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HOSPITAL REFORM IN INDONESIA
Shita Dewi
2
Context Background
The history of hospital development in Indonesia
The growth of health care industry
Missionary
The international market of health care industry
Health system development
Hospital management
Globalization
3
The Players
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
Private HospitalPublic
hospital
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The Number of Hospitals (1998-2008)
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20080
100
200
300
400
500
600
700
800
491511 518
550580
606 617 621 626 638 653589 591 593 595 598 609 617 625 642 655 667
Pemerintah Swasta
Num
ber
of h
ospi
tals
PRIVATEPUBLIC
5 CENTRAL
PROVINCE
DIST RICT
SUB-DISTRICT
VILL AGE
MINISTRY OF HEALTH
PROVINCE HEALTH OFFICE
DISCTRICT HEALTH OFFICE
NAT. HOSPT
PROV. HOSP
DIST. HOSP
HEALTH CENTERS
VILLAGE MIDWIVES
SUB HEALTH CENTERS
MINISTRY OF HOME AFFAIRS
GOVERNOR
MAYOR/BUPATI
CAMAT
HEALTH CARE SYSTEMHEALTH CARE SYSTEM
INTEGRATED POST
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Hospital Reform
Bureaucratic(Pre-1991)
Semi Autonomous (Swadana)
(1991)
Public Service Agency
(BLU/BLUD)(2007)
Bureaucratic
CorporationNot for
profitNon-
privatization
Reform Modalities and The Environment
Core public sector
Broader public sector
Market/private sectorB
ACP Budgetary Unit
Autonomized Unit Corporatized Unit Privatized Unit Harding-Prekker,
2000
The Reform Modalities and Dimension(Harding-Prekker, 2000)
Budgetary Unit
(SKPD)
Autonomized Unit
(Swanada)
Corporatized Unit(BLU)
Privatized Unit
Decision Right
Vertical Hierarchy Management Autonomy
Residual Claimant
Public Purse Private Owner
Market Exposure
Direct Budget Non Budgetary Revenue Allocation
Accountability
Direct Hierarchical Rules, Regulation, & Contract Control
Social Function
Unspecified Specified, Funded, & and Regulatedunfunded mandate
Conditions for BLU
Su
bsta
nti
ve Goods and
service deliverySpecific regional managementSpecificfunding management
Tech
nic
al Performanc
e basedHealthy accounting practices
AD
MIN
ISTR
ATIV
E Signed statement to improve performanceCorporate Governance and Clinical GovernanceStrategic PlanningMinimum Standard of PerformanceFinancial StatementAudited
Features
Budgetary Unit BLU
Revenue 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 to civil servant standard
Civil servant and contract staff, paid based on performance
Financial report
Balance sheet Income Statement, Cash Flow Statement, Financial Statement, etc
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Reform (needs) within the Organization Environment
Hospital Management
Regulator
Payer
Patient
Supplier
SupervisionEmpowermentEnforcement
CostingPayment mechanismQuality improvementPatient Safety
Pricing
ProcurementPartnership
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)
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THANK YOU
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