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Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations

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  • Meliala, Andreasta
  • Hort, Krishna
  • Trisnantoro, Laksono

Abstract

As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended.

Suggested Citation

  • Meliala, Andreasta & Hort, Krishna & Trisnantoro, Laksono, 2013. "Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations," Social Science & Medicine, Elsevier, vol. 82(C), pages 30-34.
    • Handle: RePEc:eee:socmed:v:82:y:2013:i:c:p:30-34
    DOI: 10.1016/j.socscimed.2013.01.029
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    References listed on IDEAS

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    1. Garcia-Prado, Ariadna & Gonzalez, Paula, 2007. "Policy and regulatory responses to dual practice in the health sector," Health Policy, Elsevier, vol. 84(2-3), pages 142-152, December.
    2. Claudia Rokx & George Schieber & Ajay Tandon & Pandu Harimurti & Aparnaa Somanathan, 2009. "Health Financing in Indonesia : A Reform Road Map," World Bank Publications - Books, The World Bank Group, number 2710.
    3. Eggleston, Karen & Bir, Anupa, 2006. "Physician dual practice," Health Policy, Elsevier, vol. 78(2-3), pages 157-166, October.
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    Cited by:

    1. Elena Tarasenko & Olga Khoreva, 2016. "Economic Incentives for Medical Personnel Defi cit Elimination in Rural Areas," Public administration issues, Higher School of Economics, issue 4, pages 117-142.
    2. Qin, Xuezheng & Hsieh, Chee-Ruey, 2014. "Economic growth and the geographic maldistribution of health care resources: Evidence from China, 1949-2010," China Economic Review, Elsevier, vol. 31(C), pages 228-246.
    3. Ian Anderson & Andreasta Meliala & Puti Marzoeki & Edo Pambudi, 2014. "The Production, Distribution, and Performance of Physicians, Nurses, and Midwives in Indonesia: An Update," Health, Nutrition and Population (HNP) Discussion Paper Series 91324, The World Bank.
    4. Gonzalez, Paula & Montes-Rojas, Gabriel V. & Pal, Sarmistha, 2021. "Managing Dual Practice of Health Workers: Evidence from Indonesia," IZA Discussion Papers 14899, Institute of Labor Economics (IZA).
    5. Grayman, Jesse Hession, 2014. "Rapid response: Email, immediacy, and medical humanitarianism in Aceh, Indonesia," Social Science & Medicine, Elsevier, vol. 120(C), pages 334-343.
    6. Andrew Hodge & Sonja Firth & Tiara Marthias & Eliana Jimenez-Soto, 2014. "Location Matters: Trends in Inequalities in Child Mortality in Indonesia. Evidence from Repeated Cross-Sectional Surveys," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-10, July.

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