A Closer Look at the Standards of Medical Services under GR 28/2024
On July 26, 2024, the Government of the Republic of Indonesia issued Government Regulation No. 28 of 2024 (“GR 28/2024“), which serves as an implementing regulation for Law No. 17 of 2023 on Health (“Health Law”). GR 28/2024 encompasses a broad scope of provisions concerning the implementation of the stipulations in the Health Law.
Due to the extensive range of provisions covered under GR 28/2024, this Newsflash will discuss solely on the standard for medical services provision.
GR 28/2024 provides a significant development regarding the medical services regulation in Indonesia. Further, GR 28/2024 comprehensively outlines standards for both primary and advanced medical services, addressing critical aspects such as healthcare quality, access, and the integration of modern technology into medical practice. GR 28/2024 introduces new provisions for medical services in remote areas, the use of telemedicine, and the role of digital health technologies. These changes are intended to enhance the effectiveness of medical services while ensuring they align with evolving global standards.
This Newsflash focuses on the updated standards for primary and advanced medical services, the medical services in special areas, and the technology in the healthcare sector.
♦ Primary and Advanced Medical Services
As mentioned above, GR 28/2024 establishes comprehensive standards for both primary and advanced medical services. Primary medical services (Pelayanan Kesehatan Primer) are the medical services closest to the community, serving as the first point of contact for health services. While advanced medical services (Pelayanan Kesehatan Lanjutan) focus on specialized care for patients, while also considering earlier treatments and maintaining overall patient’s health condition provided by the competent medical workforce.
Primary medical services aim to meet the community’s health needs at every stage of life by enhancing the determinants of health or factors that may impact health, such as social, economic, commercial, and environmental factors.
Primary medical services are provided by community health centers (Puskesmas) or equivalent primary care providers in the area. These services are delivered through a coordinated medical network system to improve coordination between different healthcare levels, reduce delays and enhances patient outcomes, especially for specialized care. One of the forms of coordinated medical network system is a referral system, where medical service facilities refer patients to advanced centers when necessary.
The referral system is conducted through 3 (three) types of referrals, namely:
- Vertical referral
A vertical referral is a referral from a medical service facility to another facility with a higher level of capability that aligns with the patient’s medical needs. - Horizontal referral
A horizontal referral is a referral from a medical service facility to another facility at the same level of care but with specific competencies that the referring facility does not possess. - Back-referral
A back-referral is the process of referring patients who have completed treatment at a higher-level medical service facility back to a lower-level facility for continued care or further treatment.
♦ Medical Services in Special Areas
A key aspect of GR 28/2024 is its focus on standardizing the quality of care across healthcare facilities. While the previous regulation, Government Regulation No. 47 of 2016 on Traditional Health Services (“GR 47/2016”), provided certain guidance, GR 28/2024 revoked GR 47/2016 and sets forth more comprehensive standards for patient care, which aims to address disparities in healthcare quality between urban and rural regions.
GR 28/2024 highlights the importance of delivering medical services in special areas, such as remote areas, border zones, islands, as well as in health-problems areas or underserved areas (these areas referred to as “Special Areas”). GR 28/2024 recognizes the distinct challenges encountered in these areas, including inadequate infrastructure, challenging geographical conditions, and a shortage of healthcare professionals. It assigns responsibility to both central and regional governments to ensure that residents in these regions have access to quality medical services.
While the focus on healthcare accessibility in remote and underserved areas was already regulated in GR 47/2016, GR 28/2024 introduces substantial updates to these provisions. For instance, it introduces integrated health information systems that enable effective monitoring and linkage of medical services to national databases. This initiative aligns with the government’s vision to improve healthcare delivery for marginalized communities and to tackle infrastructural challenges, such as the lack of adequate facilities and resources in Special Areas.
Medical facilities in Special Areas must be adapted to meet the specific conditions and issues of each area. Further, Article 547 of GR 28/2024 stipulates that all health data recording and reporting for all healthcare facilities in these areas must be integrated into the national health information system. In this regard, the implementation for this provision will be regulated in a separate Minister of Health regulation.
♦ Technology in Healthcare Sector
Previously, provisions regarding technology in healthcare sector were regulated under Government Regulation No. 46 of 2014 on Health Information Systems, which was revoked by GR 28/2024. On that note, GR 28/2024 introduces provisions for the integration of Information and Communication Technology (ICT) to enhance access to and the quality of medical services in Indonesia. This includes incorporating telemedicine and telehealth into the delivery of medical services.
Telemedicine facilitates remote clinical services, which enable healthcare professionals to diagnose and manage diseases without requiring patients to travel. Meanwhile, telehealth encompasses a broader range of services, including both clinical and non-clinical consultations. GR 28/2024 further stipulates the requirements for medical service facilities offering telemedicine and telehealth, including the need for adequate infrastructure, reliable internet connectivity, and adherence to national data security standards.
AKSET
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