Cipto v. Dharmais — apples/ oranges, or night & day?

Pak Fadil to RS Dharmais today for more scans and because of bleeding.  He’ll have scans of the entire body back shortly. And — insyaAllah — then the docs will no what to do.  Meanwhile, another family member was back at RS Cipto today. She waited from 9 a.m. to 2:00 pm — nearly an entire hospital day– only to be told that her medical records were lost. Well that helped explain the wait, but how to explain the things that go on at RS Cipto.

Anyway, around 3:00 they found her file. But somehow her doctor had changed and she had to begin again with the process of explaining what was wrong with her. An old Jakarta expat said, “Yea, I would imagine it’s more or less just a triage scene in there.”  I guess he’s right.

Meanwhile, weird thunderstorms with hardcore lightening bolts were all over Jak today, making a mess of Monday traffic.  Mona said riding in an ambulance isn’t so very fun and doesn’t encourage positive thinking. But it is a practical way of getting sick people to the hospital.

Coming home was a bit difficult because of pouring rain. Kind paramedics and a friendly neighbor helped Mona, Sema, Sarah and Mama wait till rain slowed to suit up the patient and help ease the stretcher through the maze of alleyways — all the way to the family’s front door.

The scanning work, morphine, heart medicine, vitamins, plus lots of hoses, gauze and the like, came to less than Rp 2,000,000 or $200.

On the bright side, that’s not too much. But is $200 enough to cure cancer and is cost a factor in Indonesia’s state-subsidized health care for the poor? All I know is what I hear. And I heard that, at Cipto, late last year, Pak Fadil got treated with a $100 chemo drug normally used for dental work. (I haven’t confirmed nor do I really understand.) Meanwhile, at Dharmais the family spoke with a family where the dad also has a tongue tumor.  They said the chemo drug used cost $2700 and patient is doing well.

In defense of comparing apples and oranges — if that’s what we’re doing — then I’d say that the comparisons and analysis have to begin somewhere.

When you’re treated at Cipto pursuant to the SKTM or another subsidized scheme, there’s this silence about costs that’s rather deafening. Back in River City where I come from — and where socialized medicine hasn’t quite caught on — when you get sick the doctors always offer you options for getting better and those options are always going to be presented in terms of cost.  If they don’t give you price info then it means you’re going to get the best treatment they can deliver. It wouldn’t cross your mind that they’re going to economize by buying cheap drugs.

But at Cipto the cost issue never comes up. It’s as if the treatment were free. But is it? What is the actual cost of using the wrong chemo drug when you only have once chance to get it right — and you get it wrong?

So let’s assume that non-VIP patients at Cipto rarely hear about costs because it’s presumed not relevant to them, since they’re not paying/presumably can’t pay. That makes sense. But I wonder if there are other reasons. Perhaps it would make the job of treating the patient significantly more difficult if s/he could override the default protocol by self-financing drugs and procedures that are otherwise unavailable. Perhaps there’s a grey area about which drugs are on the list, i.e. covered by the insurance.

Our experience with painkillers at RS Cipto was that, in our efforts to get something stronger for patient than ultram, our threats, pleas, ridicule, etc were unavailing. But once we said we identified the time-release morphine product that would normally be prescribed in this market , then it was just a matter of who would pay. When we offered to pay, we got the scrip.

Is there some type of parallel for chemo drugs?