Indonesian civil service physicians and private medical practice: Incentives and disincentives for physician-delivered health care in the public sector

During the 1970s, and continuing into the decades of the 1980s and 1990s, one of the objectives of the Indonesian government in its series of Five Year Plans has been the development of a health services network to reach the rural, predominantly poor, population which makes up approximately 80 percent of the country's total population. Health centers are the cornerstone of this network and rely upon the physician as the highest level medical, administrative and supervisory person.;The analysis concentrates on five factors felt to impede government objectives to provide physician-delivered medical services to the rural poor areas of Indonesia: (a) physician locational preferences resulting in a heavy concentration of physicians in urban areas; (b) the overall medical education process and the selection and career patterns of physician-teachers; (c) a tendency toward increased medical specialization; (d) advancement in government rank based on assumption of increased administrative duties; and (e) the distribution of rewards in the private medical sector favoring urbanization and specialization.;The dissertation is based on data collected in a sample survey of Indonesian civil service physicians conducted from February through May 1976, as well as material contained in various Indonesian government documents, newspaper articles, and private conversations. There were 252 respondents in the sample survey, randomly selected from civil service physician lists, both urban and rural locations, from five Indonesian provinces--North Sumatra, North Sulawesi, Bali, Central Java, and West Java--and the capital city of Indonesia, Jakarta.;Chapter I introduces the general problem statement and background for the study, and presents the two major conceptual hypotheses and their related specific hypotheses. Chapter II is a review of literature. Chapter III outlines the basic research design and methodology. Chapter IV looks at various elements of public sector policies and practices having an effect on physician-delivered rural health care services. Chapter V deals with private sector opportunities for government physicians and their effect on the government objective of rural health care delivery by physicians. A final chapter, VI, provides possible policy options concerning the use of physicians in the Indonesian government health services.