The aging of the population and health services

The demographic revolution--engendered in large part by modern medicine--which has led to the extraordinary and continuing increase in the number and proportion of elderly persons in the population has profound implications for health services. The elderly are disproportionately heavy utilizers of health care, primarily because of the prevalence of chronic disease. In the United States most health care for the elderly is financed through public funds, and costs have been increasing at an alarming rate. There is wide consensus that, for all the excellence of performance of the medical care system in treating acute episodes, care of chronic disease is frequently unsatisfactory in both quality and cost. Given the demographic imperatives, reform of mechanisms for chronic care is thus essential.     

In search of a governance institution model for Jakarta Metropolitan Area (JMA) under Indonesia's new decentralisation policy: old problems,new challenges

This study explores a possible governance model for Jakarta Metropolitan Area (JMA) under Indonesia's new Decentralisation Policy. At present the management of JMA development is coordinated by Badan Koordinasi Pembangunan Jabodetabekjur (BKSP) —Coordinating Board for JMA Development, but this agency is ineffective and powerless to perform its tasks because of lack of authority and power. The establishment of JMA governance model should take into account the existence of the BKSP which has been politically accepted by all provincial and local governments in the region. Involvement of central government in JMA governance is very important. A mixed model of urban governance is most suitable for the JMA. Thereunder the central government should have authority to plan and develop major physical infrastructure for the whole JMA, while the provincial and local governments retain their respective general administrative functions. Copyright © 2008 John Wiley & Sons, Ltd.     

Inter-local-government partnership for urban management in decentralizing Indonesia: from below or above? Kartamantul (Greater Yogyakarta) and Jabodetabek (Greater Jakarta) compared

Under the new decentralization policy, local governments in Indonesia tend to be inward-looking in orientation. Many local governments have exploited the local resources even more intensively, and they are not concerned with the socio-economic conditions of the larger region of which they are part. Within the context of metropolitan areas, there has been almost no effective cooperation among the bordering districts and municipalities to promote the metropolitan development. Against this backdrop, the study examines and compares the institutional partnership and governance in two Indonesia's metropolitan areas, namely Kartamantul (Greater Yogyakarta) and Jabodetabek (Greater Jakarta).     

Territorial Splits (Pemekaran Daerah) in Decentralising Indonesia, 2000–2012: Local Development Drivers or Hindrance?

Not many countries have experienced as fast a growth in the number of local governments as has present day Indonesia. This study examines how territorial splits under new decentralisation policy have effected local development. The paper also critically discusses what needs to change and improve in decentralisation policy to encourage local development. Territorial splits have reinforced spatial fragmentation and ‘local selfishness’, hindering rather than driving local development. Territorial splits have also been a substantial additional burden to the national budget, and have resulted in many conflicts, disputes and tensions at the local level. This paper recommends that there should be a comprehensive review into the practice of territorial splits and suggests that there is a need to make regional mergers a more attractive option for the efficient and effective provision of public services at the local level.     

Potential impacts of Indonesia's fiscal decentralisation reform on urban and regional development: Towards a new pattern of spatial disparity

Indonesia has now entered a new phase of decentralisation. Two basic elements in the new policy are wider regional autonomy and fiscal decentralisation. The latter is essentially expenditure-based in character, rather than revenue-based, within which a different approach to intergovernmental transfers between local and central government is emerging. The new general allocation fund and revenue-sharing system may have reduced vertical fiscal disparities, but it has tended to increase intercity and interregional disparities.