The clinicians’ perspective on the National Health Insurance implementation in Indonesia: A study in a government hospital

Abstract

ABSTRACT Effective healthcare system reforms in hospital settings depend on clinicians’ supportive responses, given their crucial role in decision-making and resource allocation. This qualitative research, conducted in a government hospital in Indonesia, explores clinicians’ reactions to challenges arising from National Health Insurance (NHI) implementation and their responses to hospital initiatives addressing NHI-related issues. Under NHI, cost control measures have constrained clinicians’ clinical autonomy, resource utilization, and, in many cases, their income. However, clinicians’ perspectives on NHI have evolved from initial scepticism and resistance to eventual adaptation and acceptance, influenced by the alignment of NHI with their professional values and goals. The responsiveness and adeptness of hospital management in balancing NHI standards with professional values have been pivotal in facilitating this transformation. The management’s effectiveness in applying mutually advantageous initiatives, harmonizing with the values and objectives of healthcare reform, healthcare professionals, and healthcare organizations, has been instrumental in the successful reform implementation. This study underscores the importance of a collaborative approach between clinicians and hospital management in navigating the complexities of healthcare reform. This research contributes valuable insights to the ongoing discourse on healthcare reform, emphasizing the interconnectedness of actors, their values, and organizational responses in shaping the outcomes of reform efforts.