Analysis of the Implementation of BLUD Financial Management on the Sustainability of Public Health Center Services
DOI:
https://doi.org/10.65150/EP-jefrr/V2E1/2026-06Keywords:
BLUD financial management, public health center, fiscal autonomy, accountability, service sustainabilityAbstract
The Regional Public Service Agency (BLUD) framework represents a key fiscal innovation within Indonesia’s decentralized health governance system, allowing public institutions such as Puskesmas to manage finances with greater flexibility while maintaining accountability. This study aims to systematically analyze the implementation of BLUD financial management and its impact on the sustainability of public health center services in Indonesia. Using the Systematic Literature Review (SLR) method under the PRISMA protocol, 25 peer-reviewed studies published between 2015 and 2025 were reviewed from both international and SINTA-indexed journals. The analysis incorporated four dimensions: financial autonomy, accountability mechanisms, efficiency of resource utilization, and service sustainability outcomes. The results show that financial autonomy under the BLUD mechanism enhances operational efficiency and service innovation, but the degree of success depends strongly on governance capacity, digitalization, and leadership quality. Regions with robust internal control systems and skilled managers experience improved service sustainability, whereas weaker administrative environments face challenges in accountability and reporting. The study concludes that BLUD financial management contributes positively to sustainable health service delivery when supported by standardized oversight and continuous institutional development. The implication of this review is that Indonesia’s fiscal decentralization should prioritize the balance between flexibility and control to ensure equitable, efficient, and accountable health service governance.
References
1) Agustina, R., Dartanto, T., Sitompul, R., & Susiloretni, K. A. (2019). Universal health coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7
2) Aryani, Y. A., & Arifin, T. (2024). Comparative Analysis of Financial Accountability between BLUD and Non-BLUD Entities. Jurnal Kebijakan Fiskal, 8(1), 44–61.
3) Aryani, Y. A., Sutaryo, S., & Arifin, T. (2024). Systematic Literature Review Riset Pelaporan Keuangan BLUD. Journal of Business, Finance and Economics, 5(2), 155–172.
4) Aryani, Y. A., Gantyowati, E., Nurrahmawati, A., Arifin, T., & Sutaryo, S. (2023). Determinants of local government public service quality: Evidence from developing economy [Special issue]. Journal of Governance & Regulation, 12(1), 218-229.https://doi.org/10.22495/jgrv12i1siart2.
5) Basabih, M., & Widhakuswara, I. (2024). Opportunities and Challenges in Implementing Regional Public Service Agency Policy in Regional Hospitals: Systematic Review. Jurnal Ilmu Kesehatan Masyarakat, 16(2), 44–63.
6) Benington, J., Moore, M.H., (2011). Public Value: Theory & Practice. New York : Palgrave Macmillan.
7) Christine, G., Sekarsari, A. A., Irawan, B., & Hartono, B. (2025). Evaluation of Capitation Scheme as a Financing Instrument for Primary Services in the National Health Insurance. International Journal of Health Policy, 8(2), 100–118.
8) Diskamara, E. R., & Hidayat, B. (2023). Gambaran Kinerja Puskesmas yang Menerapkan BLUD: Scoping Review. Innovative: Journal of Social Science Research, 4(1), 60–74.
9) Hidayat, A., & Puspitasari, R. (2020). Policy Readiness and Budget Coordination in BLUD Implementation. Jurnal Pemerintahan dan Akuntansi, 5(2), 33–47.
10) Mahendradhata, Y., Trisnantoro, L., & Listyadewi, S. (2017). The Republic of Indonesia Health System Review. World Health Organization Regional Office for South-East Asia.
11) Mboi, N., Tjandrarini, D. H., & Akbar, H. (2022). Regional Health Financing and Equity Gaps in Indonesia. Health Policy and Planning, 37(4), 564–577.
12) Nasution, M., Raharjo, D., & Siregar, R. (2023). Institutional Barriers in Implementing BLUD Financial Management. Jurnal Kinerja Aparatur Negara, 9(1), 55–70.
13) Ngarawula, B., & Rozikin, Z. (2024). Financial Management of Regional Public Service Agency: Evaluation Study of Regent’s Regulation No. 5 of 2020. International Journal of Research in Social Science, 12(1), 81–97.
14) Novita, A., Nurlaili, E., & Pratiwi, F. (2021). Measuring the Sustainability Index of Puskesmas with BLUD Status. Jurnal Akuntansi & Keuangan Publik, 9(3), 145–162.
15) Nurlaili, E., Novita, A., & Fadli, R. (2023). Impact of Fiscal Autonomy on Health Service Quality in BLUD Puskesmas. Jurnal Pelayanan Kesehatan Masyarakat, 12(2), 87–103.
16) Pramaysella, N. R., & Rahmanti, V. N. (2024). Balanced Scorecard Approach after the Implementation of PPK-BLUD (Study of Morokrembangan Health Center Surabaya). International Journal of Research on Finance & Business, 3(1), 21–35.
17) Pratiwi, S., & Handoko, M. (2021). Revenue Management and Financial Independence in BLUD Puskesmas. Jurnal Administrasi dan Manajemen Publik, 4(2), 122–138.
18) Putri, R., Aryani, Y., & Setiawan, T. (2024). Innovation and Performance Improvement in BLUD Health Centers. Jurnal Reformasi Administrasi, 6(1), 75–91.
19) Rahmanti, V. N., Adi, P., & Kusuma, Y. (2022). Governance Model Analysis of Regional Public Service Agencies. Jurnal Ilmu Pemerintahan dan Kebijakan Publik, 4(3), 99–114.
20) Ramdani, D., & Novita, A. (2025). Evaluation of Financial Management Patterns in Regional Public Service Agency at Jatisari Hospital. Jurnal EduHealth, 7(1), 55–72.
21) Sihombing, R., & Dewi, E. (2020). Internal Control Practices in Regional Public Service Agencies (BLUD). Jurnal Akuntansi Publik, 5(1),
87–102.
22) Surtiawaty, M., Yunita, J., & Zaman, M. K. (2022). Evaluation of the Implementation of the Regional Public Service Agency (BLUD) at the Public Health Center in Pekanbaru City. Keskom Journal of Community Health, 9(1), 11–27.
23) Sutaryo, S., Arifin, T., & Aryani, Y. A. (2024). Evaluation of Local Public Service Agency Financial Management Pattern (PPK-BLUD) Implementation at Puskesmas in Karanganyar Regency. International Journal of Economics, Business and Accounting Research, 8(2), 48–62.
24) Tranfield, D., Denyer, D., Smart, P. (2003). Towards a Methodology for Developing Evidence-Informed Management Knowledge by Means of Systematic Review. British Journal of Management, Vol. 14. 207-222.
25) Wardani, N., & Rahmah, D. (2025). Performance Evaluation of BLUD Puskesmas in Post-Reform Fiscal Autonomy Era. Jurnal Ekonomi Daerah, 11(2), 112–129.
26) WHO. (2017). Global Report on Health System Decentralization: Policy Trends and Country Experiences. World Health Organization, Geneva.
27) Zuhdi, R., & Toyyib, M. (2025). Digital Transformation in BLUD Financial Governance: Toward Transparent Public Services. Jurnal Ekonomi Publik, 10(2), 65–82.
28) Zuhdi, R., Toyyib, M., & Faizah, Y. N. (2025). Accrual-Based Accounting in Public Health Center BLUD: Enhancing Financial Transparency and Accountability. Ekuitas: Jurnal Ekonomi dan Keuangan, 9(1), 99–116.
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Copyright (c) 2026 Scolastika Andyna Tiara Kusuma, Fitri Zulvina (Author)
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