National Standard for Clinical Education Costs

Behind every health profession student entering a hospital lies a bill rarely known to the public. Before prospective doctors, nurses, midwives, pharmacists, nutritionists, physiotherapists, and other health workers face patients, universities first face a list of costs. There are student practice fees, orientation costs, clinical supervisor fees, examiner fees, meeting room usage, case seminars, partnership administration, and fees for opening and closing activities. Some costs are known from the start; others only emerge when students are about to be placed.

Health professional education is indeed not cheap. Clinical competence cannot be formed solely through lectures, laboratories, and simulations. Students must learn amidst the complexity of real services. Healthcare facilities also provide patients, facilities, supervisors, administration, and safety systems. Therefore, the issue is not whether student practice can be charged a fee. The issue is who determines the tariff, how the tariff is calculated, what services are obtained, and who oversees its reasonableness. When universities have no choice but to pay, while training sites can set various cost components that are difficult to compare, educational partnerships risk turning into commercial transactions.

A search of several official documents shows that student practice fees differ not only in nominal value but also in units and components. In Gunungkidul Regency, student practice fees in 2024 were set at Rp 15,000 per person per day for Diploma III, Rp 20,000 for Bachelor’s or Diploma IV, and Rp 22,000 for Master’s or professional programmes. This regulation specifically governs fees for education, training, and research services at regional public service agencies. In West Nusa Tenggara, practice for Diploma I to III students is charged Rp 12,000 per person per day. Junior doctors and professional programme students are charged Rp 20,000. This fee comprises service and facility charges. Beyond practice fees, there are also components such as orientation and hall usage. In Depok City health facilities, clinical medical practice for professional students or junior doctors is charged Rp 50,000 per person per day. Field supervisor fees can be a separate component. Meanwhile, an education service document from a mental hospital in Central Java lists a fee of Rp 125,000 per person per week for the nursing profession and Rp 175,000 for specialist nurses.

In Jakarta, DKI Jakarta Governor Regulation Number 143 of 2018 lists student practice fees at community health centres (puskesmas) at Rp 10,000 per person per day for practice inside the building and Rp 5,000 for activities outside the building. Data collection is charged Rp 150,000 per person per cycle and research Rp 250,000 per person per cycle. For hospitals in Jakarta, data transparency is even more limited. The Service Standards at one Regional General Hospital (RSUD) in 2024 state that fees for clinical clerkship, fieldwork practice, internships, comparative studies, research, and credentialing refer to Director’s Decree Number 130 of 2022. However, the nominal details are not displayed in the service standard documents available to the public. This data cannot be compared directly. The type of facility, patient complexity, education level, supervision intensity, practice duration, and facilities used differ. Yet, this inconsistency precisely reveals a fundamental problem: Indonesia does not yet have a common language to explain clinical education costs. There are fees per day, per week, per month, per department, per clinical rotation, per material, per exam, per activity, and per room. Universities find it difficult to know which components are already included in the base fee and which costs can still be billed back. In many healthcare facilities, fees are also not publicly available. The figures are stored in director’s decrees, partnership agreements, or invoices. This lack of openness removes the opportunity for campuses, students, and the public to assess whether the fees charged are rational and commensurate with the educational services provided.

Field notes on clinical practice fees at several health education providers show fees that continue to rise by 10-15 percent annually. The problem is that tuition fees are usually set before the academic year begins. When training site fees increase mid-way, universities cannot easily change semester costs. Campuses must seek additional budgets, implement cross-subsidies, reduce other academic activities, or pass the burden on to students. The bargaining position of campuses is limited. Rejecting a new fee can mean losing a practice site, delaying clinical rotations, or hindering student graduation. Accepting it means bearing unplanned costs. This is not an ordinary market. It is a market with captive buyers, limited suppliers, and a need that cannot be postponed. Students cannot choose not to practice. Universities cannot simply leave a training site. Under such conditions, the market mechanism does not automatically produce a fair price. Large universities with financial capacity and strong networks may still survive. Small institutions and universities in the regions are in a more vulnerable position. Ultimately, the opportunity to gain quality clinical experience may be determined more by the ability to pay than by learning needs.