The Recipe for High Health Spending: A Qualitative Comparative Analysis of Indonesian Districts

Abstract: This study investigates the path to high health spending among local governments in Indonesia under the setting where administrative, fiscal, and political decentralization are already in place. The motivation behind this study is that Indonesia still has low level of health outcomes. Small amount of health spending is one prominent reason for this lack of achievement. However, the effort in improving health outcomes and its spending today in Indonesia is not solely in the hand of central government. After decentralization, local governments play a decisive part in executing the health policy. In practice, the level of health spending among local governments in Indonesia is contrast. Therefore, conducting comparison is one promising strategy to observe this phenomenon. By utilizing fsQCA, this study compares several conditions in one model that seems likely to improve health spending among 295 local governments in Indonesia. This study proposes, local direct election, high central transfer, good leadership, and high social pressure is the combination that likely leads to high local health spending. Based on the evidence presented in this study, the combination of high central transfer and high social pressure is the path to the high health spending.