Strategic Management of Health Budget Efficiency in Indonesia's National Health System
Abstract
The National Health System (SKN) is a key pillar in achieving equitable public health, but its implementation still faces obstacles in the form of unequal access to services, uneven distribution of health workers, and inefficient financing. This study aims to examine the main challenges in implementing the NHC in Indonesia, formulate relevant strategies to overcome them, and analyze the effectiveness and efficiency of the national health budget within a performance-based policy framework. The study uses a descriptive qualitative approach through a literature review with data sources including government regulations, official reports, and international publications. The results show that SKN is still limited by fragmented governance, low allocation for promotive-preventive efforts, and the dominance of curative spending. However, opportunities for strengthening exist through six pillars of health transformation, including strengthening primary services, improving referral services, system resilience, financing reform, human resource development, and health digitization. The discussion emphasizes the importance of reorienting budget priorities, improving performance accountability, and diversifying funding sources to support the achievement of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study shows that performance-based budget optimization, governance strengthening, and equitable distribution of resources are key to building a more resilient, inclusive, and sustainable national health system.
References
Bappenas. (2022). Buku putih reformasi sistem kesehatan nasional. Kementerian PPN/Bappenas.
Cali, J., et al. (2018). Analysis of health financing principles in support of universal health coverage. World Health Organization.
Direktorat Kesehatan dan Gizi Masyarakat. (2022). Laporan analisis pembiayaan kesehatan nasional. Kemenkes RI.
Efawati, Yen, Rinawati, Andriani, Rian, Mubarok, Ade. (2024). Manajemen Strategi. Bandung, Edukasi Riset Digital, PT.
Fuady, A., Anindhita, M., Haniifah, M., Ahsan, A., Sugiharto, A., Haya, M. A. N., Pakasi, T., Kusuma, D., Solikha, D. A., Ali, P. B., & Widyahening, I. S. (2024). Bridging the gap: Financing health promotion and disease prevention in Indonesia. Health Research Policy and Systems, 22(1), Article 146. https://doi.org/10.1186/s12961-024-01206-7
Kemenkes RI. (2012). Peraturan Presiden Republik Indonesia Nomor 72 Tahun 2012 tentang Sistem Kesehatan Nasional. Kemenkes RI.
Kemenkes RI. (2020a). Profil kesehatan Indonesia 2020. Kemenkes RI.
Kemenkes RI. (2020b). Rencana strategis Kementerian Kesehatan tahun 2020–2024 (revisi). Kemenkes RI.
Kemenkes RI. (2022a). Review dan reformulasi sistem kesehatan nasional Indonesia. Kemenkes RI.
Kemenkes RI. (2022b). Transformasi digital kesehatan: SATUSEHAT dan integrasi layanan kesehatan nasional. Kemenkes RI.
Kemenkes RI. (2023a). National Health Accounts Indonesia tahun 2021. Badan Kebijakan Pembangunan Kesehatan.
Kemenkes RI. (2023b). Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan. Kemenkes RI.
Kemenkes RI. (2024). Permenkes Nomor 19 Tahun 2024 tentang Pedoman Pelaksanaan Layanan Primer. Kemenkes RI.
Kosen, S., et al. (2023). How JKN coverage influences out-of-pocket payments by vulnerable populations in Indonesia. International Journal for Equity in Health, 22(104). https://doi.org/10.1186/s12939-023-01839-1
Pemerintah Indonesia. (2009). Undang-Undang Nomor 36 Tahun 2009 tentang Kesehatan. Pemerintah Indonesia.
Pemerintah Indonesia. (2022). Undang-Undang Nomor 1 Tahun 2022 tentang Hubungan Keuangan Pusat dan Daerah. Pemerintah Indonesia.
Prasetyo, B., et al. (2023). Determinants of healthcare utilization under the Indonesian national health insurance system – A cross-sectional study. BMC Health Services Research, 23(211). https://doi.org/10.1186/s12913-023-09424-8
Sugiyono. (2016). Metode penelitian kuantitatif kualitatif dan R&D. Alfabeta.
UNICEF. (2024). Budget brief: Enhancing public finance for better health services for children in Indonesia. UNICEF Indonesia.
World Health Organization. (2022). Political economy analysis of health financing reforms in South-East Asia. World Health Organization.
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