The Principles of Good Governance in Health Services: Indonesian Perspective

This study provides an overview of the principles of good governance in health services in Indonesia. This needs to be known considering that health services are a constitutional right for citizens and their services must be carried out as well as possible. Providing health services is a state obligation and getting good and guaranteed health services are the right of citizens. This research is normative-legal research using statute, comparative and conceptual approaches. The results show the principles of good governance in health services that are reflected in the principles of participation, the principles of openness and transparency, the principles of effectiveness and efficiency, and the principles of accountability. Providing health services and covering all health insurance costs for the poor and underprivileged will automatically unconditionally be the responsibility of the government following the mandate of the constitution.

In addition, Article 4 (g) of Law No. 8 of 1999 (hereinafter referred to as the Consumer Protection Law) states that: "Consumers have the right to be treated or served in an appropriate and honest and non-discriminatory manner". What is regulated in art. 4, paragraph g, of the medical law, becomes the obligation of businessmen/service providers, as regulated in art. 7, letter c, of the medical law, which: "The entrepreneur/service provider should treat or serve consumers appropriately and honestly, in a non-discriminatory manner". Likewise, Article 44 of Law No. 29 of 2004 (hereinafter referred to as the Medical Practice Law), stipulates that: "In exercise of medical practice, the doctor or dentist is obliged to follow rules of medical or dental services. Article 52 (c) of the Medical Practice Law, stipulates that: "patients, when receiving services in medical practice, are entitled to receive services according to medical needs".
Thus, all professions involved in the health sector are obliged to re-explore the foundations of the Indonesian state philosophy regarding the basic values adopted, including in health services, so that they can be translated consistently from the central level to the regional level. These basic values which are stated in the laws and regulations need to specify rights, obligations, and responsibilities. For health care, the UN Declaration of Human Rights and health legislation can be used as a reference document in this way: 3 1. Rights: a) Everyone has the right to ensure a good standard of living, including health care, and to ensure safety in times of distress (1948 United Nations Declaration of Human Rights).
b) Everyone has the same right to gain access or resources in the healthcare sector, including the right to secure, quality, and affordable healthcare services. (Article 5 (1) and (2) Law No. 36 of 2009, hereinafter referred to as the Health Law).

Responsibilities:
The government is responsible for improving the degree of public health (Article 9 Health Law).
The existence of a free health program as a form of government support for the needs of the underprivileged in the health sector, as well as the government's response to the mandate of the Constitution, Health Law, and other regulations in the health sector. The free health service program is a positive solution for underprivileged people who expect a safe, quality, and affordable health service system. So that the various complex problems faced by the community so far, especially in the health sector, such as the high price of drugs, as well as the inaccessibility of hospital treatment costs, and the inability of the community to go to doctors because the costs are quite expensive, it is hoped that the free health service program can solve various problems that have been faced by the poor. This hope turns out that not all of them can match the reality, many problems are still felt and faced by the underprivileged in their efforts to obtain rights and services for free health programs. The National Social Security System as a government program aimed at ensuring security for the protection of human rights and social security for all people, as stipulated in paragraph (1) of Article 28H, paragraph (2) and paragraph (3)  with the needs of the community and are designed to be as rational and sizeable as possible. 6 Better governance, more complex issues will be fixed, especially during this pandemic. Therefore, the principles of good governance can be realized by creating good conditions and synergies between the government, private sector, and civil society in the management of natural, economic, social, and environmental resources.
The principle of good governance is used as a reference in the process and structure of good political and socio-economic relations. Because this concept refers to the achievement of a decision and its implementation, which can be accounted for collectively. The state is fully involved in providing good services for the welfare of the people with a good legal system and a government system that is accountable to the public. 7 In many low-and middle-income countries, there is a dramatic scatter in market relations in the health sector, with a large proportion of health spending and direct payment transactions attributable to them. Most countries have developed pluralistic health systems with a wide range of providers of health-related goods and services, although many governments continue to focus on the public sector. 8 Many studies conclude that quality of health is better in high-income countries, as higher-income gives greater control over many health-promoting goods and services. Health outcomes can be influenced not only by income levels but also by income distribution.
Poverty and inequality negatively affect health by limiting access to healthy and nutritious food. Franco and Rogers found that the level of inequality and poverty in a country is an important determinant of their relative health status. 9 However, Osler found no link between income inequality and health after income adjustment. 10

Problem Statement
Therefore, based on the previous description, this article will discuss the principles of good governance in public health services. This study provides an overview of the principles of good governance in health services in Indonesia. This needs to be known considering that health services are a constitutional right for citizens and their services must be carried out as well as possible.

Methods
This article uses a normative juridical review 11 , namely by focusing its study by viewing law as a complete system, a set of legal principles and legal norms. Research is carried out by abstracting concepts, principles, doctrines, theories, legal norms, and legal rules (written or unwritten) 12 in addition to values, principles, norms, and rules that will be described with state responsibility in a just free health service.

Good Governance in Health Services
Public services in the health sector are the functions of government to realize and ensure fundamental rights, which are understood by all components of society as the right to a dignified life and the rights recognized by laws and regulations. In its role as a provider of public services, the state must perform its services professionally, not just administering them, but requiring them to be based on the principles of good governance. The most important issue in the process of realizing fundamental human rights is the issue of the right of access to the needs of public services. Access to fundamental rights for such people must be adapted to development. Without meeting basic needs, participation based on independence and equality can hardly be expected. According to the provisions of Article 1 of Law No. 25 of 2009, this is an activity or a set of measures aimed at meeting the need for the provision of services by-laws and regulations for each citizen and resident of goods, services, and/or administrative services provided by publicly available service providers, in this case, the government that manages the services must be based on laws and pay attention to the principles of good governance and must be prepared to accept the consequences of what is implemented through the application of administrative law.
Implementing good governance only for free health services mentioned in this study represents the implementation of good governance principles in the health sector through free public health programs that meet equity requirements. The new concept, which became the Health Program of the Indonesian Ministry of Health, has evolved into a major program in Indonesia called Participant Sponsors (PBI) to replace the term "free health care". Correction of program documentation. 13 According to the Director of the Health Service of the Republic of Indonesia, the term "free health" is a political term used in political processes such as the Regional State Electoral Authority (PILKADA). This term is often used by politicians as a symbolic program designed to win the sympathy and support of voters, but medical services are either the National Income and Expenditure Budget (hereinafter APBN).
Currently, given the wide range of governance issues, the application of these principles to government administration today is still four key indicators.:  Media,vol. 21,no. 2. p. 204 know their citizens, their way of thinking and lifestyle, the problems they face, the way they propose, or how to solve them, which can contribute to solving the problems they face. In this way, the interests of the community can lead to policy decisions that accommodate as many community aspirations and interests as possible and are supported by the wider community. 16 The presence of direct participation is important because the system of national representation through parliament cannot be considered the only channel for the aspirations of the people. The principle of expressing ideas is different from conventional expressions. Because physical expressions do not necessarily reflect expressions of thoughts or aspirations. 17 In law enforcement, be it the police, prosecutors, lawyers, judges, and security guards, everyone needs public scrutiny to act effectively and efficiently and to guarantee justice and truth.
The presence and participation of community members in public forums, and their effective role in stimulating ideas and proposals for public health, demonstrate that health issues are a matter for both the public and government. This is not a bureaucratic issue. 18 However, it must be recognized that it is not easy to involve society at all levels in the health sector. An alternative solution is to provide access to all communities and members of society at different levels, participate in expressing the interests of the groups they represent, and present suggestions and thoughts in forums of public gatherings. Development level meetings Discussion of solutions in a city or local development councils. State policy in the field of health care. Lack of government involvement in public health can lead to public policy decisions that fail to address the diverse aspirations and interests of society in health services and do not contribute to improving public satisfaction with health services. The goals of the state health policy were not achieved. Participation means that each community has a voice that can contribute to decisions related to public health services, directly or 16 Jati, Rahendro. (2012)

b) Openness and Transparency
Transparency is based on the free flow of information. All government processes, agencies, and information should be available to stakeholders, and the information available should be sufficient to understand and monitor. Transparency means the availability and clarity of information so that the general public is aware of the process of design, implementation, and the results achieved in the framework of public policies. All governance issues in the form of public policy for both civil service and regional development must be publicly known. The content of the decision and the reason for establishing public policy must be made available to the public. 20 Likewise, disclosure and disclosure of the implementation of the policy and its implications should be made. In this case, officials must be ready to openly and honestly provide the necessary information to the public. Efforts to build a  Transparency is defined as the public's freedom to access information, it can be directly accommodated by those who need it, and easily accessible by decisionmakers in community services. The information must be understood and monitored by the community. 23 The main guidelines for implementing transparency in the health service sector are as follows: a. Agencies should provide information in a timely, timely, clear, accurate, and comparable manner and should be readily available to interested parties following their respective obligations.
b. information that needs to be disclosed includes the vision, mission, goals, and strategy of the organization, financial position, including internal controls and control systems, the system and implementation of good governance, the level of compliance, and significant events that can affect health.

Good Governance Practices in Health Services
Health as a basic need for human life is clearly defined in the 1945 Constitution of the Republic of Indonesia, it is a human right, which states that everyone has the right to live in conditions of physical and mental well-being. You have the right to a healthy and good living environment and medical services. In the international world, the  As explained earlier, before the government implemented the Kesehatan BPJS program, several earlier programs were known as the Jamkesmas program.

Conclusion
The principles of good governance must be implemented based on the mandatory rules of the constitution and applicable legal rules. There are still many poor and underprivileged people who have not been reached by the Contribution Assistance Participants (PBI) program by the government, transparency in the financing, medicines and there are still many complaints from the public (consumers) in health services, especially in the PBI program managed by BPJS. So that the poor and underprivileged people should not be seated as Contribution Beneficiary (PBI) participants, but the state has a "constitutional obligation" to automatically place them as participants in free health services financed by the government and become the "constitutional right" of the poor, not as a community receiving contribution assistance.