Exploring Indonesia’s “low hospital bed utilization-low bed occupancy-high disease burden” paradox

Indonesia’s current hospital bed to population ratio of 6.3/10 000 population compares unfavourably with a global average of 30/10 000. Despite low hospital bed-to-population ratios and a significant “double burden” of disease, bed occupancy rates range between 55% - 60% in both government and private hospitals in Indonesia, compared with over 80% hospital bed occupancy rates for the South-East Asian region. Annual inpatient admission in Indonesia is, at 140/1 0 000 population, the lowest in the South East Asian region. Despite currently low utilisation rates, Indonesia’s Human Resources for Health Development Plan 2011-2025 has among its objectives the raising of hospital bed numbers to 10/10 000 population by 2014. The authors examined the reasons for the paradox and analysed the following contributory factors; health system’s shortcomings; epidemiological transition; medical tourism; high out-of-pocket payments; patronage of traditional medical practitioners, and increasing use of outpatient care. Suggestions for addressing the paradox are proposed.