HEALTH FINANCING ANALYSIS OF MINIMUM SERVICE STANDARDS IN THE HEALTH SECTOR
Background: This research focuses on health financing Minimum Service Standards (MSS) in the health sector in Lumajang Regency, Indonesia, spanning 2019 to 2022. Despite the government's emphasis on Health MSS, disparities in service access and health conditions persist across different regions.
Aims: The research aims to provide insights into the effectiveness of health financing, serving as a foundation for policy recommendations to enhance the efficiency and effectiveness of health fund allocation in Lumajang Regency.
Methods: The research employs a quantitative descriptive approach, utilizing DHA and CBA. The study also investigates the budget allocation for MSS Health services.
Results: The findings of the research reveal that the realization of Local Original Revenue (LOR) in the Health sector tends to fall below targets. Non-Physical DAK dominate the funding sources in Community Health Centers (Puskesmas). Maternal health services receive the highest MSS Health budget allocation, but the spending proportion relative to total health expenditure is decreasing.
Conclusion: The research underscores the importance of addressing disparities in health financing and service access in Lumajang Regency. Recommendations include the diversification of funding sources, optimization of financing at the Puskesmas level, and a reevaluation of the budget allocation for maternal health services.
Keywords: CBA, DHA, health financing analysis, minimum service standards
Introduction
Quality health services are a fundamental prerequisite for achieving societal well-being. In this context, the health sector’s Minimal Service Standards (MSS) are a crucial benchmark(Organization, 2022). MSS in Health, as regulated by Minister of Health Regulation No. 4 of 2019, mandates that every citizen is entitled to basic health services of a minimal type and quality. However, despite Health MSS being a government priority to narrow regional gaps, on-the-ground realities still reveal significant disparities in service access and health conditions across various regions. The implementation of MSS poses a complex challenge, particularly concerning local health financing schemes(Myloneros & Sakellariou, 2021). In this context, the study of local health financing schemes in Indonesia becomes a focal point of interesting debate. Local governments are responsible for planning, financing, and distributing health services, but policy complexity and local political interests influence their role in health financing allocation Sunarto, 2020(Santinha & , 2023). In an effort to achieve Health MSS targets, the central government's role in health financing regulation remains dominant. In Lumajang Regency, despite an increase in the regional budget value in recent years, the budget allocation for health MSS has not seen a proportional increase.
The data show that health financing in Lumajang Regency is still far from the desired target, as reflected in the decreasing percentage of the budget allocated to health MSS from year to year. Reconciliation results of the Regional Budget Implementation of Lumajang Regency (2019-2022) reveal data for Health MSS financing recorded as 5.89% of the regional government's health budget in 2019 (amounting to IDR 19,871,181,718 out of a total of IDR 337,220,278,143.91). Subsequently, in 2020, it was 3.94% of the regional government's health budget (amounting to IDR 13,175,653,782 out of a total of IDR 334,306,388,483.6). In 2021, it was only 2.01% of the regional government's health budget (amounting to IDR 8,525,902,328 out of IDR 423,663,017,207.13). The latest data for 2022 show a further decrease to 1.89% of the regional government's health budget (amounting to IDR 7,963,801,042 out of IDR 421,720,186,525.47)(Lumajang, 2022).
Reconciliation results of budget and Health MSS realization data from 2019 to 2022 indicate significant fluctuations, with some Health MSS indicators still below 50% of the target. This condition raises serious concerns, especially when compared to the monitoring and evaluation results of the Lumajang Regency Health MSS team, noting that the performance of the Health MSS program has not yet reached the 100% target. Therefore, this study delves deeper into the health financing scheme in Lumajang Regency. The primary focus will be on District Health Account (DHA) analysis as a tool to understand health fund flows systematically(Haryani et al., 2022)(Gani, 2022). Additionally, the Cost and Benefit Analysis (CBA) approach will be applied to measure the economic efficiency of basic health services and evaluate the impact of investments in fulfilling Health MSS financing(Brent, 2023). This study is expected to reveal a clearer connection between health financing schemes, the fulfillment of Health MSS targets, and the economic impact of these investments(Darrudi et al., 2022). Better alignment between programs, activities, outputs, and outcomes is anticipated through comprehensive and evidence-based analysis(Lundmark & , 2021). This serves as an important initial step to enhance the effectiveness and efficiency of resource utilization in achieving Health MSS targets in Lumajang Regency(Xu & , 2018).
Method
This research employed a descriptive research design with a quantitative analysis approach to provide an overview or description of government-sourced health financing in the implementation of Minimal Service Standards (MSS) in the health sector in Lumajang Regency from 2019 to 2022. The integrated approach includes a District Health Account (DHA) and Cost- Benefit Analysis (CBA) with a focus on income allocation, expenditure allocation, and budget expenditure appropriateness(Murniati et al., 2020). Secondary data used are derived from MSS Health budget documents in Lumajang Regency from 2019 to 2022. Secondary data collection involves instruments in the form of data collection forms prepared by the researchers. Data analysis was carried out through pivot tables, considering nine dimensions of the District Health Account (DHA), involving funding sources, budget managers, service providers, types of activities, budget items, programs, activity levels, and beneficiaries(John & , 2019).
The research was conducted in the Lumajang Regency Government, involving the Health Office and Community Health Centers. The research period extended from January to September 2023, covering the permission process, primary data collection, data cleaning and processing, data analysis, and result writing. The research object is MSS Health service activities in the Health Office and Community Health Centers in Lumajang Regency. Data processing used a computer with simple calculations using pivot tables, followed by data analysis(Palupi & , 2020). Identification of costs and benefits was conducted to illustrate the comparison between total costs and total benefits received from MSS Health financing(Hauck & , 2019).
After identifying the value of benefits and costs, a Benefit-Cost Ratio (BCR) calculation was performed to evaluate whether the benefits are proportional to the investment made(Rahmiyati & , 2018). BCR was calculated by comparing total benefits with total costs. Research ethics approval involves informed consent, anonymity, and confidentiality of research subject information. This research has been submitted to the Ethics Commission of the Faculty of Dentistry, University of Jember. The analysis was conducted to assess the cost requirements for meeting the targets of the
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