If this is the future, hospitals will become places where diseases are met with fees, and doctors will cry behind their masks while counting the installments of their lives.
ONE day, in a meeting room of the Most Central Public Hospital, the director held a stack of papers. His hands trembled, not from a mild stroke, but from the large numbers just sent from the center: “Hospital Revenue Target for This Year: IDR 1.6 Trillion.”
And so, stethoscopes across the country began to weep. But perhaps the story at the beginning of this article is just a rumor, a tremor circulating throughout the system. But, as the saying goes on social media: “If it’s not true, why does it sound so convincing?” Why, too, do hundreds of professors cry out?
Yes, the rumor that our beloved Ministry of Health has set revenue targets in the billions or even trillions for public hospitals has spread across thousands of digital screens. It sounds like the result of a brainstorming session between Excel and capitalist demons.
The more dramatic part is that doctors are starting to feel like the most powerless creatures in this republic. They feel that they no longer work to serve humanity, but to chase quotas. Sadly, not quotas of merit but quotas for revenue.
Imagine this: doctors in the ER no longer ask patients, “How are you feeling?” but ask their families, “Can you pay in cash or in installments via ShopeePay?”
Of course, we are not making this up. While rumors may not have birth certificates, the concern among doctors is very real – just like their eye bags. Even one doctor, a friend of the writer, said bitterly:
"I can’t imagine if doctors across Indonesia rise up against the power that oppresses them." A sentence that, if turned into an orchestra, could become a new national anthem: Indonesia (Is Already) Sick.
So, where did all this turmoil begin?
According to Taufiq Fredrik Pasiak — a brain scientist still thinking clearly despite living in a chaotic country — this all started from a shift in perspective towards the medical profession. The Dean of the Faculty of Medicine at UPN Veteran Jakarta wrote a lengthy article about it on jernih.co.
You know, our Minister of Health, Budi Gunadi Sadikin (BGS), is not a product of the Faculty of Medicine, but rather the Faculty of Applied Capitalist Economics (read: a skilled banker). So, it’s understandable if he sees hospitals as branches of banks: with KPIs, income projections, and of course, targets. Perhaps even with SPGs involved.
In BGS's view, hospitals may be strategic production units. Doctors? Human resources. Patients? Maybe part of the customer experience unit. And medical science? Ah, that’s something you can print out quickly, like instant noodles with a dash of empathy broth.
Seeing this, Pasiak concluded, "This is not just a policy, but a battle between two paradigms." One is a logistics paradigm, the other is an ethical and humanistic one.
But what can be done? The minister is wielding the ‘mapatu’ – the Manado term for a knife handle – slicing specialist programs arbitrarily. Meanwhile, the professors only carry idealism — an item that cannot be sold, especially not in the E-Catalog.
Meanwhile, the training of specialist doctors in the country is not entirely pure. There are long-standing issues: a hierarchical system that oppresses, sky-high costs, and frustrating bureaucracy.
In some cases, specialist students working in hospitals are treated more like laborers with ID cards rather than carefully trained future healers. They are pressured to handle large numbers of patients.
Currently, Indonesia has 49,670 specialist doctors. According to Bappenas, the ideal ratio of specialists to population is 0.28 per 1,000 people. This means Indonesia still lacks around 29,179 specialist doctors. Additionally, their distribution is highly concentrated in Java, with around 59% of specialists located there.
At the same time, specialist education is slow and costly. Currently, Indonesia only produces about 2,700 specialists per year from 24 medical faculties that provide specialist education — far from the ideal need of 32,000.
This gap is what BGS seized upon with a “reform” spirit. His challenge was to meet this need, with the noble goal of ensuring the health of the Indonesian nation. He saw obstacles to accelerating the creation of specialist doctors.
So, BGS introduced a breakthrough during the Jokowi era. The government officially launched the Hospital-Based Specialist Education Program (PPDS) in May of the previous year. This launch took place at the RSAB Harapan Kita in Jakarta.
Unfortunately, rather than addressing the root cause, BGS chose to trim the leaves: speeding up, splitting paths, and moving the education center from universities to hospitals. As if producing doctors was as easy as printing ATM cards.
On the other hand, the rumor about the trillions of revenue from RSUP is not just a number. It’s a symbol — of how the government now sees hospitals: no longer as bastions of humanity, but as warehouses of profit. No wonder doctors are now suffering from an existential crisis. They feel they are no longer warriors on the frontlines, but insurance salespeople in white coats.
So, what will happen if this rumor is true? Perhaps a new profession will emerge: “Doctorpreneurs.” They will open clinics with slogans like: “We don’t heal, we target.”
Patients will not be seen based on urgency, but based on profit margins. The ER will become a cashier, and operations will be scheduled based on financial graphs. The poor? They will have to wait at the back of the queue or turn to alternative treatments.
But we must not be hopeless. Pasiak offers a peaceful path: a thorough audit, forming a transitional council, and fixing the system from the top down. The government needs to engage in dialogue with the medical community—not just regulate from above with spreadsheets and PowerPoints. Because doctors are not products, and medical education is not a factory.
If you don’t believe it, try asking your doctor, “Doctor, has the target for today been reached?” If they answer, “Still two operations and one endoscopy short,” then rest assured: we are moving backward to the future — where the healthcare system no longer heals, but sells the illusion of healing.
And in the end, we, as the people, can only hope: may this rumor not become a reality. Because if it does, hospitals will become places where diseases are welcomed with fees, and doctors will cry behind their masks while counting their life’s installments.
Welcome to the Republic of Health, Terms and Conditions Apply.
Ma’had Tadabbur al-Qur’an, May 20, 2025
* CAK AT – Ahmadie Thaha
Source: https://kbanews.com/english-edition/doctors-crying-at-the-cash-register-of-the-state/