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Bulletin of Indonesian Economic Studies
ISSN: 0007-4918 (Print) 1472-7234 (Online) Journal homepage: http://www.tandfonline.com/loi/cbie20
Managing Public Health Expenditure in Indonesia
Yefriza
To cite this article: Yefriza (2015) Managing Public Health Expenditure in Indonesia, Bulletin of Indonesian Economic Studies, 51:1, 147-148, DOI: 10.1080/00074918.2015.1023414
To link to this article: http://dx.doi.org/10.1080/00074918.2015.1023414
Published online: 30 Mar 2015.
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Bulletin of Indonesian Economic Studies, Vol. 51, No. 1, 2015: 147–49
ISSN 0007-4918 print/ISSN 1472-7234 online/15/000147-3
ABSTRACTS OF DOCTORAL THESES
ON THE INDONESIAN ECONOMY
Managing Public Health Expenditure in Indonesia
Yefriza (yeyeck@yahoo.com)
Accepted 2014, Monash University
Since decentralisation in Indonesia, there has been a mismatch between spending
responsibilities at the local level and local governments’ abilities to effectively
manage resources. This research investigates the relationship between institu
-tional arrangements for public expenditure management (PEM) and inequalities
in health outcomes in selected districts of Bengkulu province. This study aims
primarily to identify factors contributing to eficiency determinants and to differ -ences in health outcome attainment. In doing so, it explains the role of the central
government and the own-source capacity of district-level governments in inanc -ing health resources.
Using the new institutional economics (NIE) perspective as a guideline, this research differs from previous work by focusing on the ineficiency of the district-level health sector, which has been associated with weak PEM systems, in order to explain the signiicant disparity in health outcome attainment within a country. Mixed-methods research procedures were adopted: quantitative and qualitative data were collected concurrently. The quantitative study used secondary data from datasets of government institutions. A correlational analysis was applied to assess the relation between public health expenditure and other determinants with health outcomes at the provincial level. The qualitative study used primary data from in-depth face-to-face interviews with 20 key actors involved in health
budgeting in four district governments in Bengkulu.
This study reveals that changes in public health expenditure as a percentage
of gross regional domestic product (GRDP) and real public health expenditure
per capita and other determinants have been important factors behind observed declines in infant and child mortality and increases in life expectancy in the prov-ince. Other determinants of health outcomes comprise real GRDP per capita, the percentage of population participation in managed care, the percentage of
deliv-ering mothers assisted by health personnel, the ratio of midwives per 100,000 population, and the female literacy rate. The role of central government in inanc -ing health resources in the districts studied is also prominent. These districts rely
heavily on the central government and have limited inancial capacity. Conse
-quently, district governments have dificulty performing their functions in the health sector because of frequently insuficient or reduced public health spending
in the central budget.
148 Abstracts of Doctoral Theses on the Indonesian Economy
This study also inds that the inability of institutional arrangements to adopt PEM principles has undermined the eficiency of government intervention in the health sector at the district level. Weak institutional arrangements in PEM have
had harmful effects on the size, allocation, and use of public health expenditure,
and have contributed to inequalities in health outcomes in Bengkulu province. Such weaknesses include the absence of constructive political engagement; a lack of policy clarity, consistency, affordability, and predictability; and low lev -els of transparency, comprehensiveness, integration, and accountability. District
governments also face severe ineficiencies in PEM, owing to delays in budget approvals. The introduction of market-based practices in the PEM of the district
governments studied has not prevented potential opportunistic political behav-iour. Policymakers have therefore failed to reduce or eliminate the costs of nego-tiating and enforcing political agreements in allocating public resources, since the
budget can be viewed as a contract.
These indings reinforce criticism that the applicability of the PEM technique is country-speciic. Proper institutional arrangements that address an Indonesia-speciic context are required for the success of PEM. The indings support the view that using hierarchies as an alternative mode of governance is more appro
-priate than relying on markets, which cannot reduce transaction costs. The results- oriented nature of the PEM approach makes it dificult to implement, owing to
serious measurement problems in the health service.
© 2015 Yefriza http://dx.doi.org/10.1080/00074918.2015.1023414
Regional Income Disparities in Indonesia:
Measurements, Convergence Process, and Decentralisation
Andi Irawan (irawan1@illinois.edu)
Accepted 2014, University of Illinois at Urbana-Champaign
The unifying theme of this dissertation is spatial inequality, driven by two pri
-mary motivations. First, spatial inequality can contribute to overall inequality across households or among individuals. Second, spatial inequality can jeopard -ise the fabric of society, upsetting social and political stability. Regional disparities have increasingly become the focus of policy and academic interests, especially in
a diverse society such as Indonesia, where geographic units often align with divi -sions in economic performance, political and cultural aspirations, language, and
religion, among others. This dissertation assesses spatial inequality and conver
-gence dynamics across districts in East Java and studies the impact of Indonesia’s 2001 iscal decentralisation on regional income disparities across these districts.
East Java was chosen as a case study because of its economical and geopolitical importance to Indonesia. In addition, East Java has been dubbed a case of ‘bal -anced development’, an assessment that this dissertation intends to re-examine. By synthesising the approaches of sigma and beta convergences and
distribu-tion dynamics, and by employing a variety of methods, this dissertadistribu-tion inds an increasing trend of inequality, as well as the strong presence of clubs convergence with a slow and conditional catch-up process. The clusters of low-, medium-, and
