Critique Of The Concept Of Efficiency In Public Health Management: A Qualitative Review Of Social Justice-Based Health Policy
DOI:
https://doi.org/10.56294/hl2025762Keywords:
Efficiency, Public Health Management, Social Justice, Health Policy, Social Inequality, Health EquityAbstract
Introduction: the concept of efficiency in public health management is increasingly central to global health policy. However, it often creates tension with social justice, particularly in contexts where cost-effectiveness takes precedence over equitable access to care. This research highlights the importance of examining how efficiency-driven health policies may unintentionally exacerbate social inequalities.
Methods: this study uses a qualitative literature review to analyze 35 peer-reviewed articles, policy documents, and global health reports published between 2010 and 2024. Thematic analysis was employed to identify patterns and tensions between efficiency goals and social justice principles in public health policy.
Results: the review reveals three key findings: (1) Efficiency-focused policies often deprioritize marginalized populations; (2) Technocratic policy design tends to overlook structural inequalities; (3) Integrated approaches that combine cost-effectiveness with equity considerations remain limited but are emerging in some contexts.
Conclusion: this study emphasizes the need for health policies that balance efficiency with equity. Embedding social justice in health policy design is critical for ensuring that public health systems are both effective and fair. The findings call for a paradigm shift towards inclusive health governance that does not sacrifice justice for the sake of efficiency.
References
1. Organization WH. WHO global report on traditional and complementary medicine 2019. World Health Organization; 2019.
2. Peacock S, Chan C, Mangolini M, Johansen D. Techniques for measuring efficiency in health services. Product Comm Staff Work Pap 2001;
3. Harrow J. New Public Management and social justice: Just efficiency or equity as well? In: New Public Management. Routledge; 2005. page 153–72.
4. (CMS) Centers for Medicare and Medicaid Services. Annual Healthcare Cost Report. 2018;
5. Kemenkes RI. Laporan Kesehatan Nasional. 2020;
6. Ruger JP. Health and social justice. Lancet 2004;364(9439):1075–80.
7. Statistik BP. Badan Pusat Statistik (BPS) 2022. Stat Indones 2022;1101001.
8. Craig G, Burchardt T, Gordon D. Social justice and public policy: Seeking fairness in diverse societies. Policy Press; 2008.
9. Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol 2017;32:537–46.
10. Organization WH. Essential public health functions, health systems and health security: developing conceptual clarity and a WHO roadmap for action. 2018;
11. Frenk J. Dimensions of health system reform. Health Policy (New York) 1994;27(1):19–34.
12. Klugman B. Effective social justice advocacy: a theory-of-change framework for assessing progress. Reprod Health Matters 2011;19(38):146–62.
13. Drevdahl D. Social justice or market justice? The paradoxes of public health partnerships with managed care. Public Health Nurs 2002;19(3):161–9.
14. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low-and middle-income countries: a systematic review. PLoS Med 2012;9(6):e1001244.
15. Islam F. New Public Management (NPM): A dominating paradigm in public sectors. African J Polit Sci Int Relations 2015;9(4):141.
16. Daniels N. Justice and access to health care. 2008;
17. Tiemann O, Schreyögg J. Changes in hospital efficiency after privatization. Health Care Manag Sci 2012;15:310–26.
18. Denier Y. Efficiency, justice and care. Springer; 2007.
19. Embrett MG, Randall GE. Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med 2014;108:147–55.
20. Purbacaraka, P., & Soekanto S. Perihal kaidah hukum. Bandung: Citra Aditya Bakti.;
21. ADITYA H. Optimalisasi Manajemen Pelayanan Gerai Sehat di Layanan Kesehatan Cuma-Cuma (LKC) Dompet Dhuafa Jawa Tengah. 2023;
22. La Eha J. Analisis Pengaruh Tingkat Pendidikan Terhadap Kesejahteraan Masyarakat Menggunakan Indikator Badan Kependudukan dan Keluarga Berencana Nasional. J Geogr Sci Educ 2024;2(1):27–35.
23. Hasibuan R. Bahan ajar administrasi dan kebijakan kesehatan. 2020;
24. Indiahono D, TOBIRIN T, Km JCC, Tengah KCKBJ. Kebijakan dan Pelayanan Publik: Berbasis Keadilan Sosial di Era Disrupsi dan Big Data. 2021;
25. Ardani SS, Fransisco S, Febriyanti A, Rizma FA. PENERAPAN PRINSIP GOOD GOVERNANCE PADA KUALITAS PELAYANAN PUBLIK DI PUSKESMAS BAKTIJAYA KOTA DEPOK. J Ekon dan Manaj 2024;3(2):126–35.
26. Sumantri I. Reorientasi reformasi birokrasi dan good governance dalam penyelenggaraan sektor publik di Indonesia. PAPATUNG J Ilmu Adm Publik, Pemerintah Dan Polit 2022;5(2):63–72.
27. Asvatourian V, Craig T, Horgan G, Kyle J, Macdiarmid J. Relationship between pro-environmental attitudes and behaviors and dietary intake patterns. Sustain Prod Consum 2018;
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Copyright (c) 2025 Robert One Daniesha Mahendra, Dini Aulia Cahya, Nurhidayati Ningsih, Lely Setyawati Kurniawan, Loso Judijanto (Author)
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