A pay-for-performance system for civil service doctors: the Indonesian experiment

Area of Science:

• Public Health Policy
• Health Economics
• Human Resources in Health

Background:

• Indonesia introduced the Functional Position System (FPS) in 1980 for civil servants, linking pay to skills and performance.
• Doctors were included in the FPS in 1987, aiming to provide career development and stimulate productivity.
• The FPS contrasts with Indonesia's traditional low, uniform wages reflecting a 'shared poverty' philosophy.

Purpose of the Study:

• To evaluate the effectiveness of Indonesia's Functional Position System (FPS) for community physicians.
• To assess the FPS's alignment with national health policy objectives outlined in Repelita V.
• To identify conceptual and practical shortcomings of the FPS as an incentive system.

Main Methods:

• Evaluation of the Functional Position System (FPS) implementation for Indonesian doctors.
• Analysis of the FPS's design in relation to stated objectives and Indonesian context.
• Assessment of career development and incentive impacts within the community physician sector.

Main Results:

• The FPS design disregards crucial inputs like effort and time, limiting its effectiveness as an incentive.
• The system fails to promote professional excellence and achieve stated health policy objectives.
• The FPS offers limited career development alternatives for community physicians.

Conclusions:

• The Functional Position System (FPS) in Indonesia has conceptual and practical shortcomings.
• The FPS is not an effective incentive system for promoting professional excellence or health policy goals.
• The FPS inadequately supports career development for community physicians in Indonesia.