Effects of the Revised Law on the Placement of Medical Specialists on the Distribution of Specialist Services in Indonesia

Abstract

Background: The maldistribution and disparities in the provision of medical specialists to provinces and districts in big cities and rural areas in Indonesia are one reason why the government of Indonesia has managed the placement of medical specialists through the WKDS, which in the year 2019 became the PGDS. The impact of these changes and their implementation requires analysis and evaluation. Objectives: To investigate the difference between mandatory and voluntary placement, evaluate the planning, recruitment, and deployment of medical specialists by interviewing key stakeholders, and identify factors that support and inhibit the deployment of medical specialists in Indonesia. Methods: This qualitative analysis focuses on a content analysis and in-depth interviews; it also conducts a literature review and reviews existing regulations and secondary data from 2017–2022. The purpose of this study is to determine whether the revised law, which has changed a mandatory service to a voluntary service, has had a significant impact on the distribution of specialist services in Indonesia. The analysis is based on in-depth interviews and other secondary data, including the number of patient, outpatient, and inpatient visits and the number of referral cases, morbidities, and mortalities in eight chosen provinces (Sulawesi Barat, Sulawesi Tengah, Sulawesi Tenggara, Maluku Utara, Maluku, Nusa Tenggara Barat Nusa Tenggara Timur, and Jambi). Results: Overall, the change from mandatory to voluntary placements for medical specialists has had both positive and negative effects. In implementing the program, the WKDS in DTPK regions across Indonesia continuously met the needs of medical specialists and minimized their maldistribution across health facilities. When the program became voluntary, its ability to meet the needs of medical specialists and to place them across Indonesia was reduced. Conclusion: The deployment of medical specialists is surely one central-government program that benefits citizens all across Indonesia. A few supporting and inhibiting factors have been shown to act as advantages and disadvantages in the mandatory or voluntary placement of medical specialists. Given the urgent need to distribute medical specialists throughout Indonesia (especially in DTPK regions) and considering various supporting and inhibiting factors, it would be better for the government to continue implementing the mandatory placement of medical specialists without actually using the word “mandatory,” while making a few adjustments to the regulations, in particular those related to rights, financial and non-financial incentives, placement mechanisms, and the commitment of local government.