Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations
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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DOI：
10.1016/j.socscimed.2013.01.029
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发表时间：
2013-04-01
影响因子：
5.4
通讯作者：
Trisnantoro, Laksono
中科院分区：
文献类型：
--
作者：
Meliala, Andreasta;Hort, Krishna;Trisnantoro, Laksono
与许多国家一样，印度尼西亚卫生工作人员的地理分布不均衡，集中在城市和较发达地区，农村和偏远地区则很少。关于专科医生分布情况的资料较少，但其分布的不平等可能影响到2014年实现全民覆盖的努力。本文使用2007年和2008年的数据来描述印度尼西亚专科医生的地理分布，并研究影响分布的两个关键因素，以及当前政策的目标：专科医生的收入来源和专科医生从事私人执业。数据表明，印度尼西亚各省之间专科医生与人口的比例差别很大，爪哇岛各省的比例较高，印度尼西亚东部较偏远省份的比例低得多。专科医生收入的65%至80%来自非公立医院或私人诊所的私人执业。尽管有规定将执业地点限制在三个，但在省会城市研究的大多数专家都在三个以上的地点工作，有些人在多达7个地点工作，每周在政府医院执业的时间只有几个小时。我们的研究表明，在私营部门不断发展和医生收入主要来自私人来源的背景下，目前的监管政策和财政激励措施未能有效解决专科医生分布不均的问题。建议采取更广泛和更综合的政策办法，包括为农村和偏远地区提供更有创意的服务战略。(C)2013爱思唯尔有限公司保留所有权利。
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 mal-distribution 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. (C) 2013 Elsevier Ltd. All rights reserved.