On 11 July 2023, the House of Representatives of the Republic of Indonesia (Dewan Perwakilan Rakyat or "DPR") passed the Health Bill into Law No 17 of 2023 on Health ("Health Law"), which was ratified by The President of Indonesia Joko Widodo on 8 August 2023 to take effect immediately.
The enactment of the new Health Law provides a fresh perspective on healthcare law in Indonesia. In the form of an omnibus law, this newly enacted Health Law has direct impacts on the existing regulations. There are, at least, 13 preceding regulations that are affected due to the enactment of this law. The laws that govern epidemics up to the ones on midwives will be repealed. Additionally, Health Law will also amend several regulations including Law No 20 of 2003 on the National Education System, Law No 40 of 2004 on the Social Security System, and Law No 24 of 2011 on the Social Security Administrative Body.
Despite the ongoing debates over the latest draft, DPR remains committed to enacting the health bill into law. To better understand the regulation, we provide a comprehensive overview of the key points in the new Health law.
Responsibilities of Central and Local Governments
In Health Law, the central and local government, ("Government") share the responsibility to plan, regulate, organize, develop, and supervise the implementation of healthcare, aimed at achieving the desired quality, safety, efficiency, equity, and accessibility. Furthermore, Government is also responsible for increasing and developing healthcare to ensure the accessibility and healthcare standards through assessment and research in accordance with the prevailing laws and regulations.
Besides the responsibility to improve the implementation, the Government is correspondingly responsible for the availability of healthcare by providing fiscal or non-fiscal incentives, in accordance with the prevailing laws and regulations.
As this new regulation revokes the previous health law, it is important to note that Covid-19 had a significant impact on lawmakers' deliberations, adding the responsibilities of the government to implement alertness activities to prevent such outbreaks or epidemics.
(Article 8 of Health Law)
Although this new regulation has replaced the previous regulations, some of the new provisions merely clarify the old ones in healthcare implementation. As a reference, the previous regulations only impose the healthcare implementation as a brief concept of the equitable principle as stated in the elucidation of Article 2 (10) of the previous healthcare law.
Health Law regulates healthcare implementation by stipulating one chapter that focuses on healthcare implementation, which consists of (i) health efforts, (ii) health resources, (iii) and health management (Article 17 of Health Law).
The provisions regarding Telemedicine were previously regulated under the Minister of Health Regulation Number 20 of 2019 on Implementation of Telemedicine Services ("MoH Reg 20 of 2019")
Furthermore, renewing the law is necessary in some situations, considering that the Covid 19 pandemic had huge impacts on various sectors, including social, technological, and economic developments, also government policies. The previous law was imposed on only the health service providers. Health Law is enacted to provide detailed stipulations of telemedicine services and their implementations. According to Article 334 of Health Law, medical technology shall be implemented, produced, circulated, developed, and evaluated through research, development, and assessment to increase the health resources and efforts.
The enactment of Health Law provides the needed support to improve telemedicine practice, which has been widely developed in Indonesia, especially during the Covid-19 outbreak, which required social distance and limited physical interaction. Such practice is considered effective in health services.
License and Registration
Besides replacing the preceding regulations, including Law No 36 of 2014 on Healthcare Workers ("Law 36/2014"), Health Law has simplified the requirement for obtaining Registration Certificate (Surat Tanda Registrasi or "STR") and Practice License (Surat Izin Praktek or "SIP"). According to Article 261 of Health Law, obtaining STR only requires (i) a Diploma Certificate, and (ii) a Certificate of Competency. Furthermore, STR is now valid for life, while Law No 36/2014 regulated a valid STR period of five years.
In addition to STR, Health Law also simplifies the necessary procedure to obtain SIP. Under the previous regulations, Health Workers needed to provide recommendations of professional organizations (i.e., Ikatan Dokter Indonesia or Indonesian Doctors Association ("IDI"), valid STR, and the practice location, whereas Health Law only requires them to provide Valid STR and the practice location.
The newly enacted Health Law signifies the main issue on utilization of human resources. Although the previous Law No 36 of 2009 on Healthcare already stipulated that, we note that several changes and additions in the new law regarding the utilization of human resources which gave rise to various controversies. Please be informed that Government's main objectives for changing the provisions are because the quantity and quality of medical and healthcare personnel in Indonesia is still very low, and the country still lacks of qualified medical personnel, especially in the public healthcare sectors. At present, the regulation of human resources in the healthcare system is deemed sufficient to achieve the national goals in healthcare sectors.
In accordance with Article 197 of Health Law, the human resources in healthcare are classified into:
(a) Medical Personnel;
(b) Health Workers;
(c) Traditional Health Workers; and
(d) Health Support of Support Staff.
Under this new regulatory regime, the utilization of human resources is divided into four types.
Please refer below for our elaboration regarding the utilization of medical personnel and health workers in Indonesia.
1. Utilization of Medical Personnel and Health Workers in Indonesia
The central and regional governments are responsible for assigning medical personnel and health workers through a selection process to implement equal distribution of health services. Furthermore, the placement of medical personnel and health workers is carried out with various methods such as:
(i) appointment as civil servants;
(ii) special assignments; and
(iii) appointment as employees in accordance with the prevailing laws and regulations.
(Article 231 of Health Law)
2. Utilization of Health Reserve Forces for Extraordinary Events (Kejadian Luar Biasa or "KLB"), Epidemics, and Health Disaster Responses
Please note that with the existence of Covid-19, the Government has already taken measures to prevent similarly dangerous events in the future. Through this newly enacted Health Law, the Health Reserve forces shall be established in the event of KLB, Epidemics, and/or Disasters, which will be used for disaster mobilization.
(Article 238 of Health Law)
3. Utilization of Indonesian Citizens as Medical Personnel and Health Workers Overseas
The utilization of Indonesia's medical personnel and health workers in foreign countries is stipulated under Article 240 of Health Law. This must be carried out upon the consideration of a balance between healthcare needs in Indonesia and employment opportunities for Indonesian professionals abroad.
(Article 240 of Health Law)
4. Utilization of Indonesian Medical Personnel and Health Workers who Graduate Abroad
Indonesian citizens who graduated as medical personnel and health workers overseas shall commence the competency assessments carried out by the Ministry of Health ("MoH"). They include:
(i) Administrative completeness assessment; and
(ii) Practical ability assessment.
These assessments shall be conducted before they are allowed to provide any medical practices in Indonesia. (Article 241 of Health Law)
In addition to the competency assessments, Indonesian citizens who want to practice as health and medical personnel are required to obtain STR and SIP.
(Article 242 of Health Law)
5. Utilization of Medical Personnel and Health Workers of Foreign Citizens Graduated in Indonesia
Foreign Citizens who graduated as health or medical personnel in Indonesia shall only practice upon request from the healthcare facilities, within specific periods, and they must obtain STR and SIP.
(Article 246 of Health Law)
Utilization of Medical Personnel and Health Workers of Foreign Citizens
Under the new Health Law, foreign medical personnel and health workers are allowed to establish practices in Indonesia with a mandatory competent evaluation, consisting of:
(i) Administrative completeness assessment, and
(ii) Practical ability assessment.
However, foreign medical personnel and health workers who graduated abroad are only eligible to perform medical practices in Indonesia, subject to specialized and subspecialized Medical Personnel and Health Workers at specific competency levels, after commencing the mandatory competent evaluation.
(Article 233 of Health Law)
By allowing foreign medical doctors to work in Indonesia, the country will be able to meet the demand for quality health services within the country. In addition, the presence of foreign medical doctors in Indonesia can expand the Indonesian health industry to new medical technology and knowledge.
Health Information System
Furthermore, the new health law also stipulates that the health information system enhances the effectiveness of health efforts taken by the central government, local authorities, healthcare facilities, as well as the public as individuals or groups ("Provider"). Providers are responsible for providing the health information integrated into the National Health Information System (Sistem Kesehatan Nasional or "SKN"), and they are supported by the Ministry of Health
(Article 345 of Health Law).
In addition to the above, to ensure adequate operation of the health information system, a Provider is obliged to ensure that the health information system must consist of:
c. Maintenance; and
Enforcement of Professional Discipline
Under the new Health Law, Medical Personnel and Health Workers are legal subjects of their professional actions. They must be held accountable for their actions in case of medical malpractice. Pursuant to Article 304 of Health Law, it is mandatory to enforce professional discipline to support and maintain the level of professionalism of Medical Personnel and Health Workers. The Ministry of Health has formed a council responsible for carrying out tasks in the field of professional discipline. The council will determine whether any violation of professional discipline is committed by a Medical or Healthcare Personnel.
Please be informed that violations of professional discipline are subject to various sanctions, including:
(i) Written Warning
(ii) Obligatory attendance of education programs or trainings provided by the relevant institutions in the field of healthcare, or the nearest educational Hospital with the competence to conduct such trainings;
(iii) Temporary Suspension of STR; and/or
(iv) Recommended Revocation of STR.
Under this new Health law, the provision regarding healthcare funding is one of the examples of newly added provisions. The health funding is deemed as a step to provide sustainable financial support, ensure sufficient allocation, support effective utilization, and improve efficiency to elevate the health status of the population to the highest possible level. Such acknowledgement should come from the Central Government, Local Governments, public, and other legitimate and non-binding sources.
(Article 401 of Health Law)
Furthermore, the government is obliged to ensure the availability of funds that are used for community health efforts with a priority on promotive, preventive, curative, and/or rehabilitative approaches.
On the other hand, this new health law eliminates the requirement for a mandatory minimum spending of 5% by the central government and 10% by local governments, previously allocated for prioritizing public services, particularly for the underprivileged population, elderly, and orphaned children, These are main issues that have been challenged by medical doctors and the Indonesian doctors' organization (i.e., IDI).
We emphasize the fact that this new health law offers a fresh perspective and practical ways to enhance the regulatory regime, and improve the modern, standard practices of healthcare. The law also simplifies the processes of, among others, permitting foreign doctors to work in Indonesia, and providing the funding mechanisms to ensure sustainable financial support to facilitate the growth of health services in Indonesia. It is important to acknowledge the fact that the implementation of this health law has sparked ongoing debates over its necessity. However, we note that this health law will have a significant impact on the health industry, optimize the resources, and reinforce the existing laws and regulations.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.