F ROM R ESEARCH TO P OLICY An example of how Indonesia’s NSP study result influenced a policy

I NDONESIA NSP STUDY In 2009 we examined the recent growth of private hospital services in Indonesia, in collaboration with the Nossal Institute for Global Health. Objectives of the NSP study: to identify factors contributing to and impacting on the growth of the private hospitals in Indonesia to explore the potential regulatory and policy responses

I NDONESIA NSP S TUDY R ESULT (1) there is a long tradition of charitable and religious based service provision in Indonesia even before the public system is established; (2) the private hospitals account for 50% of the total hospital providers available in the health system; largely in the form of not-for-profit (NFP) Foundations (81,8%), with the remainder as for-profit Limited Company (13,8%) and NFP Community Associations (4,4%); (3) during the last 10 years, the growth of NFP hospitals has been stagnant (some converted to for-profit hospitals), while the growth of the for-profit hospitals has been doubled; (4) there are no tax incentives for private hospitals, in particular NFP which provide charity care or social benefits. For-profit hospitals and NFP hospitals face the same tax and levies burden.

W HAT DID WE DO : Premise: there should be a policy change to support the NFP hospital to ensure their sustainability Strategy: Stakeholders engagement First, we identified the immediate stakeholders, namely the NFP hospital associations, to engage them in the policy community dialogue. Then, we identified policy champions in the National parliament and the Ministry of Health (MoH).

H OW WE DID IT Context A more open policy dialogue opportunity Content Evidence-informed recommendations Actors NFP hospital associations, National Parliament Process Study visit, forum for NFP hospitals, media exposure, policy briefs, continuous advocacy

T HE RESULT, SO FAR The Hospital Act (2009) finally distinguished for- profit and NFP hospitals for the first time, and acknowledged the rights to tax incentives for the NFP hospitals. Challenges: need to be developed to give effect to this provision. One operational regulation will have to come from the MoH (to define specific criteria of NFP hospital), the other will have to come from the Ministry of Finance (to regulate the tax incentives).

Task force within the MoH: an academic representative, representatives of the NFP hospital associations (six people), and representatives of MoH (three people). At the end of 2010 the task force developed a Brief to the Minister of Health. Challenge 1: turning the Brief into a legal operational regulation Challenge 2: advocating the case to the MoF Challenge 3: supporting MoH and MoF with more evidences

T AKE HOME MESSAGE Context matters Awaken the potential role of non state sector Evidence to make a case for (or against) an issue Transform an issue into policy agenda Build coalition: need shared value and recognize different interests Policy making has its own pace