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Hospital Autonomy in Indonesia

Indonesia initiated a program of hospital autonomy (Unit Swadana) in 1991 to encourage hospitals to recover some of their costs. Indonesian Unit Swadana hospitals are still government-owned with a high level of supervision and control by both the Ministry of Health and by local authorities at the provincial and district levels which depend on the centralized Ministry of Interior. Nevertheless hospital directors are given some control over the portion of their total revenues that comes from the fees they collect at the facility. Unlike many other countries, the fees collected by Indonesian hospitals have been significant — 30- 80% of total income — the rest coming from subsidies from the national and local governments. Prior to being certified as Unit Swadana, a hospital was required to turn over all of the own source revenues to the governmental level which administered them.