An Integrative Conceptual Model for the Management of Regional Public Service Agencies (BLUD): A Synthesis of New Public Management, Good Governance, Agency Theory, Stewardship Theory, and Public Value Theory

Abstract

Regional Public Service Agencies (BLUDs) are a major public sector reform in Indonesia designed to improve healthcare quality, efficiency, and sustainability through greater managerial and financial flexibility. However, BLUD governance remains complex and cannot be fully explained by a single theoretical perspective. This study develops an Integrative Governance Framework by synthesizing New Public Management, Good Governance, Agency Theory, Stewardship Theory, and Public Value Theory. Using a conceptual approach, the framework explains how managerial flexibility, governance quality, leadership orientation, and organizational capacity interact to influence BLUD performance. The model proposes that these factors collectively generate public value through improved service quality, organizational efficiency, fiscal sustainability, public trust, and societal well-being. The study offers a comprehensive foundation for future empirical research on sustainable BLUD governance.