ANALISIS TRADE-OFF DALAM REFORMASI SISTEM PELAYANAN KESEHATAN DI INDONESIA

Abstract

The impact of regional autonomy Act has resulted in health
services system reform in Indonesia by central, province as
well as district/municipalities. The article is to analyze the “trade
of f” of Indonesian health services reform after the
implementation of regional autonomy Act by the use of normative
goals of health system, i.e equity, quality, and efficiency, as
assessment parameters. The analysis revealed that: (i) the
implication of regional autonomy Act has resulted in Indonesian
health services system reform which is partial and scattered,
(ii) part of health services system reformation has moved to
socialism, another part of the reformation has moved to
liberalism, with the implication of trade-off between equity,
quality and efficiency, (iii) the whole Indonesian health services
system remains in the position of liberalism (market system),
(iv) the choice toward socialism or liberalism is inherent with
the trade-off of advantages and disadvantages, so the
intervention of its negative impacts are important. The article
recommended that it is of importance to set in advance the end
goal of Indonesian health services system by all stakeholders,
whether choosing liberal (market) system or social system,
then setting up a clear road map completed with feasible
incremental programs to achieve the predetermined end goal.
Keywords: regional autonomy, liberalism, socialism, trade-off