HEALTH SYSTEM

1. THE SYSTEMIC CONCEPT AND COMPONENTS

The health care system consists of all personal medical care services; prevention, diagnosis, treatment, and rehabilitation. Plus, the institutions and personnel that provide these services and the government, public, and private organizations and also the agencies that finance service delivery.

Therefore,  basically, I can conclude that human resources, information, financing, governance, and service provision are part of the systemic concept and components in health system.

I would like to put Health System as a complex consists of 3 interrelated components:

People in need of health care services	Health care consumers
People who deliver health care services and the systematic arrangements for delivering health care	The professionals and practitioners called health care providers
The public and private agencies that organize, plan, regulate, finance, and coordinate services	The institutions or organizations of the health care system

*The institutional component includes hospitals, clinics, and also the insurance companies.

Other institutions are the professional schools that train students for careers in medical, public health, dental, and allied health professions, such as nursing.

Also included are agencies and associations that research and monitor the quality of health care services; license and accreditation providers and institutions; local, state, and national professional societies; and the companies that produce medical technology, equipment, and pharmaceuticals.

These are the examples of 2 independent institutions being formed to put into practice the Medical Practice Acts:

INDONESIAN MEDICAL COUNCIL (KKI)	INDONESIAN MEDICAL DISCIPLINE HONORARY ASSEMBLY (MKDKI)
Protect patients against malpractice. Encourage doctors to increase their knowledge and enhance their service quality. Regulate medical practice. Guide medical practitioners in keeping their professionalism. Issue certificates of medical registry for doctors.	Enforce doctor's discipline in their medical practice Warn doctors who have conducted a malpractice

2. THE GOALS

The goals of health system in any country are generally almost similar upon their basic target: to create, improve, and maintain a good care (services).

I found it useful to have a specific reference to state the goals of health system in Indonesia which based on "The Healthy Indonesia 2010’ goals:

• To initiate and lead a health orientation of the national development
• To maintain and enhance individual, family, and public health along with improving the environment
• To maintain and enhance quality, accessible, and affordable health services
• To promote public self-reliance in achieving government health

3. OBSTACLES IN ACHIEVING GOOD OUTCOMES

A good health system delivers quality services to all people;  No matter when or where they need them.

Proposed Ultimate Health System Outcomes (Harvard)

• Health status
• Citizen satisfaction
• Financial risk protection

The obstacles I able to captured so far are:

a. DECENTRALIZATION

At the first place, decentralization are part of the pillars in setting up the Strategy for National Health Development which is based on the new Vision and Mission of National Health Development. However, much of its disadvantages causing it to be one of the most significant obstacles in yielding good outcomes of the Health System.

Some of those are the fact that it causes more doctors moving to urban area and eventually most cases reported that it's hard to get specialist in the remote area. As decentralization causing focus of management pointing in the higher level of administration, it causes heaps of career and development targeting at the area so limiting those in the district and province area.

Precautions, principally good governance are necessary to prevent any adverse effects of decentralization.

b. UTILIZATION

Low utilization may be due to poor quality of services; limited health insurance coverage; and the blurred distinction between private and public health care. Most health personnel are also private providers after office hours. This creates a conflict of interest which adversely affects the performance of the public health facilities.

c. STAFFING DISTRIBUTION

One of the best examples of this problem is the fact that many health personnel are reluctant to work in rural areas. It’s becoming a key issue in the decentralized health system if health personnel are directly recruited and paid by district governments.

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References:

• "Introduction of Block 4.2. Health System and its Outcomes", lecture by Prof. dr. Laksono Trisnantoro MSc, PhD
• "Human Resources Management in Health and Medical Doctor Career", lecture by dr. Andreasta Meliala, DPH, M. Kes, MAS
• "International Health and Decentralization", lecture by dr. Yodi Mahendradhata, M. Sc., PhD
• "Legal Aspect in Medicine". lecture by dr. Hendro Widagdo, Sp. F
• WHO Country Health System Profile: Indonesia
• WHO GOVERNMENT AND PEOPLE: HEALTH AND DEVELOPMENT CHALLENGE