The fiasco of a BPJS doctor’s appointment at Siloam

I recently used my BPJS insurance to have a health concern checked out (spoiler: I’m fine).

BPJS is the government-run health insurance scheme in Indonesia. It’s available to KITAS holders – it used to be all KITAS holders but I believe it’s now only those who have an IMTA work permit.

They make it complicated and time-consuming to do anything using this system so I decided to document my experience here in the hope it may help others. I also found out the reason WHY it requires so many trips for what should be a quite straightforward checkup (scroll down to the bottom if you just want to read this bit).

Here is the process I had to go through as a BPJS insurance holder:
BPJS insurance at Siloam hospital

Step 1: Visit your local clinic

The first step with anything BPJS-related is to visit your local clinic (which you specify at the time of sign-up). If there is one near you that caters to tourists and is part of the scheme, my advice would be to register with that one, simply because they’re likely to provide a better service. I have ended up at a puskesmas – a general health clinic that includes a dental clinic and a midwife service.

Anything that’s not an emergency requires a visit to your local clinic first – even if you know you require more advanced medical treatment at a hospital.

At our puskesmas there is no appointment system. You turn up, take a numbered ticket, and wait. And wait, and wait, and wait. And then you’re called up to be registered. Then there’s more waiting before it’s your turn to see a nurse or doctor.

If they can’t diagnose and medicate the problem there and then, they’ll write a letter to refer you to a hospital for further tests.

Step 2: Visit the hospital you’ve been referred to

Not all hospitals in Bali are part of the BPJS scheme, and you may have no choice over which one your clinic refers you to. I was lucky because they gave me a choice of Siloam hospital or another one I’d never heard of. Siloam is not only one of the best hospitals in Bali, it’s also less than 10 minutes from my home, so that would have been my first choice anyway.

So I went to Siloam, letter in hand. There is a BPJS poliklinik around the back which handles all BPJS patients.

I went in, showed them my letter, and was told the doctor I needed to see started at 2pm every day. Not ideal because I have to pick my daughter up from daycare by about 4pm but I had no choice. He was fully booked that day so I was asked to come back tomorrow.

I was told I had an appointment for 2 o’clock and should arrive at 1.30. Great.

Step 3: Turn up for your appointment

So I rocked up at 1.30pm the next day and was told to take a numbered ticket. I tried to explain that I had an appointment, but they said I still had to take a ticket and wait my turn. It was approaching 2pm by the time my number was called – not a good sign. They took my letter and entered my details on the computer, then gave me a sticker which showed I was number 8 in the queue to see this doctor. Not a good sign at all.

I had to take a seat and the waiting game began again. About another hour passed before I was called through to the nurses’ station, then told to get a number to queue for the pharmacy. I was called straight up, handed over my number, and told to sit down again. Then I was called back to the nurse’s station. This part made no sense at all.

Anyway, I was finally “in” and directed to a doctor’s office on the third floor. There I had to wait again. I was getting anxious by now because of the looming school pickup. After seeing a couple of people go in before me, I went and asked the nurses how far along in the queue I was and how much longer I’d have to wait.

You’d think I’d asked them the square root of pi from the way they reacted. All they could tell me was that there were other patients waiting and I should just wait for my name to be called. I was left wondering if there was any kind of system at all in place. After another 15 minutes or so I asked again and explained I had to leave soon to pick up my daughter. I don’t know if it’s because of this that my name was called next, but anyway, I finally found myself in front of the doctor.

The doctor did a quick check and then told me I needed an ultrasound scan. I was running late by this point and just wanted to go out of there. He handed me two letters – one to book my radiology appointment and one to book a second visit to him with the results of the scan.

I had to go to the radiology department to book myself in for the scan. I didn’t have time to do it right then, but that’s ok because neither did they. I was told to come back two days later at 11am. My name was written in their appointment book. BUT I still had to go back to the BPJS Poliklinik to make my appointment official before I came to them.

Waiting for BPJS appointment at Siloam hospital

Step 4: Go back again

So two days later, as instructed, I went back to the BPJS poliklinik at Siloam to make an appointment for the scan I already had an appointment for. I didn’t take a ticket, but instead waited until one of the receptionists was free and then showed her my letter. She registered me right there and directed me to the nurses’ station.

After a few minutes of hanging around one of the nurses spoke to me and checked my details. She said I had to go back to the front desk to get some more stickers printed. Right. So I went back and waited again for one of the receptionists to become free. I could feel rows of people glaring at me, wondering why I thought I had the right to jump the queue. I would have done the same about an hour into my wait just two days before.

Anyway, stickers printed, I returned to the nurses and was then told I could go to radiology. It was 11:01 when I arrived.

Even though my name was written in their book for the 11am slot, it was nearer 12 by the time I was called through. Scan done, I was told to go back to the Poliklinik to make another appointment to see the doctor.

The soonest appointment they had was over a week away, but that was partly because the holidays of Nyepi, Galungan and Kuningan were coming up.

And then came a familiar line: “Your appointment is at 2 o’clock but come at 1:30 to register.”

Step 5: Go back again

This time, I came prepared. Phone fully charged and a book for backup. Knowing how the system worked, I was better prepared for an afternoon of hanging around.

Even so, when 3:15 arrived and I still hadn’t been called through to the nurses’ station, I went to the front desk to enquire how much longer it would be. I had seen other people come in and be called up while I was waiting. Maybe there was a logical explanation for this – maybe they were seeing a different doctor who didn’t have such a long queue – but I was getting frustrated.

The receptionist told me to go and ask a nurse. I did, and was asked to wait. A few minutes later, my name was called. Would this have happened if I hadn’t gone to ask them? Or would I have been left sitting in the waiting room for the rest of eternity? We will never know.

I went back up to the doctor’s office as directed. This time I didn’t have to wait so long up there to be called. I went in, the doctor opened my file, and asked where my scans were. Apparently I was supposed to have collected them myself from radiology. I said I hadn’t been told about this, but as the words came out of my mouth I vaguely recalled receiving this instruction the week before.

I offered to go and pick the scans up myself so the doctor could see someone else in the meantime, but he sent one of the nurses to do it. Having apologised for not picking it up myself, I explained that I found the system rather confusing. I mentioned that I had been waiting over two hours to see him (not meaning to complain; more to make conversation).

The doctor went on to tell me that the BPJS system is as confusing/annoying for doctors as it for patients. He also explained why the hospital makes you visit on so many different occasions (I’ll share this with you in just a moment).

Once the nurse returned, the doctor had a quick look over my scan results, told me everything was fine, then handed me my file and said “Congratulations, this is what you waited two hours for.”

And that was it. I was free to go home and get on with my life.

Why do hospitals make BPJS patients visit so many times?

Ok so, here is what the doctor told me while we were waiting for my scan results to arrive.

When you are referred to Siloam hospital via the BPJS system, the government pays a certain amount to the hospital PER VISIT. For consultations and many procedures that’s just 100,000 rupiah. So, if I went one day and had my consultation, got a scan, and then had another consultation to check the results, the hospital would receive 100k. By dragging it out over three visits, they get 300k instead.

You have to wonder whether it’s really worth it, with the amount of extra admin work they are creating for themselves by having this system in place. Not to mention plummeting levels of customer satisfaction.

They will also keep BPJS patients in overnight when it is completely unnecessary, for much the same reason. Say someone has a small wound that requires stitches. A walk-in private patient would get the stitches, pay, and leave. But if a BPJS patient does that, the government only pays out 160k to the hospital, and that’s not even enough to cover their material costs, the doctor explained.

By making the patient stay a night, even if their health condition doesn’t require it, the hospital’s payment is bumped up to 1.5 million or more.

The doctor said he recommended only using BPJS for emergencies, and for more routine problems just paying for the treatment yourself. I’d have to say I agree with him after this experience, although of course I didn’t know that all I would require was an ultrasound scan.

I don’t want to sound ungrateful that, as a foreigner living in Indonesia, I can still have access to affordable health insurance. I also recognise that the whole process was dealt with quite quickly – perhaps just 10 days from start to finish even with the big holidays in the middle. With some countries’ public healthcare systems it could drag on a lot longer.

The bit that I AM complaining about is the massive waste of my time. If they could just implement a proper appointment system – where you book an appointment for 2pm and you are seen by the doctor around that time – it would make it much easier for everyone.

And I guess I’m lucky because I have the flexibility to visit the doctor four times in two weeks. What about workers whose employers won’t let them take that much time off, or who dock their pay for the hours missed?

The BPJS system is still only a couple of years old and I’m sure the government is still working on ways to improve it. But there seems to be a need for hospitals and clinics to be held accountable for the quality of service they provide to patients so they stop just doing whatever makes them the most money.

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