Draft ‘Omnibus’ Health Law Is Rejected
It would be very wise for the DPR and the current administration cancel or at least postpone this "omnibus" health bill, which is included in the House’s 2023 priority legislation.
In recent weeks, there has been public discourse about the emergence of a draft health law prepared as an omnibus bill.
“Omnibus” comes from Latin and means “for all”.
We have not forgotten that in the last few years, there have been uproars and demonstrations related to the enactment of the Omnibus Law on Job Creation Law, and even ended in a lawsuit to the Constitutional Court.
Now, in the midst of the ongoing Covid-19 pandemic, with cases even increasing in some area, an omnibus health bill has been formulated. This bill combines several regulations and materials, adding or modifying new articles or new content for several existing laws.
It can be ascertained that the reason that the government and the House of Representatives (DPR) is combining several health and occupational laws into one overarching law is because several existing laws on occupations and health are considered ineffective, so it is necessary to simplify them into one law.
Unclear
At least regulations related to occupations and health have been combined into one law. Of course, there are also articles with new content that change or revoke materials from existing laws and regulations, such as Law No. 29/2004 on medical practice, Law No. 38/2014 on nursing, Law No. 4/2019 on midwifery, Law No. 36/2014 on health workers, Law on quarantine and outbreaks, Law on the Health Care and Social Security Agency (BPJS), as well as several other laws related to health.
However, it is not clear which parts of the existing laws overlap or have been deemed convoluted and lengthy. So why did they outline a draft “omnibus” health law? What is really behind the drafting of this “omnibus” health bill?
Various parties have speculated that the bill was created to facilitate foreign investment in the health sector and to make it easier for foreign doctors and health workers to enter the country. In this regard, there are also other issues, as though Indonesian doctors were afraid of the presence of foreign doctors in this country.
There are also those who say that this bill was drafted because professional organizations such as the Indonesian Medical Association (IDI) and the Indonesian Dental Association (PDGI) were too strong, so they often hindered government policies, such as on opening medical faculties (FK) and specialist study programs in tertiary education (PT).
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Without intending to defend the bill, this author can confirm that all of the above is completely untrue.
Foreign doctors who enter this country are also not a problem, as long as they have clear competencies and qualifications, as well as certain skills and qualifications that we need and don't have at home. In fact, our doctors can learn and add to their skills and experience from foreign doctors.
In the mutual recognition arrangement (MRA) at the level of the ASEAN Economic Community (MEA), it has been agreed that the mobilization of doctors in each country must follow the local regulations. In Indonesia, we already have Health Ministry Regulation (Permenkes) No. 14/2022, while competency evaluation is regulated in Medical Council Regulation No. 97/2021.
Without intending to defend the bill, this author can confirm that all of the above is completely untrue.
Indeed, every country in the world has regulatory mechanisms that protect against foreign workers, including doctors, with the aim of ensuring public safety and interests.
The opening of FK or specialist PT programs is entirely under the university’s authority. Professional organizations, in this case collegiate organizations, only give various considerations and inputs in an effort to maintain the quality and standards of graduate doctors and specialists, especially regarding the availability of human resources/teaching staff and education facilities.
The omnibus health bill currently circulating has started generating massive resistance from a number of professional health organizations at both the provincial and district levels, such as in Jakarta, Banten, West Nusa Tenggara (NTB), Central Java, South Kalimantan, East Java, Riau, South Sumatra, North Sumatra, West Kalimantan, South Sulawesi and Gorontalo, as well as in cities like Kudus, Sukoharjo, and Medan, and will soon be followed by other regions.
The strong rejection and reaction are not unreasonable. Protecting the public must be prioritized by health workers such as doctors, nurses and midwives in carrying out their duties.
Reason for rejection
There are several reasons for rejecting the "omnibus" health bill. First, the drafting process was neither participatory nor transparent. This clearly violates the procedure for formulating a law. None of the professional organizations or the public, as stakeholders, were involved.
After a press conference involving several professional organizations at the Indonesian Doctors Association Executive Board(PB IDI) some time ago, several professional organizations like the IDI, PDGI, PPNI, IBI and IAI were invited by the House Legislative Body (Bamus) to express their views in early October 2022.
This means that the process of drafting this bill has violated the provisions in Law No. 12/2011, alongside those in Law No. 15/2019 and Law No. 13/2022. Public participation, including stakeholders such as professional organizations, should be strengthened in formulating a law. The public’s opinions and inputs need to be heard and should be considered in drafting a bill. The philosophical, sociological, and juridical elements that should be considered when formulating a law are not clearly visible here.
Second is the takeover of professional roles. This health bill makes it very clear that there has been a reduction in the role of professional organizations, especially collegiate organizations, in setting the standards of professional education and doctors’ competencies, which have been taken over by the government. Not recognizing the IDI as the only professional organization for doctors and the PDGI for dentists is a real mistake.
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In fact, internationally, the IDI is the only doctors’ organization in Indonesia that is recognized by the World Medical Association (WMA). Why does the state itself not recognize it?
Third is centralized regulation. The regulation for recognizing the competence of health workers, including the issuance of medical licenses (STR), which has b33n the authority of the Indonesian Medical Council (KKI) as the regulator of professional medical practice, has been taken over by the Health Ministry. Worryingly, the STR is very important because the license guaranteeing that a competent doctor may practice is issued only once in a lifetime for an indefinite duration.
Meanwhile, according to the Medical Practice Law, the STR must be renewed every five years upon the proof that a doctor is pursuing continuing medical education (P2KB) to update their knowledge and skills. Monitoring and maintaining doctors’ competence over a certain period is necessary for patient safety.
The IDI is the only doctors’ organization in Indonesia that is recognized by the World Medical Association (WMA). Why does the state itself not recognize it?
In comparison, in the United States, a medical license must be renewed every two years. In Malaysia and Singapore, a medical license is valid for only one year and in the Philippines, it is valid for three years.
It is difficult to find a country in the world where a medical license is valid for life. The KKI, as an independent state institution, has been directly responsible to the head of state as stated in Article 4, Paragraph 2 of Law No. 29/2004 on medical practice. Meanwhile, in the new health bill, the KKI is placed under the Health Ministry. Of course, the KKI cannot be independent in carrying out its duties in regulating the medical profession.
Here, it is very clear that the medical council must be independent in supervising and developing the medical profession. This can be realized because out of the 17 members of the KKI are three representatives from the community apart from representatives of professional and collegiate organizations, and the government (the ministries of education and health).
What should be done?
Actually, various health and profession laws exist and have been running well so far, with almost zero problems. This means that enacting an omnibus health law is not at all urgent at this time.
If certain things in the existing laws have not been running optimally, the only thing to do is to improve the implementing regulations and coordination between the relevant institutions, agencies and professional organizations. What is very urgent at this time is the presence of a good and comprehensive law on the national health system (SKN), including a health financing system through the National Health Insurance (JKN), referral arrangements and improving the quality of health facilities.
The IDI and other professional organizations will certainly be ready to assist the state in compiling a comprehensive SKN.
In the end, it would be very wise for the DPR and the current administration cancel or at least postpone this "omnibus" health bill, which is included in the House’s 2023 priority legislation. This is important to show that we are on the side of ensuring the protection, safety and interests of the people in this country.
Sukman Tulus Putra
Sukman Tulus Putra, Chairman of the Indonesian Pediatric Cardiology Society, member of the Advisory Council of the Indonesian Doctors Association Executive Board (PB IDI), council member of the ASEAN Pediatric Federation (APF)
This article was translated by Kurniawan Siswo.
