To What Extent Can Value-Based Healthcare Governance Be Applied In Value-Based Hospitals? Lessons from MENA for Indonesia
DOI:
https://doi.org/10.15294/lslr.v10i2.35836Keywords:
Value Based Healthcare, Faith-based Hospitals, Healthcare Governance, MENA, Indonesia HospitalsAbstract
The Value-Based Healthcare (VBHC) paradigm shifts the focus of care from quantity to quality and the efficiency of patient outcomes, a transformational shift in healthcare management that is now widely adopted in the MENA region (Middle East and North Africa). In Indonesia, despite rapid growth in the private sector, value-based hospitals operated by foundation-based legal entities still face stagnation in service delivery due to high operational costs, low profitability, and weak professional governance. This research aims to study the extent to which value-based healthcare governance can be implemented in Indonesia by drawing valuable lessons from the transformation in the MENA region. Using a descriptive approach with qualitative methods supplemented by quantitative field data, this study evaluates operational readiness and formulates a value-based governance framework. The findings indicate that the implementation of VBHC is highly dependent on an integrated governance ecosystem involving regulation, procurement, accreditation, digital infrastructure, leadership, and outcome measurement. Drawing lessons from Saudi Arabia and Egypt, coordination among regulators, payers, and accreditation bodies is an absolute pre-condition. In Indonesia, foundation hospitals require a contextual approach that takes into account their financial sustainability, organizational capacity, and specific nonprofit characteristics. Policy implications call for the Ministry of Health and BPJS Kesehatan to strengthen cross-institutional coordination in order to integrate VBHC principles into financing governance, outcome indicators, and value-based service delivery mechanisms.
References
Al Tamimi & Company. “Egypt: Universal Health Insurance Law.” November 25, 2020. https://www.tamimi.com/law-update-articles/egypt-universal-health-insurance-law/.
———. “Saudi Value Based Healthcare.” November 15, 2024. https://www.tamimi.com/news/saudi-value-based-healthcare/.
AlJohani, Buthaynah Abdullah, and Bussma Ahmed Bugis. “Advantages and Challenges of Implementation and Strategies for Health Insurance in Saudi Arabia: A Systemic Review.” INQUIRY: The Journal of Health Care Organization, Provision, and Financing 61 (2024): 00469580241233447. https://doi.org/10.1177/00469580241233447.
Alzahrani, Ahmed Ali, Milena Pavlova, Nizar Alsubahi, Ala’eddin Ahmad, and Wim Groot. “Impact of the Cooperative Health Insurance System in Saudi Arabia on Universal Health Coverage—A Systematic Literature Review.” Healthcare 13, no. 1 (2025): 60. https://doi.org/10.3390/healthcare13010060.
Amengay, Abdelkarim. “How Populist Are Arab Citizens? Assessing Populist Attitudes in the Arab World.” Middle East Law and Governance 17, no. 1 (2025): 33–61. https://doi.org/10.1163/18763375-20251489.
Antari, Putu Eva Ditayani. “The Implementation of Omnibus Law in Indonesia Law Making Process on Philosophy Review.” De Jure: Jurnal Hukum dan Syar’iah 14, no. 1 (2022): 179–94. https://doi.org/10.18860/j-fsh.v14i1.15757.
Badan Pusat Statistik. Statistik Indonesia 2025. Jakarta: Badan Pusat Statistik, 2025. https://www.bps.go.id/id/publication/2025/02/28/8cfe1a589ad3693396d3db9f/statistik-indonesia-2025.html.
Batran, Radwa Ahmed, Mohab Kamel, Ayman Bahr, Ahmed Khalil, and Mohamed Elsokary. “Value-Based Healthcare in Oncology: Can It Drive Transformative Shifts in the Middle East and North Africa Region?” Health Policy and Technology 13, no. 6 (2024): 100939. https://doi.org/10.1016/j.hlpt.2024.100939.
Baumhauer, Judith F., and Kevin J. Bozic. “Value-Based Healthcare: Patient-Reported Outcomes in Clinical Decision Making.” Clinical Orthopaedics and Related Research 474, no. 6 (2016): 1375–78. https://doi.org/10.1007/s11999-016-4813-4.
Colldén, Christian, and Andreas Hellström. “Value-Based Healthcare Translated: A Complementary View of Implementation.” BMC Health Services Research 18 (2018): 681. https://doi.org/10.1186/s12913-018-3488-9.
Council of Health Insurance. “CHI Providers Classification Program.” N.d. Accessed 22 July 2026. https://www.chi.gov.sa/en/knowledge-center/Documents/CHI%20Providers%20Classification%20Program.pdf.
———. “The Council of Health Insurance Launches Its 2025–2027 Strategy.” N.d. Accessed 22 July 2026. https://www.chi.gov.sa/en/MediaCenter/News/pages/2025-7-20.aspx.
Dinana, Hesham, Basma M. Saleh, Eman Mohamed Aly, Fatma M. A. Barakat, Hebatalla Ahmed Ismail, Marwa Hafiz, and Ranin Soliman. “Sustainability and Resilience in the Egyptian Health System.” Partnership for Health System Sustainability and Resilience, 2024. https://www3.weforum.org/docs/WEF_PHSSR_Egypt_2024.pdf.
Egypt Healthcare Authority. “About Egypt Healthcare Authority.” N.d. Accessed [date]. https://eha.gov.eg/en/about-eha/.
El-Hini, Yasmine, Sudha Bala Krishnan, and Andrew Myburgh. “Country Private Sector Diagnostic: Egypt Health Sector Deep Dive.” Washington, DC: International Finance Corporation, 2023..
El-Sobky, Ahmed, and Mazen Aladdin. “From Reform to Excellence: The Future of Health Care in Egypt.” Lancet Global Health 12, no. 10 (2024): e1584–85. https://doi.org/10.1016/s2214-109x(24)00310-3.
Fadila, Tiara, and Mursyid Hasan Basri. “Healthcare Ecosystem Mapping in Secondary Health Facility for Hypertension Case.” In Proceedings of International Conference on Management in Emerging Markets (ICMEM) SBM ITB, vol. 3. 2021.
General Authority for Healthcare Accreditation and Regulation. GAHAR Handbook for Hospital Accreditation Standards. 2025 ed. Cairo: General Authority for Healthcare Accreditation and Regulation, 2025.
Hariri, Bayan A., Faisal M. Albagmi, and Afnan A. Aljaffary. “Conceptualization and Establishment of Value-Based Healthcare in Saudi Arabia: A Scoping Review.” Journal of Taibah University Medical Sciences 19, no. 4 (2024): 835–46. https://doi.org/10.1016/j.jtumed.2024.07.008.
Haryani, Endang, Rini Darmastuti, and Sri Winarso Martyas Edi. “Model of Financial Communication to Reinforce Financial Literacy for Indonesian Society.” Ultimacomm: Jurnal Ilmu Komunikasi 16, no. 1 (2024): 186–207. https://doi.org/10.31937/ultimacomm.v16i1.3891.
Hidayat, La Ode. “Studi Sustainability Competitive Advantage pada Rumah Sakit Swasta di Kota Makassar.” PhD diss., Universitas Hasanuddin, 2023.
Israel, Onilari. “Assessing How Well Value-Based Care Models Improve Health Outcomes.” ResearchGate, April 2025. https://www.researchgate.net/publication/391279761.
“Jumlah Rumah Sakit di Indonesia Meningkat tapi Masih Belum Merata.” Lestari Kompas, March 18, 2024. https://lestari.kompas.com/read/2024/03/18/140000686/jumlah-rumah-sakit-di-indonesia-meningkat-tapi-masih-belum-merata.
Khalifa, Ahmed Yehia, Jean Yacoub Jabbour, Awad Mataria, Magdy Bakr, Mai Farid, and Inke Mathauer. “Purchasing Health Services under the Egypt’s New Universal Health Insurance Law: What Are the Implications for Universal Health Coverage?” International Journal of Health Planning and Management 37, no. 2 (2022): 619–31. https://doi.org/10.1002/hpm.3354.
Khamis, Mona, Zainab Almoosa, Marie Santos, Diaa Kamal, Suhail Yaghmor, Muhammad Daniyal, and Abbas Al Mutair. “Analysis of Value-Based Healthcare (VBHC) Framework by Incremental Cost-Effectiveness of Surgical and Therapeutic Interventions: A Retrospective Study at Tertiary Private Health Group.” BMC Health Services Research 25 (2025). https://doi.org/10.1186/s12913-025-13272-w.
Komisi Akreditasi Rumah Sakit. Standar Nasional Akreditasi Rumah Sakit. Jakarta: KARS, 2022.
Korhonen-Kurki, Kaisa, Daniela D’Amato, Alexander Belinskij, Damir Lazarevic, Pekka Leskinen, Eeva-Johanna Nylén, Mika Pappila, et al. “Transformative Governance: Exploring Theory of Change and the Role of the Law.” Earth System Governance 23 (2025): 100230. https://doi.org/10.1016/j.esg.2024.100230.
Law of the Republic of Indonesia No. 16 of 2001 on Foundations (Undang-Undang Republik Indonesia Nomor 16 Tahun 2001 tentang Yayasan). State Gazette of the Republic of Indonesia 2001 No. 112.
Law of the Republic of Indonesia No. 28 of 2004 on Amendment to Law No. 16 of 2001 on Foundations (Undang-Undang Republik Indonesia Nomor 28 Tahun 2004 tentang Perubahan atas Undang-Undang Nomor 16 Tahun 2001 tentang Yayasan). State Gazette of the Republic of Indonesia 2004 No. 115.
Macey, Jonathan R. Corporate Governance: Promises Kept, Promises Broken. Princeton, NJ: Princeton University Press, 2010. https://doi.org/10.1515/9781400829781.
Mahmudah, Zustika Nada, and Diska Arliena Hafni. “Penerapan Standar Rumah Sakit Syariah di Bidang Akuntansi dan Keuangan pada RS. Muhammadiyah Lamongan.” In Proceeding of National Conference on Accounting & Finance 4 (2022): 536–42. https://doi.org/10.20885/ncaf.vol4.art67.
Mathauer, Inke, Ahmed Yehia Khalifa, and Awad Mataria. Implementing the Universal Health Insurance Law of Egypt: What Are the Key Issues on Strategic Purchasing and Its Governance Arrangements? Health Financing Case Study. Geneva: World Health Organization, 2018.
McManaman, Linus J. “Social Engineering: The Legal Philosophy of Roscoe Pound.” St. John’s Law Review 33, no. 1 (1958): 33.
Mertokusumo, Sudikno. Mengenal Hukum. Yogyakarta: Universitas Atma Jaya Yogyakarta, 2010.
Minister of Health of the Republic of Indonesia. Regulation No. 3 of 2023 on Standard Rates for Health Services in the Implementation of Health Insurance (Peraturan Menteri Kesehatan Nomor 3 Tahun 2023 tentang Standar Tarif Pelayanan Kesehatan dalam Penyelenggaraan Program Jaminan Kesehatan).
Møberg, Kristoffer Dahl, and Margit Malmmose. “A Value-Based Healthcare Approach: Patchy Institutionalized Logics Infusing Managers’ VBHC Perceptions.” Financial Accountability & Management 41, no. 1 (2025): 19–41. https://doi.org/10.1111/faam.12402.
Notohamidjojo, O. Demi Keadilan dan Kemanusiaan: Beberapa Bab dari Filsafat Hukum. Jakarta: BPK Gunung Mulia, 1975.
Octora, Rena, Efrila Efrila, and Ani Maryani. “Peran BPJS Kesehatan dalam Sistem Jaminan Sosial dari Perspektif Hukum Bisnis.” Jurnal Cahaya Mandalika 3, no. 1 (2024): 652–57.
PEA. “Kemana Arah RS NonProfit?” Manajemen Rumah Sakit, July 1, 2024. https://manajemenrumahsakit.net/2024/07/kemana-arah-rs-nonprofit/.
Porter, Michael E. “What Is Value in Health Care?” New England Journal of Medicine 363, no. 26 (December 2010): 2477–81. https://doi.org/10.1056/nejmp1011024.
Porter, Michael E., and Elizabeth Olmsted Teisberg. Redefining Health Care: Creating Value-Based Competition on Results. Boston: Harvard Business School Press, 2006.
Prananingrum, Dyah Hapsari, Abigail Prasetyo, Oliviani Yanto, and Kezia Annabel RP. “Telemedisin Rumah Sakit Berbadan Hukum Yayasan Menurut Prinsip Kepastian Hukum.” Yuridika 7, no. 3 ([year]). https://doi.org/10.31328/wy.v7i3.5232.
Rana, Tarek, Gillian Vesty, Miia Jansson, and Kerryn Butler-Henderson. “VBHC Control, Performance Measurement and Risk Management: Future Research Agenda.” In Accounting for Healthcare, 103–26. Routledge, 2024.
Staalduinen, Dorine J. van, Petra van den Bekerom, Sandra Groeneveld, Martha Kidanemariam, Anne M. Stiggelbout, and M. Elske van den Akker-van Marle. “The Implementation of Value-Based Healthcare: A Scoping Review.” BMC Health Services Research 22 (2022): 270. https://doi.org/10.1186/s12913-022-07489-2.
Teisberg, Elizabeth, Scott Wallace, and Sarah O’Hara. “Defining and Implementing Value-Based Health Care: A Strategic Framework.” Academic Medicine 95, no. 5 (May 2020): 682–85. https://doi.org/10.1097/ACM.0000000000003122.
“3 Approaches to Ecosystem Governance.” MIT Sloan, March 5, 2024. https://mitsloan.mit.edu/ideas-made-to-matter/3-approaches-to-ecosystem-governance.
Utomo, Achmad Yoga Setyo, Bagoes Widjanarko, and Zahroh Shaluhiyah. “Mutu Pelayanan dengan Kepuasan Pasien Rawat Inap di Rumah Sakit: Literature Review.” Media Publikasi Promosi Kesehatan Indonesia (MPPKI) 6, no. 9 (2023): 1708–14. https://doi.org/10.56338/mppki.v6i9.3720.
Wijayanti, Dhiana, and Christina Tri Setyorini. “Implementation of Good Corporate Governance in Public Hospitals in Indonesia: Systematic Literature Review Approach.” Buletin Poltanesa 24, no. 1 (2023): 29–39. https://doi.org/10.51967/tanesa.v24i1.2567.
Zanotto, Bruna Stella, Ana Paula Beck da Silva Etges, Miriam Allein Zago Marcolino, and Carisi Anne Polanczyk. “Value-Based Healthcare Initiatives in Practice: A Systematic Review.” Journal of Healthcare Management 66, no. 5 (2021): 340–65. https://doi.org/10.1097/JHM-D-20-00283
Downloads
Published
Article ID
35836Issue
Section
License
Copyright (c) 2026 Dyah Hapsari Prananingrum, Endang Haryani, Bagoes Widjanarko, Vivi Retno Intening (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
All writings published in this journal are personal views of the authors and do not represent the view of this journal and the author's affiliated institutions. Authors retain the copyrights under this license, see our copyrights notice.
