1
HOSPITAL REFORM
IN INDONESIA
Shita Dewi
Context Background
2
Health system
development
Hospital management
Missionary
The history of
hospital development
in Indonesia
The growth of
health care
industry
Globalization
The
international
market of
health care
industry
The Players
3
Public hospital
Private Hospital

Corporation Hospital


Mainly for profit
Foundation Hospital
Faith-based & Non faith
based
 Not-for-profit




Association hospital
NGO’s
 Not for profit



National hospital
Teaching state-owned
hospital
Province hospital
District hospital
The Number of Hospitals (1998-2008)
4
800
Number of hospitals
700
600
589
591
500
491
593
511
518
1999
2000
595
550
598
580
642
655
667
609
617
625
617
621
626
638
653
606
2003
2004
2005
2006
2007
2008
400
300
200
100
0
1998
2001
2002
Pemerintah
PUBLIC
Swasta
PRIVATE
HEALTH CARE SYSTEM
5
CENTRAL
MINISTRY OF
HEALTH
MINISTRY OF
HOME AFFAIRS
NAT. HOSPT
GOVERNOR
PROVINCE
PROVINCE HEALTH OFFICE
PROV. HOSP
MAYOR/BUPATI
DIST RICT
DISCTRICT HEALTH OFFICE
SUB-DISTRICT
VILL AGE
HEALTH CENTERS
VILLAGE
MIDWIVES
SUB HEALTH
CENTERS
INTEGRATED
POST
DIST. HOSP
CAMAT
Hospital Reform
6
Bureaucratic
Corporation
Not for profit
Nonprivatization
Bureaucratic
(Pre-1991)
Semi
Autonomous
(Swadana)
(1991)
Public Service
Agency
(BLU/BLUD)
(2007)
Reform Modalities and The Environment
Core public sector
Broader public
sector
B
A
C
P
Harding-Prekker, 2000
Market/private
sector
Budgetary Unit
Autonomized Unit
Corporatized Unit
Privatized Unit
The Reform Modalities and Dimension
(Harding-Prekker, 2000)
Budgetary Unit
(SKPD)
Decision Right
Vertical Hierarchy
Residual
Claimant
Public Purse
Autonomized
Unit
(Swanada)
Corporatized
Unit
(BLU)
Privatized
Unit
Management
Autonomy
Private Owner
Market Exposure Direct Budget
Non
Budgetary Revenue
Allocation
Accountability
Direct Hierarchical
Rules, Regulation, &
Contract Control
Social Function
Unspecified
and
unfunded mandate
Specified, Funded, &
Regulated
Performance
based
Healthy
accounting
practices
ADMINISTRATIVE
Goods and
service delivery
Specific regional
management
Specific
funding
management
Technical
Substantive
Conditions for BLU
Signed statement
to improve
performance
Corporate
Governance and
Clinical
Governance
Strategic
Planning
Minimum
Standard of
Performance
Financial
Statement
Audited
Features
Budgetary Unit
Revenue
BLU
General account
BLU account
Has to submit application to
use revenue
Revenue can be used directly
Government funding isn’t
calculated as revenue
Government funding is
calculated as revenue
Spending
Line budget
Flexible budget
Loans
Not allowed
Funding through loan is
allowed
Hospital
Supervisory
Board
None
Yes
Features (continued)
Budgetary Unit
BLU
Investment
Not allowed
Allowed
Partnership
Not allowed
Allowed
Procurement
According to Keppres
80/2003 (regulated
bidding)
Keppres 80/03 is not
compulsory for items
purchased by non
government budget revenues
HR
Civil servant, paid according Civil servant and contract
to civil servant standard
staff, paid based on
performance
Financial report
Balance sheet
Income Statement, Cash Flow
Statement, Financial
Statement, etc
Reform (needs) within the Organization
Environment
12
Regulator
Procurement
Partnership
Supplier
Supervision
Empowerment
Enforcement
Hospital
Management
Payer
Costing
Payment mechanism
Quality improvement
Patient Safety
Pricing
Patient
Key Messages





Reform is also a political issue: pay attention to
political-economy context
Clarify (and agreed on) the meaning and concept of
what is the reform about and what it is not
Manage the “human” side of reform because reform is
painful
The importance of timing and enabling environment:
hospital doesn’t exist in vacuum
Pay attention to different interests of at different level
of government (Central and Local)
14
THANK YOU