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THE EFFICIENCY OF HEALTHCARE SYSTEM IN INDONESIA IN 2014-2018
Corresponding Author(s) : Hastarini Dwi Atmanti
Humanities & Social Sciences Reviews,
Vol. 7 No. 6 (2019): November
Abstract
Purpose of the study: The purpose of the study is to measure the efficiency of the healthcare system in Indonesia in 2014-2018.
Methodology: The Data Envelopment Analysis model was used to analyze 33 Provinces in Indonesia in the 2014-2018 period. The input variables are the number of health human resources at the community health centre, health human resources at the hospital, the number of hospitals, the number of community health centres and the realization of per capita deconcentration health funds. The output variable was Life Expectancy Index.
Main Findings: The results of the analysis show that Lampung, West Java, Banten, West Nusa Tenggara and West Sulawesi whose health system reaches efficiency compared to other provinces in Indonesia during the observation period.
Applications: This result suggests that the provinces where health services are inefficient are caused by the low absorption of health deconcentration funds. These findings indicate that the distribution of health services in all regions has not been equally conveyed. These findings can be used to develop a program to assist and improve the efficiency of the health care system in Indonesia.
Novelty: One of the input variables used in this study is the realization of health deconcentration funds per capita which is the novelty of previous research.
Keywords
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- Alexander, C. A., Busch, G. and Stringer, K. Implementing and Interpreting A Data Envelopment Analysis Model to Assess The Efï¬ciency of Health Systems in Developing Countries. IMA Journal of Management Mathematics 14. pp 49–63. https://doi.org/10.1093/imaman/14.1.49 DOI: https://doi.org/10.1093/imaman/14.1.49
- Asandului, L., Roman, M., Fatulescu., P. 2014. The efficiency of healthcare systems in Europe: a Data Envelopment Analysis Approach. Procedia Economics and Finance 10. pp. 261-268. https://doi.org/10.1016/S2212-5671(14)00301-3 DOI: https://doi.org/10.1016/S2212-5671(14)00301-3
- Atkinson, S., Cohn, A., Ducci, M.E., Fernándes, L. and Smyth F. 2008. Promotion and Prevention within A Decentralized Framework: Changing Health Care in Brazil and Chile. The International Journal of Health Planning and Management 23, pp.153–71. https://doi.org/10.1002/hpm.919 DOI: https://doi.org/10.1002/hpm.919
- Banker, R., Charnes. A., dan Cooper, W. 1984. Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science 30(4). pp. 1078-1092. https://doi.org/10.1287/mnsc.30.9.1078 DOI: https://doi.org/10.1287/mnsc.30.9.1078
- Benneyan, J., Ceyhan, M. E. dan Sunnetci, A. 2007. Data Envelopment Analysis of National Healthcare Systems and Their Relative Efficiencies. Proceedings of the 37th International Conference on Computers and Industrial Engineering, October 20-23, 2007, Alexandria, Egypt.
- Charnes, A., Cooper, W. W. and Rhodes, E. 1978. Measuring The Efficiency Of Decision Making Units. European Journal of Operational Research, 2(6). pp. 429-444. https://doi.org/10.1016/0377-2217(78)90138-8 DOI: https://doi.org/10.1016/0377-2217(78)90138-8
- Central Bureau of Statistics. 2015. Indonesian Health Profile 2014. Jakarta.
- Central Bureau of Statistics. 2016. Indonesian Health Profile 2015. Jakarta.
- Central Bureau of Statistics. 2017. Indonesian Health Profile 2016. Jakarta.
- Central Bureau of Statistics. 2018. Indonesian Health Profile 2017. Jakarta.
- Central Bureau of Statistics. 2019. Data and Indonesian Health Profile 2018. Jakarta.
- Debora, Y. 2017. Indeks Kesehatan Indonesia Masih Sangat Rendah. Downloaded on 15th August 2019.
- Farrell, M.J. 1957. The Measurement of Productive Efficiency. Journal of the Royal Statistical Society 120 (3). pp. 253-290. https://doi.org/10.2307/2343100 DOI: https://doi.org/10.2307/2343100
- Grosskopf, S., Self. S. and Zaim, O. 2006. Estimating The Efficiency of The System of Healthcare Financing in Achieving Better Health. Applied Economics 38. pp. 1477-1488. https://doi.org/10.1080/00036840500424798 DOI: https://doi.org/10.1080/00036840500424798
- Mahlberg, B dan Obersteiner, M. 2011. Remeasuring the HDI by Data Envelopment Analysis. Interim Report IR-01-069 International Institute for Applied Systems Analysis.
- Mathers, C., Iburg K., dan Begg, S. 2006. Adjusting for Dependent Comorbidity in the Calculation of Healthy Life Expectancy. Population Health Metrics 4 (1) 4. pp. 1-12. https://doi.org/10.1186/1478-7954-4-4 DOI: https://doi.org/10.1186/1478-7954-4-4
- Mirmirani, S., Li, H. C., and Ilacqua, J. A. 2008. Health Care Efficiency In Transition Economies: An Application of Data Envelopment Analysis. International Business & Economics Research Journal. Vol. 7, No. 2. pp. 47-56. https://doi.org/10.19030/iber.v7i2.3221 DOI: https://doi.org/10.19030/iber.v7i2.3221
- Musgrave, P. 1999. Public Spending on Health Care: How are Different Criteria Related? Health Policy 47. pp. 207-223. https://doi.org/10.1016/S0168-8510(99)00024-X DOI: https://doi.org/10.1016/S0168-8510(99)00024-X
- Payne G., Laporte A., Deber R. dan Coyte P. 2007. Counting Backward to Health Care’s Future: Using Time-to-Death Modelling to Identify Changes in End-of-Life Morbidity and the Impact of Aging on Health Care Expenditures. The Milbank Quarterly Vol. 85, No. 2. pp. 213– 257. https://doi.org/10.1111/j.1468-0009.2007.00485.x DOI: https://doi.org/10.1111/j.1468-0009.2007.00485.x
- Rivera, B. 2001. The Effects of Public Health Spending on Self-assessed Health Status: An Ordered Probit Model. Applied Economics 33 (10). pp. 1313-1319. https://doi.org/10.1080/00036840121921 DOI: https://doi.org/10.1080/00036840121921
- Schultz, Theodore William. 1961. Investment in Human Capital. The American Economic Review, Vol. 51, No. 1 (March 1961), pp. 1 – 17.
- Todaro, M. P dan Stephen C. S. 2006. Pembangunan Ekonomi. Jilid 1 edisi kesembilan. Jakarta : Penerbit Erlangga.
- Zaim, O., Fa¨ re, R. and Grosskopf, S. 2001. An Economic Approach to Achievement and Improvement Indexes. Social Indicators Research 56. pp. 91–118. https://doi.org/10.1023/A:1011837827659 DOI: https://doi.org/10.1023/A:1011837827659
- Seiford, L. M., & Thrall, R. M. (1990). Recent developments in DEA: the mathematical programming approach to frontier analysis. Journal of Econometrics, 46(1-2), 7-38. https://doi.org/10.1016/0304-4076(90)90045-U DOI: https://doi.org/10.1016/0304-4076(90)90045-U
- Hadad, S., Hadad, Y., & Simon-Tuval, T. (2013). Determinants of healthcare system’s efficiency in OECD countries. The European journal of health economics, 14(2), 253-265. https://doi.org/10.1007/s10198-011-0366-3 DOI: https://doi.org/10.1007/s10198-011-0366-3
- Anderson, G. F., Frogner, B. K., Johns, R. A., & Reinhardt, U. E. (2006). Health care spending and use of information technology in OECD countries. Health Affairs, 25(3), 819-831. https://doi.org/10.1377/hlthaff.25.3.819 DOI: https://doi.org/10.1377/hlthaff.25.3.819
- Rao, R. R., Jani, R., & Sanjivee, P. (2008). Health, quality of life and GDP: An ASEAN experience. Asian Social Science, 4(4), 70-76. https://doi.org/10.5539/ass.v4n4p70 DOI: https://doi.org/10.5539/ass.v4n4p70
- Kanchanachitra, C., Lindelow, M., Johnston, T., Hanvoravongchai, P., Lorenzo, F. M., Huong, N. L., . . . Dela Rosa, J. F. (2011). Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. The Lancet, 377(9767), 769-781. https://doi.org/10.1016/S0140-6736(10)62035-1 DOI: https://doi.org/10.1016/S0140-6736(10)62035-1
- Anand, S., & Bärnighausen, T. (2004). Human resources and health outcomes: cross-country econometric study. The Lancet, 364(9445), 1603-1609. https://doi.org/10.1016/S0140-6736(04)17313-3 DOI: https://doi.org/10.1016/S0140-6736(04)17313-3
- Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., . . . Elzinga, G. (2004). Human resources for health: overcoming the crisis. The Lancet, 364(9449), 1984-1990. https://doi.org/10.1016/S0140-6736(04)17482-5 DOI: https://doi.org/10.1016/S0140-6736(04)17482-5
- Hollingsworth, B., & Wildman, J. (2002). The efficiency of health production: re-estimating the WHO panel data using parametric and nonparametric approaches to provide additional information. Health Economics, 12: 493–504. https://doi.org/10.1002/hec.751 DOI: https://doi.org/10.1002/hec.751
- Husain, M. J. (2010). Contribution of health to economic development: A survey and overview. Economics: The Open-Access, Open-Assessment E-Journal, 4. https://doi.org/10.5018/economics-ejournal.ja.2010-14 DOI: https://doi.org/10.5018/economics-ejournal.ja.2010-14
- Robine, J. M., & Ritchie, K. (1991). Healthy life expectancy: evaluation of global indicator of change in population health. Bmj, 302(6774), 457-460. https://doi.org/10.1136/bmj.302.6774.457 DOI: https://doi.org/10.1136/bmj.302.6774.457
- Strauss, J., & Thomas, D. (1998). Health, nutrition, and economic development. Journal of economic literature, 36(2), 766-817.
- Yakunina, R., & Bychkov, G. (2015). Correlation analysis of the components of the human development index across countries. Procedia Economics and Finance, 24, 766-771. https://doi.org/10.1016/S2212-5671(15)00692-9 DOI: https://doi.org/10.1016/S2212-5671(15)00692-9
- Well, D. N. (2007). Accounting for the effect of health on economic growth. The quarterly journal of economics, 122(3), 1265-1306. https://doi.org/10.1162/qjec.122.3.1265 DOI: https://doi.org/10.1162/qjec.122.3.1265
- Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., & Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723), 1375-1387. https://doi.org/10.1016/S0140-6736(10)60233-4 DOI: https://doi.org/10.1016/S0140-6736(10)60233-4
- Chongsuvivatwong, V., Phua, K. H., Yap, M. T., Pocock, N. S., Hashim, J. H., Chhem, R., . . . Lopez, A. D. (2011). Health and health-care systems in southeast Asia: diversity and transitions. The Lancet, 377(9763), 429-437. https://doi.org/10.1016/S0140-6736(10)61507-3 DOI: https://doi.org/10.1016/S0140-6736(10)61507-3
- Gunawan, J., & Aungsuroch, Y. (2015). Indonesia health care system and Asean economic community. International Journal of Research in Medical Sciences, 3(7), 1571-1577. https://doi.org/10.18203/2320-6012.ijrms20150231 DOI: https://doi.org/10.18203/2320-6012.ijrms20150231
- Kruk, M. E., & Freedman, L. P. (2008). Assessing health system performance in developing countries: a review of the literature. Health policy, 85(3), 263-276. https://doi.org/10.1016/j.healthpol.2007.09.003 DOI: https://doi.org/10.1016/j.healthpol.2007.09.003
- Tchouaket, É. N., Lamarche, P. A., Goulet, L., & Contandriopoulos, A. P. (2012). Health care system performance of 27 OECD countries. The International journal of health planning and management, 27(2), 104-129. https://doi.org/10.1002/hpm.1110 DOI: https://doi.org/10.1002/hpm.1110
- Ramadhan, A. P., & Santoso, D. (2015). Health workers absenteeism: Indonesia urban public health centres. Journal of Public Health, 23(3), 165-173. https://doi.org/10.1007/s10389-015-0667-6 DOI: https://doi.org/10.1007/s10389-015-0667-6
- Assan, J. K., Assan, S. K., Assan, N., & Smith, L. (2009). Health inequality in resource poor environments and the pursuit of the MDGs: Traditional versus modern healthcare in rural Indonesia. Journal of Health Management, 11(1), 93-108. https://doi.org/10.1177/097206340901100107 DOI: https://doi.org/10.1177/097206340901100107
References
Alexander, C. A., Busch, G. and Stringer, K. Implementing and Interpreting A Data Envelopment Analysis Model to Assess The Efï¬ciency of Health Systems in Developing Countries. IMA Journal of Management Mathematics 14. pp 49–63. https://doi.org/10.1093/imaman/14.1.49 DOI: https://doi.org/10.1093/imaman/14.1.49
Asandului, L., Roman, M., Fatulescu., P. 2014. The efficiency of healthcare systems in Europe: a Data Envelopment Analysis Approach. Procedia Economics and Finance 10. pp. 261-268. https://doi.org/10.1016/S2212-5671(14)00301-3 DOI: https://doi.org/10.1016/S2212-5671(14)00301-3
Atkinson, S., Cohn, A., Ducci, M.E., Fernándes, L. and Smyth F. 2008. Promotion and Prevention within A Decentralized Framework: Changing Health Care in Brazil and Chile. The International Journal of Health Planning and Management 23, pp.153–71. https://doi.org/10.1002/hpm.919 DOI: https://doi.org/10.1002/hpm.919
Banker, R., Charnes. A., dan Cooper, W. 1984. Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science 30(4). pp. 1078-1092. https://doi.org/10.1287/mnsc.30.9.1078 DOI: https://doi.org/10.1287/mnsc.30.9.1078
Benneyan, J., Ceyhan, M. E. dan Sunnetci, A. 2007. Data Envelopment Analysis of National Healthcare Systems and Their Relative Efficiencies. Proceedings of the 37th International Conference on Computers and Industrial Engineering, October 20-23, 2007, Alexandria, Egypt.
Charnes, A., Cooper, W. W. and Rhodes, E. 1978. Measuring The Efficiency Of Decision Making Units. European Journal of Operational Research, 2(6). pp. 429-444. https://doi.org/10.1016/0377-2217(78)90138-8 DOI: https://doi.org/10.1016/0377-2217(78)90138-8
Central Bureau of Statistics. 2015. Indonesian Health Profile 2014. Jakarta.
Central Bureau of Statistics. 2016. Indonesian Health Profile 2015. Jakarta.
Central Bureau of Statistics. 2017. Indonesian Health Profile 2016. Jakarta.
Central Bureau of Statistics. 2018. Indonesian Health Profile 2017. Jakarta.
Central Bureau of Statistics. 2019. Data and Indonesian Health Profile 2018. Jakarta.
Debora, Y. 2017. Indeks Kesehatan Indonesia Masih Sangat Rendah. Downloaded on 15th August 2019.
Farrell, M.J. 1957. The Measurement of Productive Efficiency. Journal of the Royal Statistical Society 120 (3). pp. 253-290. https://doi.org/10.2307/2343100 DOI: https://doi.org/10.2307/2343100
Grosskopf, S., Self. S. and Zaim, O. 2006. Estimating The Efficiency of The System of Healthcare Financing in Achieving Better Health. Applied Economics 38. pp. 1477-1488. https://doi.org/10.1080/00036840500424798 DOI: https://doi.org/10.1080/00036840500424798
Mahlberg, B dan Obersteiner, M. 2011. Remeasuring the HDI by Data Envelopment Analysis. Interim Report IR-01-069 International Institute for Applied Systems Analysis.
Mathers, C., Iburg K., dan Begg, S. 2006. Adjusting for Dependent Comorbidity in the Calculation of Healthy Life Expectancy. Population Health Metrics 4 (1) 4. pp. 1-12. https://doi.org/10.1186/1478-7954-4-4 DOI: https://doi.org/10.1186/1478-7954-4-4
Mirmirani, S., Li, H. C., and Ilacqua, J. A. 2008. Health Care Efficiency In Transition Economies: An Application of Data Envelopment Analysis. International Business & Economics Research Journal. Vol. 7, No. 2. pp. 47-56. https://doi.org/10.19030/iber.v7i2.3221 DOI: https://doi.org/10.19030/iber.v7i2.3221
Musgrave, P. 1999. Public Spending on Health Care: How are Different Criteria Related? Health Policy 47. pp. 207-223. https://doi.org/10.1016/S0168-8510(99)00024-X DOI: https://doi.org/10.1016/S0168-8510(99)00024-X
Payne G., Laporte A., Deber R. dan Coyte P. 2007. Counting Backward to Health Care’s Future: Using Time-to-Death Modelling to Identify Changes in End-of-Life Morbidity and the Impact of Aging on Health Care Expenditures. The Milbank Quarterly Vol. 85, No. 2. pp. 213– 257. https://doi.org/10.1111/j.1468-0009.2007.00485.x DOI: https://doi.org/10.1111/j.1468-0009.2007.00485.x
Rivera, B. 2001. The Effects of Public Health Spending on Self-assessed Health Status: An Ordered Probit Model. Applied Economics 33 (10). pp. 1313-1319. https://doi.org/10.1080/00036840121921 DOI: https://doi.org/10.1080/00036840121921
Schultz, Theodore William. 1961. Investment in Human Capital. The American Economic Review, Vol. 51, No. 1 (March 1961), pp. 1 – 17.
Todaro, M. P dan Stephen C. S. 2006. Pembangunan Ekonomi. Jilid 1 edisi kesembilan. Jakarta : Penerbit Erlangga.
Zaim, O., Fa¨ re, R. and Grosskopf, S. 2001. An Economic Approach to Achievement and Improvement Indexes. Social Indicators Research 56. pp. 91–118. https://doi.org/10.1023/A:1011837827659 DOI: https://doi.org/10.1023/A:1011837827659
Seiford, L. M., & Thrall, R. M. (1990). Recent developments in DEA: the mathematical programming approach to frontier analysis. Journal of Econometrics, 46(1-2), 7-38. https://doi.org/10.1016/0304-4076(90)90045-U DOI: https://doi.org/10.1016/0304-4076(90)90045-U
Hadad, S., Hadad, Y., & Simon-Tuval, T. (2013). Determinants of healthcare system’s efficiency in OECD countries. The European journal of health economics, 14(2), 253-265. https://doi.org/10.1007/s10198-011-0366-3 DOI: https://doi.org/10.1007/s10198-011-0366-3
Anderson, G. F., Frogner, B. K., Johns, R. A., & Reinhardt, U. E. (2006). Health care spending and use of information technology in OECD countries. Health Affairs, 25(3), 819-831. https://doi.org/10.1377/hlthaff.25.3.819 DOI: https://doi.org/10.1377/hlthaff.25.3.819
Rao, R. R., Jani, R., & Sanjivee, P. (2008). Health, quality of life and GDP: An ASEAN experience. Asian Social Science, 4(4), 70-76. https://doi.org/10.5539/ass.v4n4p70 DOI: https://doi.org/10.5539/ass.v4n4p70
Kanchanachitra, C., Lindelow, M., Johnston, T., Hanvoravongchai, P., Lorenzo, F. M., Huong, N. L., . . . Dela Rosa, J. F. (2011). Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. The Lancet, 377(9767), 769-781. https://doi.org/10.1016/S0140-6736(10)62035-1 DOI: https://doi.org/10.1016/S0140-6736(10)62035-1
Anand, S., & Bärnighausen, T. (2004). Human resources and health outcomes: cross-country econometric study. The Lancet, 364(9445), 1603-1609. https://doi.org/10.1016/S0140-6736(04)17313-3 DOI: https://doi.org/10.1016/S0140-6736(04)17313-3
Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., . . . Elzinga, G. (2004). Human resources for health: overcoming the crisis. The Lancet, 364(9449), 1984-1990. https://doi.org/10.1016/S0140-6736(04)17482-5 DOI: https://doi.org/10.1016/S0140-6736(04)17482-5
Hollingsworth, B., & Wildman, J. (2002). The efficiency of health production: re-estimating the WHO panel data using parametric and nonparametric approaches to provide additional information. Health Economics, 12: 493–504. https://doi.org/10.1002/hec.751 DOI: https://doi.org/10.1002/hec.751
Husain, M. J. (2010). Contribution of health to economic development: A survey and overview. Economics: The Open-Access, Open-Assessment E-Journal, 4. https://doi.org/10.5018/economics-ejournal.ja.2010-14 DOI: https://doi.org/10.5018/economics-ejournal.ja.2010-14
Robine, J. M., & Ritchie, K. (1991). Healthy life expectancy: evaluation of global indicator of change in population health. Bmj, 302(6774), 457-460. https://doi.org/10.1136/bmj.302.6774.457 DOI: https://doi.org/10.1136/bmj.302.6774.457
Strauss, J., & Thomas, D. (1998). Health, nutrition, and economic development. Journal of economic literature, 36(2), 766-817.
Yakunina, R., & Bychkov, G. (2015). Correlation analysis of the components of the human development index across countries. Procedia Economics and Finance, 24, 766-771. https://doi.org/10.1016/S2212-5671(15)00692-9 DOI: https://doi.org/10.1016/S2212-5671(15)00692-9
Well, D. N. (2007). Accounting for the effect of health on economic growth. The quarterly journal of economics, 122(3), 1265-1306. https://doi.org/10.1162/qjec.122.3.1265 DOI: https://doi.org/10.1162/qjec.122.3.1265
Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., & Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723), 1375-1387. https://doi.org/10.1016/S0140-6736(10)60233-4 DOI: https://doi.org/10.1016/S0140-6736(10)60233-4
Chongsuvivatwong, V., Phua, K. H., Yap, M. T., Pocock, N. S., Hashim, J. H., Chhem, R., . . . Lopez, A. D. (2011). Health and health-care systems in southeast Asia: diversity and transitions. The Lancet, 377(9763), 429-437. https://doi.org/10.1016/S0140-6736(10)61507-3 DOI: https://doi.org/10.1016/S0140-6736(10)61507-3
Gunawan, J., & Aungsuroch, Y. (2015). Indonesia health care system and Asean economic community. International Journal of Research in Medical Sciences, 3(7), 1571-1577. https://doi.org/10.18203/2320-6012.ijrms20150231 DOI: https://doi.org/10.18203/2320-6012.ijrms20150231
Kruk, M. E., & Freedman, L. P. (2008). Assessing health system performance in developing countries: a review of the literature. Health policy, 85(3), 263-276. https://doi.org/10.1016/j.healthpol.2007.09.003 DOI: https://doi.org/10.1016/j.healthpol.2007.09.003
Tchouaket, É. N., Lamarche, P. A., Goulet, L., & Contandriopoulos, A. P. (2012). Health care system performance of 27 OECD countries. The International journal of health planning and management, 27(2), 104-129. https://doi.org/10.1002/hpm.1110 DOI: https://doi.org/10.1002/hpm.1110
Ramadhan, A. P., & Santoso, D. (2015). Health workers absenteeism: Indonesia urban public health centres. Journal of Public Health, 23(3), 165-173. https://doi.org/10.1007/s10389-015-0667-6 DOI: https://doi.org/10.1007/s10389-015-0667-6
Assan, J. K., Assan, S. K., Assan, N., & Smith, L. (2009). Health inequality in resource poor environments and the pursuit of the MDGs: Traditional versus modern healthcare in rural Indonesia. Journal of Health Management, 11(1), 93-108. https://doi.org/10.1177/097206340901100107 DOI: https://doi.org/10.1177/097206340901100107