sumyunggai
Well-Known Member
- Joined
- Aug 10, 2016
- Messages
- 337
Just trying to deal with sick mother-in-law.
First thing try to get treated using BPJS (national health insurance).
You need a letter referring from one level to the next to the next, and then the beds at a reasonable hospital are all full.
So we tried private. (Siloam / Lippo Group)
Nightmare.
Doctor 1: 'ibu arisan', turns up to hospital like she is going to a social engagement. Claims that paracetemol is not an NSAID.
Doctor 2: cardiologist. m-i-l suffering malnutrition and dehydration. ECG shows irregularities (a month ago was fine). Internist suggests it might be ok after some electrolytes restored. But cardiologist says need echocardiogram and heart x-ray (!) I reject both. ECG performed after 40 hours, heart is absolutely fine.
Doctor 3. internist. Agree on arrival that everything above 500 ribu will be checked. Have discussion with doctor then (on Saturday) and he said 'we need a gastroscopy', and can't say anything till then. Ok fine.
Go home, later the evening (11:30pm) get WhatsApp from female doctor. Want to give albumin along with a bunch o other things, some of which I reject straight away. Albumin ok whatever.
Next morning get call from hospital, saying they want to give albumin costing 7.2 million, and patent antibiotic that's regulated as 'last resort' only costing 5.8 million. Plus electrocardiogram, heart x-ray, ECG, gastroscopy. I approve only the gastroscopy and ECG.
Next day (today) arrive at the hospital and check bill. Drugs I'd rejected already on there. Go and see doctor. He is performing gastroscopy. Gastroscopy is fine, nothing to see. Ask him why he is using this expensive patent antibiotic. 'We need strong antibiotics' Me: 'What?! We don't know what the bacteria is, this drug is a last resort, and you told me the patient was not an emergency. Why have you gone for this super-pricey 'last resort' antibiotic?' He says because of impaired renal function. Then ask him about the albumin. He says that it is to correct low albumin in the blood. I say 'if there is low albumin in the blood why have you not tested the urine to see if it is being excreted there?' Him 'But we have this test you did a month ago.': Me 'But when I arrived you said we needed new blood tests why don't you re-check the urine as well? We don't want to just add albumin if there is a serious disease, that makes no sense.' Him: 'The patient is malnourished we need to restore protein.' Me 'But that's better by a proper diet, now the patient is here we can control the diet and see how things go.'
Eventually I drop the argument to try and work out what is actually wrong. Doctor says 'malnutrition'. Ok, fine.
After that I go to administration to find out where these drugs came from. They said 'the doctor contacted you on Whatsapp'. I said, 'yes but she didn't say it cost 7.5 million, and after she contacted me and I was told the price by you, I said I don't want it.'
After several hours of arguing a hospital manager arrives. Argue some more. I point out that the albumin is unnecessary and the antibiotic was not discussed. He says 'so what do you want to do, we have already given it to the patient.' I say 'that is not my fault, you should follow your own procedures, you need to remove it from the bill'. So manager agrees to do that. Doctor is still unhappy and tries to sell me this albumin. I say 'no, this discussion is over'. I said we want something more economical in terms of the antibiotic and no albumin, dietary protein will be sufficient.
Finally they switch to a different antibiotic. The original was probably ok but ridiculousy expensive. The albumin is just a rip-off and a scam. According to medical documents that I read it's NOT an effective therapy for malnutrition-related protein deficiency. But at 7.5 million and the doctor will be getting a %, he doesn't care.
So instead of trying to figure out cure for (rather unclear) illness, I spent my time arguing about overpriced medicine.
This is where an insurance-based system would be better because doctor would not get away with prescribing medicines that are so far from cost-effective or even indicated, under any kind of clinical guidelines. Only they think they can get away with it with private patients because they don't know any better.
Not sure how it all fits together. Standard practice because bule at the hospital or if the hospital does it to everyone? But it does look like we will have to go (in the case of private care) for 'rawat jalan' in the future because with 'rawat nginap' at these hospitals they can build t
First thing try to get treated using BPJS (national health insurance).
You need a letter referring from one level to the next to the next, and then the beds at a reasonable hospital are all full.
So we tried private. (Siloam / Lippo Group)
Nightmare.
Doctor 1: 'ibu arisan', turns up to hospital like she is going to a social engagement. Claims that paracetemol is not an NSAID.
Doctor 2: cardiologist. m-i-l suffering malnutrition and dehydration. ECG shows irregularities (a month ago was fine). Internist suggests it might be ok after some electrolytes restored. But cardiologist says need echocardiogram and heart x-ray (!) I reject both. ECG performed after 40 hours, heart is absolutely fine.
Doctor 3. internist. Agree on arrival that everything above 500 ribu will be checked. Have discussion with doctor then (on Saturday) and he said 'we need a gastroscopy', and can't say anything till then. Ok fine.
Go home, later the evening (11:30pm) get WhatsApp from female doctor. Want to give albumin along with a bunch o other things, some of which I reject straight away. Albumin ok whatever.
Next morning get call from hospital, saying they want to give albumin costing 7.2 million, and patent antibiotic that's regulated as 'last resort' only costing 5.8 million. Plus electrocardiogram, heart x-ray, ECG, gastroscopy. I approve only the gastroscopy and ECG.
Next day (today) arrive at the hospital and check bill. Drugs I'd rejected already on there. Go and see doctor. He is performing gastroscopy. Gastroscopy is fine, nothing to see. Ask him why he is using this expensive patent antibiotic. 'We need strong antibiotics' Me: 'What?! We don't know what the bacteria is, this drug is a last resort, and you told me the patient was not an emergency. Why have you gone for this super-pricey 'last resort' antibiotic?' He says because of impaired renal function. Then ask him about the albumin. He says that it is to correct low albumin in the blood. I say 'if there is low albumin in the blood why have you not tested the urine to see if it is being excreted there?' Him 'But we have this test you did a month ago.': Me 'But when I arrived you said we needed new blood tests why don't you re-check the urine as well? We don't want to just add albumin if there is a serious disease, that makes no sense.' Him: 'The patient is malnourished we need to restore protein.' Me 'But that's better by a proper diet, now the patient is here we can control the diet and see how things go.'
Eventually I drop the argument to try and work out what is actually wrong. Doctor says 'malnutrition'. Ok, fine.
After that I go to administration to find out where these drugs came from. They said 'the doctor contacted you on Whatsapp'. I said, 'yes but she didn't say it cost 7.5 million, and after she contacted me and I was told the price by you, I said I don't want it.'
After several hours of arguing a hospital manager arrives. Argue some more. I point out that the albumin is unnecessary and the antibiotic was not discussed. He says 'so what do you want to do, we have already given it to the patient.' I say 'that is not my fault, you should follow your own procedures, you need to remove it from the bill'. So manager agrees to do that. Doctor is still unhappy and tries to sell me this albumin. I say 'no, this discussion is over'. I said we want something more economical in terms of the antibiotic and no albumin, dietary protein will be sufficient.
Finally they switch to a different antibiotic. The original was probably ok but ridiculousy expensive. The albumin is just a rip-off and a scam. According to medical documents that I read it's NOT an effective therapy for malnutrition-related protein deficiency. But at 7.5 million and the doctor will be getting a %, he doesn't care.
So instead of trying to figure out cure for (rather unclear) illness, I spent my time arguing about overpriced medicine.
This is where an insurance-based system would be better because doctor would not get away with prescribing medicines that are so far from cost-effective or even indicated, under any kind of clinical guidelines. Only they think they can get away with it with private patients because they don't know any better.
Not sure how it all fits together. Standard practice because bule at the hospital or if the hospital does it to everyone? But it does look like we will have to go (in the case of private care) for 'rawat jalan' in the future because with 'rawat nginap' at these hospitals they can build t
