Ethical and Professional Dilemmas encountered by Doctors in the National Health Insurance System

Abstract

Background: The implementation of the National Health Insurance System in Indonesia has not only increased access to medical services but also raised various dilemmas among doctors. Objective: This study aims to analyse various ethical and professional dilemmas among physicians in the National Health Insurance System (NHIS).Methods: This is a cross-sectional descriptive study with a purposive sampling method. A questionnaire was distributed online between June to December 2019 to physicians practicing in Indonesia.Results: Of the 87 doctors who participated in this study, 60.92% were general practitioners and 39.08% were specialists. The inability to maintain professional independence (63.41%) is the most common ethical dilemma faced by doctors with 65.38% of them experienced in advanced level health facilities. Meanwhile, the limitation of adequate medical care in an emergency (25.45%) is the most dilemmatic situation experienced in terms of professionalism with 85.71% occurring in advanced level health facilities.Conclusion: Physicians in Indonesia were deal with various dilemmas while practicing in the NHIS. The high rate of dissatisfaction and the various ethical problems and professional disciplines require a review of the health system to improve the quality of services and maintain the professionalism of doctors.