Decentralization in the Provision of Health Care Services: Study on the Provision of Regional Health Insurance (Jamkesda) In Malang Regency East Java Province

Abstract

This study holds two objectives. Firstly, to describe decentralization process in the provision of health care services through the Jamkesda or Regional Health Insurance System. Secondly, to describe driving and constraining factors in such decentralized provision of health care. This study used the qualitative approach. The focus of study is more on the execution of Jamkesda system within the context of the implementation of the delegation of government affairs in the health sector by the central government to regency administration pursuant to Government Regulation (PP) Number 38/2007. Data and information were acquired through in-depth interview to study informants using the snow-ball technique, field observation, and documentation. The study’s source of information referred to three health services public service elements, namely service consumer, service provider, and service arranger/regulator. The data processing and analysis referred to steps formulated by Creswell. Results of study showed that the implementation of Jamkesda system in Malang Regency is not purely initiated by Malang Regency Local Government, but more on the response toward regulation launched by the East Java Province Government. Therefore, the commitment and consistency of the Malang Regency Local Government in implementing Jamkesda is very weak. This commitment and inconsistency are actually the main constraints in the implementation of Jamkesda in Malang Regency.

Key Words: health services, regional health insurance, decentralization, local government.