn’t be a surprise when Wal-Mart begins providing some variation of medical clinics or some other means of providing healthcare.


However, this conversation isn’t limited to Wal-Mart and other chains that have already placed variations of treatment centers in their superstores or pharmacies. CVS pharmacies have stopped selling cigarettes. Telemedicine is becoming more and more prominent a part of healthcare. Healthcare is coming to your computers and smartphones. Prevention is expanding as a complement to the practice of medicine (www.sterlingmedicaladvice.com, anyone?). On another front, have you noticed there’s zero rush to replace the 45,000 shortage of physicians? Nurse practitioners and physician assistants will be your new providers and a major part of the new world order in healthcare, for better or worse.
Call it innovation, change, progress or whatever you like, but pay attention. This isn’t your parents’ healthcare anymore. Job #1 is for you to become more empowered and better stewards of your own care. Learn to find reliable, trustworthy sources for information and advice. This will get interesting.

This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK (844-762-8255) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd. Please like and share our blog with your family and friends. We’re here for you 24/7 with immediate, personalized information and advice. Contact your Personal Healthcare Consultant at http://www.SterlingMedicalAdvice.com or 1-844-SMA-TALK.

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