DKI Jakarta Case ShitaDewi
Outline of Session • Background • The creation of three private hospitals • Hospital performance after conversion • Challenges of converting public hospitals to private ownership • Discussion
Background • DKI Jakarta city owned 5 public hospitals (1 for each borough) • Rp400 billion per year for operational cost • Problems • inefficiency in hospital management • poor services • huge investment for quality and services improvement but no significant improvements • Source of Problems • Hospitals had no financial authority • they got bulk budget from DKI Jakarta government, and all revenues went back to DKI Jakarta government revenue. Any changes in budget needed to be approved by DKI Jakarta Parliament. • Proposed solution • DKI Jakarta government wanted to give more financial authority to hospital and in turn expected improved quality and services. • They also wanted to re-allocate subsidy to the demand-side (more money to cover the poor).
The changes • Managed privately and delivered services to private patients and public patients • Increased effort in flexible planning management and operational efficiency measures • Introduced performance based HR management
The result • RS Cengkarengwas considered a success • happy staff • more disciplined health staff (e.g. doctors were available according to their work schedule) • good/acceptable quality • staff and clients satisfied • RS Hajicontinued to operate well • shift in clientele to government supported (low-income) population has been successful • staff and population satisfied • RS PasarRebocontinued to serve the poor • almost 80% of the patients are government-funded/subsidized
Current standings • Public Service Agency Act (2005) • enabled hospital to become Public Service Agency in order to give them more financial authority • All public hospitals in DKI Jakarta are now Public Service Agencies • Hospital Act (2009) • forbade government to convert government-owned hospital to private ownership • Public Service Act (2009) • Allowed corporation, or any other legal institution, manage and operate a public service institution, or provide public services. • PT RumahSakitPasarRebo and PT RumahSakitCengkareng still exist • PT RumahSakitHajitaken over by Ministry of Health (for the time being)
Questions for discussion: • What went right? Why? • What went wrong? Why? • Do you anticipate that similar challenges might apply in your country/province/state/district as well? If so, how would you deal with them? • What are the key lessons from the case that are most relevant to your country?
Key Messages • Consider innovative ways to provide publicly funded health service products. • Pay attention to the required political process surrounding a policy. • Be sensitive to the human side of change. • A good policy/design of reform on paper might yield an unexpected outcome in the real world.