The Integration Traditional Medicine Practice at National Health

Insurance in Indonesia

Riza Alifianto Kurniawan and Sapta Aprilianto

Universitas Airlangga, Dharmawangsa Dalam Selatan, Surabaya, Indonesia

Keywords: traditional, medicine, integrated, health service.

Abstract: Health service has become the most demanded service when it provided simultaneously by the state. Based

on National Social Guarantee Regulation, issued in 2008, force Government to provide and establish health

insurance for Indonesian. National health insurance system was established since then and require more

medical practitioners to participate not only medical doctors, nurse, but also traditional medical practitioners.

One of the obstacles is certification for competency of traditional medical practitioners. The certification is a

recognition by the society to show a trust for traditional medical practitioner for its competency. Furthermore,

traditional medicine has been regulated in Health Act, Law No 35 Year 2009. The Act also followed by the

Government Regulation which specifically regulated Traditional Medicine. Based on Health Act and

Traditional Medicine Regulation, traditional medicine is recognised and has equal rights to develop the

practice and the knowledge for providing its service to the society. This paper objective is to find out the

problems and obstacles for traditional medical practitioners serving its knowledge to the society. Thus, every

obstacles and issues which have been found, will be followed by proposing program or policy to remove the

obstacle and improve traditional medicine practitioners to be accepted to practice or giving service at social

health insurance.

1 INTRODUCTION

Health is a very important thing needed by every

human being and is one of the basic needs other than

clothing, food and shelter. What we could be

ascertained that no one wants to experience pain in

the period of his life. Every effort will be made to heal

and improve his health condition. Health is a human

right and one of the elements of welfare that must be

realized in accordance with the ideals of the

Indonesian people as intended in the Pancasila and

the 1945 Constitution of the Republic of Indonesia

(UUD NRI 1945). As a basic right for everyone,

health care is a right that every citizen deserves. In the

1945 Constitution of the Republic of Indonesia it is

mandated that health insurance for the peoples,

especially the poor and incapable is the responsibility

of the central and regional governments. Article 28 H

(1) of the 1945 Constitution of the Republic of

Indonesia states that "Everyone has the right to live

physically and mentally prosperously, to reside, and

to have a good and healthy environment and the right

to obtain health services." This provision is then

implemented by Law Number 36 Year 2009

concerning Health (hereinafter referred to as the

Health Act).

Every activity and effort to improve the level of

public health is the highest responsibility of the

government and the community, thus, development

efforts in the region, especially in the city of

Surabaya, must be based on health insights and

carried out based on non-discriminatory,

participatory, protection and sustainable principles

that very important for the creation of human

resources of Indonesia, increasing the resilience and

competitiveness of the nation, and national

development. Related to health improvement efforts

Bahder Johan Nasution states that (Koeswadji,1995):

Efforts to improve the quality of human life in the field

of health, is a vast and comprehensive effort, the

business includes the improvement of physical and

non-physical health. Within the national health

system it is mentioned that health concerns all aspects

of life whose scope and scope is very broad and

complex. From the above understanding, it can be

understood that basically health issues concerning all

aspects of human life, both past life, present, and the

future. Judging from the history of its development,

Kurniawan, R. and Aprilianto, S.

The Integration Traditional Medicine Practice at National Health Insurance in Indonesia.

DOI: 10.5220/0010049900130017

In Proceedings of the International Law Conference (iN-LAC 2018) - Law, Technology and the Imperative of Change in the 21st Century, pages 13-17

ISBN: 978-989-758-482-4

there has been a change of orientation of values and

thoughts about efforts to solve health problems. The

process of change of orientation and thought is

always evolving in line with technological and socio-

cultural developments.

Health problems are a crucial issue, but not all

communities have their right to health care. Although

there has been a program of Public Health Insurance,

Regional Health Insurance, and so on, but not yet able

to serve all levels of society of Surabaya.

Therefore, the main goal of health efforts is to

improve the distribution and quality of health efforts

that are effective and efficient and affordable by all

people. For the implementation of health efforts,

effective and efficient policies and management are

needed so that equitable and quality health services

can be achieved. As regulated in Law Number 36

Year 2009 on Health (hereinafter referred to as the

Health Act) that every person has the right to health

and have equal rights in obtaining safe, quality and

affordable health services.

Indonesian Traditional Health Urgency.

Indonesian traditional health practices have been

known for a long time. The demand for traditional

health services begins with the consumption of herbal

medicine in Indonesia. Based on the data from the

Ministry of Health of the Republic of Indonesia, the

consumption of herbal medicine managed to reach

59.12% of the total population of Indonesia in 2010.

(WHO, 2014) Biodiversity also provides wealth for

Indonesia because it managed to become a source of

traditional health ingredients that have the potential to

cure diseases. Traditional health already has a special

place in the lives of Indonesian people.

Traditional medicine in many countries is rooted

in the culture and history of each region. Some of the

most widely known is traditional medical techniques

and practices of Ayurveda, traditional Chinese

medicine. In addition, the development of alternative

medicine (complementary medicine) is growing

rapidly such as anthroposophical medicine,

chiropractic, homeopathy, naturopathy, and

osteopathy. Alternative medicine is currently in the

popular and used by the community.

Healthcare systems around the world have

experience in dealing with chronic disease endemics

and swelling of health insurance bills all over the

country. The community (patient) and health-care

providers have demanded a change or revitalization

in the provision of health services, on the provision of

individual-centered care guarantees. The concept of

providing health services based on individual needs

(person-centered care) is expected to provide equal

access and opportunity for actors or providers of

traditional health services or traditional health

workers to provide services and competencies in

improving national health quality. The variety of

types and forms of regulations and policies which

regulates traditional health personnel and all forms of

services complicate the development of healthcare

services and products internationally. Based on data

released by WHO (World Health Organization)

shows an increase in demand for traditional health

products and services in several countries, for

example, in China in 2012 demand reached US $ 83.1

billion, there was an increase of more than 20% over

the previous year. The increase in demand for

traditional health services also occurred in South

Korea in 2004 of US $ 4.4 billion to US $ 7.4 billion

in 2009.

1.1 Reason for using Traditional

Medicine

There are many reasons for people to demand

traditional medicine services. The factors that

influence are culture, historical significance and

regulations. On the other hand, there is no uniform

standard to examine patterns of use traditional

medicine. There are there general patterns for people

using traditional medicine (WHO,2014):

1. Traditional medicine becomes primary source

of health care. This pattern becomes a primary

option because the availability and/or

accessibility of conventional medicine-based

health services is, on the whole, limited. The

example, traditional medicine in Africa and

some developing countries.

2. Traditional medicine applied due to cultural

and historical influences. Some countries such

as Singapore and The Republic of Korea

where the conventional health-care system is

quite well established. There is approximately

76%-86% of population at both countries

using traditional medicine.

3. Traditional medicine as complementary

therapy. This pattern is common at developed

countries. The health system structure is well

built and developed, traditional medicine

becomes secondary option to increase the

health level for people in developed countries.

The other motivation for people to use traditional

medicine is the unsatisfactory of existing health-care

services. The increasing demand of traditional

medicine services because of the awareness of people

about disease treatment. Some people see other

treatments are failed to cure a disease and initiate for

iN-LAC 2018 - International Law Conference 2018

the desire of a healthy lifestyle were the main motives

for using traditional medicine.

1.2 Advantages for using Traditional

Medicine

Reason for patients for using traditional medicine is

various based on many perspectives. Some patient

applies traditional medicine because to save more

money than using general health service. For

example, the cost for using physiotherapy, manual

therapy, and general practitioner care for neck pain.

The budget for applying of all services, manual

therapy is less spending. It needs one third of the costs

of the highest service (practitioner care).

Traditional medicines also give patients trust. The

relationship between patients and traditional

medicine practitioners create social bond. Patients

entrust their health care to the traditional medicine

practitioners, because they believe, that the therapies

are trustworthy and will not committed neglect action

which can endangered patient’s health.

1.3 Type and Qualification for

Traditional Medicine Practitioners

Before traditional medicine practitioners give

medical aid or services. Well-trained practitioners are

become significant factor for high quality health

services. Many developing countries see this factor to

be enhanced. Most traditional medicine practitioners

who give services are argued or questioned their

competencies. There is no certification to certified

traditional practitioners to control their competencies.

Indonesia based on health act, implemented

certification for traditional health practitioners.

Moreover, this encouraged policy, would trigger for

many traditional practitioners who have skills or

training to apply for certification.

Skill and knowledge in traditional medicine in

Indonesia are variety in diversity. Traditional potion

medicine or traditional health services will be

developed. The development of traditional medicine

service will be emphasized to potion-based and skill-

based. The objective of this development is to

enhance health condition, disease prevention,

curative goals, and enhancing quality of

life.(Pitono,2006)

The objective of traditional health medicine in

Indonesia will be based on body of knowledge. This

will lead traditional health service in Indonesia would

coherence with social norm and religious values.

Traditional health service which blend together with

religious values will complement general health

service, which emphasizes biomedicine, the synergy

between them would occur and become an option for

patients.

In order to enhance the competencies and quality

of traditional medicine practitioners, Indonesia issues

a policy for planning, mapping, development, and

supervision traditional medical practitioners.

Ministry of health became the institution in Indonesia

which is given by the regulation to manage traditional

medicine practitioners. A strategy for enhance the

competencies, universities or higher education

institutions in medicine have significant role. The role

these institutions are operating a study in traditional

medicine. From this study, it would produce a

continuous traditional medical practitioner and

developing the knowledge and method in traditional

medicine education. Universities and higher

education institutions are not only developing

knowledge and method in traditional medicine but

also organizing and promoting training for traditional

medicine practitioners to enhance and developing

their skills.

Safety and quality assurance for traditional

medicine services also become awareness. Based on

Indonesia government regulation, every practitioner

(traditional medicine) must hold a licence.

(Pudjiastuti, 2015) This licence is a permit from

government and legal basis for traditional medicine

practitioners practise their skill and knowledge to the

community or patients. In addition, based on

government regulation a licence is a compulsory

permit, if violates, it would be a legal consequence.

Government through ministry of health has obligation

to oversight licence that has been issued and maintain

quality assurance of traditional medicine

practitioners.

Another strategy for maintain quality assurance in

traditional medicine is applying ethics code and build

a strong professional association. Ethics are important

for professional when they conduct their skill or

method. Traditional medicine practitioners must

honour and respect ethics when they give services to

patients. Patients will feel save and encourage trust to

their practitioners. (Suharto, 2015) Negligence could

be minimized and will lead to quality health care

services. A strong professional association among

traditional health practitioner also give significant

role for quality assurance. The Association will give

assistance to government for educating and

promoting policies, method, and development in

traditional health skills. The bond of association

members to obey ethics and quality assurance in

health service could emerge among them and easily

to enhance quality assurance.

The Integration Traditional Medicine Practice at National Health Insurance in Indonesia

1.4 Type of Traditional Health Service

There are 3 (three) type of services that offered by

traditional medicine practitioners toward patients or

communities. Legal basis for services that offered is

regulated at Indonesian Government regulation about

traditional medicine. The services are: (Indonesian

Traditional Medicine Act, 2014)

1. Empirical Traditional medicine service

2. Complementary traditional medicine service

3. Integrated traditional medicine service

Empirical traditional medicine service is the first

level of service to the community. This type of

medicine service must have safety and could be

implemented empirically based on science and skills

of medicine treatment knowledge. Empirical

traditional treatment could be implemented by skills

and combination between skills and traditional

potions. Another service that could be provided is

complementary traditional medicine service.

Complementary traditional medicine service is higher

level than previous one. This service provides health

treatment with implementation of bio culture science

and bio medical science which have proven its

function and safety assurance. Requirement for

complementary traditional medicine service are:

a) Must follow scientific method

b) Does not harm patients or communities

c) The best interest for patient interest must

become priority

d) Have a potential for promotive function,

prevention function, curative function, and

rehabilitative function. In addition, the

service could enhance quality of life.

e) Must be done by certified traditional

medicine practitioners

Final type for traditional medicine service model,

which can be offered, is integrated traditional

medicine service. This type of service is a

combination between conventional health services

with complementary traditional medicine service.

Integrated traditional medicine service needs a

collaboration service for medical practitioners with

traditional medicine practitioners. The service must

be held at medical facilities. The offered service at

integrated traditional medicine, must be verified and

have a licence from medical committee whether

applied in conventional medical facilities such as

hospital.

In addition, model for traditional medicine service

not only become a concern to enhance the quality

assurance. The medical traditional practitioner is also

become priority in order to offer a safe and high-

quality service. Human resources in traditional

medicine play a key role to gain thrust from society.

The integration of health service between

traditional medicine and conventional medicine

service is possible to be offered to strengthen health

insurance in Indonesia. Problem which may occur for

this integration health service is the trust from society.

People in Indonesia still believe that conventional

health service is more useful for curative and

maintaining their health. On the other hand, the many

health facilities are insufficient, especially in rural

areas and border areas. In addition, medical workers

such as doctors and nurses are not always available.

Some of health facilities are lack of doctor to give

services to communities. This problem could be

solved with encouraging involvement of traditional

health practitioners.

2 CONCLUSION

The integration between traditional medicine and

conventional health service is possible. Indonesia

government has issued a regulation to encourage the

integration service. The regulation has objectives to

achieve condition that are:

1. Give a legal basis for complementary

traditional medicine to give services at health

facilities with save, integrity, and high quality

2. As a guideline for medical workers to operate

integrated traditional medicine services

3. Establish an integrated management of service

for integrated traditional medicine

4. Establish a monitoring and quality assurance

system for traditional medicine practitioners

by government.

The integration service will enhance quality and

offering various services to communities for maintain

and fulfil their health rights and demands. Thus,

quality and facilities to complete the integration

health service could be developed with offering more

trainings and safety assurance to traditional medicine

practitioners which could triggered the developing

quality of health services.

REFERENCES

Koeswadji, Hermien Hadiati, 1995, Hukum Kesehatan,

Citra Aditya Bhakti.

Soeparto, Pitono et.al,2006, Etik dan Hukum Di Bidang

Kesehatan, Airlangga University Press.

iN-LAC 2018 - International Law Conference 2018

Pudjiastuti, Lilik, Licencing and Legalization of Traditional

Medicine to Ensure Public Health Quality, Jurnal

Dinamika Hukum, vol 15 no 2 May 2015.

Suharto, Bekti, Human Rights Dimension in Health Service

(Functional Relation Among Patient, Doctor, and

Hospital), Jurnal Dinamika Hukum, Vol 18 (2), May

2018.

WHO, 2014, WHO Traditional Medicine Strategy 2014-

2023, Internal Publication.

The Integration Traditional Medicine Practice at National Health Insurance in Indonesia