Bureaucratic autonomy and policy capacity in the implementation of capitation payment systems in primary healthcare: comparative case studies of three districts in Central Java, Indonesia

ABSTRACT

Substantial variations in policy implementation at the subnational level have long plagued Indonesia – a vast developing country that has witnessed regional variations in policy performance since administrative decentralization took place. Using a comparative case study method, this study examined institutional factors that affected the implementation of capitation payment systems among primary healthcare providers in three districts in Indonesia. Though possessing jurisdictional similarities in terms of their sociocultural characteristics and political party dominance, differences in the degree of bureaucratic autonomy and policy capacity among local health actors at the district level engendered implementation variations in terms of the policy performance and implementation styles of local health actors. Both diagnostic and analytical insights derived from the findings of this study could pave the way towards better stakeholder engagement when contemplating local level capacity-building initiatives, making them better suited to local policy contexts in the future.

KEYWORDS:

• Implementation
• capitation
• bureaucratic autonomy
• policy capacity
• Indonesia

Acknowledgements

This review is supported by the National University of Singapore (NUS) Lee Kuan Yew School of Public Policy Graduate Research Scholarship to the author. The author wishes to thanks Dr Ng Kok Hoe, Assistant Professor of Lee Kuan Yew School of Public Policy, National University of Singapore, for his critical and constructive comments during the preparation of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Law of the Republic of Indonesia Number 20 of 2004 concerning the National Social Security System (SJSN).

2. Law of the Republic of Indonesia Number 24 of 2011 concerning the National Social Security Administering Body (BPJS).

3. Regulation of the President of Republic of Indonesia Number 32 of 2014.

4. Regulation of the Ministry of Health Number 52 of 2016.

5. Joint regulation of the Secretariat General of Ministry of Health in Indonesia and President Director of BPJS number HK.02.05/III/SK/089 of 2016.

6. Data obtained from BPJS-Health Branch Office in Magelang Municipality as at April 2017.

7. Data obtained from BPJS-Health Branch Office in Banyumas Regency as at April 2017.

8. See Effendi et al. (2012) for a detailed analysis of unequal distribution of health workers in the rural and urban settings across Indonesia.

9. Data obtained from BPJS-Health Branch Office in Banjarnegara Regency as at April 2017.

Additional information

Funding

This work was supported by the National University of Singapore (NUS) Lee Kuan Yew School of Public Policy Graduate Research Scholarship.

Notes on contributors

Si Ying Tan

Si Ying Tan is PhD Candidate at the Lee Kuan Yew School of Public Policy, National University of Singapore. Her research interests encompass examining the implementation and evaluation of health policy reforms in developing countries, social welfare policies, social work interventions and health of marginalised populations in Asia.