IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v82y2013icp30-34.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613000567
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2013.01.029?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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, December.
    3. Eggleston, Karen & Bir, Anupa, 2006. "Physician dual practice," Health Policy, Elsevier, vol. 78(2-3), pages 157-166, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. 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.
    2. 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.
    3. 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).
    4. 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.
    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. González, Paula & Macho-Stadler, Inés, 2013. "A theoretical approach to dual practice regulations in the health sector," Journal of Health Economics, Elsevier, vol. 32(1), pages 66-87.
    2. Socha, Karolina Z. & Bech, Mickael, 2011. "Physician dual practice: A review of literature," Health Policy, Elsevier, vol. 102(1), pages 1-7, September.
    3. Michael Kuhn & Robert Nuscheler, 2020. "Saving the public from the private? Incentives and outcomes in dual practice," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 22(4), pages 1120-1150, August.
    4. Barış Alpaslan & King Yoong Lim & Yan Song, 2021. "Growth and welfare in mixed health system financing with physician dual practice in a developing economy: a case of Indonesia," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 51-80, March.
    5. Xidong Guo & Sarah Parlane, 2020. "Addressing Private Practice in Public Hospitals," Working Papers 202013, School of Economics, University College Dublin.
    6. Socha, Karolina, 2010. "Physician dual practice and the public health care provision. Review of the literature," DaCHE discussion papers 2010:4, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    7. Kok, Lucy & Boyle, Seán & Lammers, Marloes & Tempelman, Caren, 2015. "Remuneration of medical specialists. Drivers of the differences between six European countries," Health Policy, Elsevier, vol. 119(9), pages 1188-1196.
    8. Indranil Dutta & Mario Pezzino & Yan Song, 2022. "Should developing countries ban dual practice by physicians? Analysis under mixed hospital competition," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2289-2310, November.
    9. Damien Besancenot & Karine Lamiraud & Radu Vranceanu, 2023. "A model for dual health care market with congestion differentiation," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 32(2), pages 400-423, April.
    10. Paula González & Gabriel Montes-Rojas & Sarmistha Pal, 2017. "Dual Practice by Health Workers: Theory and Evidence from Indonesia," Working Papers 17.12, Universidad Pablo de Olavide, Department of Economics.
    11. Johar, Meliyanni, 2010. "The effect of a public health card program on the supply of health care," Social Science & Medicine, Elsevier, vol. 70(10), pages 1527-1535, May.
    12. Geir Godager & Hilde Lurås, 2009. "Dual job holding general practitioners: the effect of patient shortage," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1133-1145, October.
    13. Mohamed Mousa & Monowar Mahmood, 2023. "Mental Illness of Management Educators: Does Holding Multiple Academic Jobs Play a Role? A Qualitative Study," Public Organization Review, Springer, vol. 23(2), pages 647-665, June.
    14. Budi Aji & Manuela De Allegri & Aurelia Souares & Rainer Sauerborn, 2013. "The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease?," IJERPH, MDPI, vol. 10(7), pages 1-19, July.
    15. Gaston Brice Nkoumou Ngoa & Roger Tsafack Nanfosso & Benjamin Fomba Kamga, 2021. "Le recours des professionnels de santé à la pluriactivité dans un pays en développement: Le cas des métropoles du Cameroun," African Development Review, African Development Bank, vol. 33(2), pages 249-262, June.
    16. Godager, Geir, 2009. "Four Empirical Essays on the Market for General Practitioners' Services," HERO Online Working Paper Series 2009:7, University of Oslo, Health Economics Research Programme.
    17. Terence C. Cheng & Guyonne Kalb & Anthony Scott, 2018. "Public, private or both? Analyzing factors influencing the labour supply of medical specialists," Canadian Journal of Economics, Canadian Economics Association, vol. 51(2), pages 660-692, May.
    18. 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).
    19. Shono, Aiko & Kondo, Masahide & Ohmae, Hiroshi & Okubo, Ichiro, 2014. "Willingness to pay for public health services in rural Central Java, Indonesia: Methodological considerations when using the contingent valuation method," Social Science & Medicine, Elsevier, vol. 110(C), pages 31-40.
    20. Gacevic, Marijana & Santric Milicevic, Milena & Vasic, Milena & Horozovic, Vesna & Milicevic, Marko & Milic, Natasa, 2018. "The relationship between dual practice, intention to work abroad and job satisfaction: A population-based study in the Serbian public healthcare sector," Health Policy, Elsevier, vol. 122(10), pages 1132-1139.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:82:y:2013:i:c:p:30-34. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.