Do you think there is a place for pay-for-performance in the Indonesian health care system? If so, how could it be used?
The main reason is that P4P is effective in the country where salaries are low, relatively the same, and differ mainly by seniority(1). Medical personnel (including physicians) who are mostly civil servants are paid generally low in comparison with those in the private sector.
The P4P system for doctors was introduced in 1987 and is still in use today. The system is called the Functional Position System (FPS), using credits scores system which is designed to provide career development path and increase efficiency. Scores are gained by activities and attributes within three main areas i.e. knowledge, performance and professional development. The accumulation of the scores leads to promotion through a professional or technical scale, and to financial rewards(1). However, the system so far does not take quality into account. It only provides quantitative measures of performance, for instance awards are made by number of patient examined (0.1 credits per hundred patients). Moreover, the system is based on self-reporting, which can lead to moral hazards. Therefore, it seems to me that P4P in Indonesia is still far from the ideal goal, to increase quality of services.
Apart from that, regardless the position of civil servants, the incomes only covers 1/3 of monthly living expenses(2). As a result, many doctors engage in private practices which are paid on the basis of a fee-for-service, without leaving the civil services. It is then generally speaking that better quality of services is provided by private sectors.
References:
1. Chernichovsky D, Bayulken C: A pay-for-performance system for civil service doctors: the Indonesian experiment. Soc Sci Med 41:155–161, 1995
2. Government of Indonesia. Ministry for the Reform of the Civil Service (MENPAN) and Central Bureau of Statistics. Research into Civil Services Salary and Incentive System. Jakarta, Indonesia, 1990
1. Chernichovsky D, Bayulken C: A pay-for-performance system for civil service doctors: the Indonesian experiment. Soc Sci Med 41:155–161, 1995
2. Government of Indonesia. Ministry for the Reform of the Civil Service (MENPAN) and Central Bureau of Statistics. Research into Civil Services Salary and Incentive System. Jakarta, Indonesia, 1990
in the philippines, government officials are paid equally or better than those in private sectors; whilst indonesian government may not be able to pay high salaries for all of its employees, it might be possible to make the salary equal with private sectors for certain critical positions with severe punishment when they committed wrong doings. this may improve their services. salam.
ReplyDeleteThen why so many doctors wanted to work at the civil service although it's less money?
ReplyDelete@aroengbinangThanks for your information on how the situation in the Philippines is. The idea about reward and punishment seems to be effective in certain situation, however some researches show that there are more complex factors that determine the improvement in health care. Anyway, in our country it needs long time due to the influence of the system in general.
ReplyDelete@EvyIt's simply because it is hard to find job in Indonesia.. What's more, civil servant is regarded as a long stable occupation and even though the salary is relatively low but we can corrupt the time.. Does it make sense?
ReplyDeleteis it require more than just simple way of appraise the performance in P4P in Indonesian Health System?will it be better if P4P is replaced by as fee for servicesor capitation in Indonesian context?
ReplyDeleteI don't have any idea as to what is the best way for applying P4P in the Indonesian health system. But there is still a place for P4P due to low of remuneration for those in the civil services. Fee for services and capitation such as managed care is a good way to help people who cannot afford for health services. But to increase the performance, what is suitable?? May be just waiting for the improvement in the system in all sectors, in which moral hazards difficult to occur. In that situation whatever the P4P method, I suppose it will benefits the system in general..
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