Maharani Asri, Femina Devi, Tampubolon Gindo
Medical Faculty, University of Brawijaya, Indonesia and Institute for Social Change, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester M13 9PL, UK Medical Faculty, University of Brawijaya, Indonesia and Institute for Social Change, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester M13 9PL, UK
Medical Faculty, University of Brawijaya, Indonesia and Institute for Social Change, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester M13 9PL, UK.
Health Policy Plan. 2015 Jul;30(6):718-27. doi: 10.1093/heapol/czu049. Epub 2014 Jun 25.
In 1991, Indonesia began a process of decentralization in the health sector which had implications for the country's public hospitals. The public hospitals were given greater authority to manage their own personnel, finance and procurement, with which they were allowed to operate commercial sections in addition to offering public services. These public services are subsidized by the government, although patients still pay certain proportion of fees. The main objectives of health sector decentralization are to increase the ability of public hospitals to cover their costs and to reduce government subsidies. This study investigates the consequences of decentralization on cost recovery rate of public hospitals at district level. We examine five service units (inpatient, outpatient, operating room, laboratory and radiology) in three public hospitals. We find that after 20 years of decentralization, district hospitals still depend on government subsidies, demonstrated by the fact that the cost recovery rate of most service units is less than one. The commercial sections fail to play their role as revenue generator as they are still subsidized by the government. We also find that the bulk of costs are made up of staff salaries and incentives in all units except radiology. As this study constitutes exploratory research, further investigation is needed to find out the reasons behind these results.
1991年，印度尼西亚开始了卫生部门的权力下放进程，这对该国的公立医院产生了影响。公立医院被赋予了更大的权力来管理自己的人事、财务和采购，凭借这些权力，它们除了提供公共服务外，还被允许经营商业部门。这些公共服务由政府补贴，不过患者仍需支付一定比例的费用。卫生部门权力下放的主要目标是提高公立医院覆盖成本的能力，并减少政府补贴。本研究调查了权力下放在地区层面公立医院成本回收率方面的后果。我们考察了三家公立医院的五个服务单元（住院部、门诊部、手术室、实验室和放射科）。我们发现，经过20年的权力下放，地区医院仍然依赖政府补贴，这体现在大多数服务单元的成本回收率低于1这一事实上。商业部门未能发挥创收作用，因为它们仍由政府补贴。我们还发现，除放射科外，所有单元的大部分成本都由员工工资和激励措施构成。由于本研究属于探索性研究，需要进一步调查以找出这些结果背后的原因。
