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This study is intended to analyze the implementation of the value for money approach in assessing financial performance at RSUD Kota Tangerang during the period of 2022–2024. The research employs a descriptive quantitative approach using secondary data derived from budget realization reports. This analysis carried out using three main ratios: economy, efficiency, and effectiveness. The findings show that the hospital’s financial performance is categorized as economical, as reflected by economy ratios under 100% throughout the observed year. In terms of effectiveness, performance was considered effective in 2022 and 2023 but declined in 2024, indicating that the revenue target was not fully achieved. Meanwhile, efficiency performance remains suboptimal, as efficiency ratios exceed 100%, suggesting that the costs incurred are higher than the revenue generated. Overall, the hospital demonstrates the ability to manage its budget economically and achieve revenue targets, but still faces challenges in improving resource efficiency. Therefore, efforts are needed to optimize cost management and enhance service productivity to achieve a balance among economy, efficiency, and effectiveness in line with the value for money principles.

Regional financial management in the era of decentralization demands absolute transparency and accountability from local governments to the public. This article is the result of a Public Sector Audit Project aimed at critically analyzing the interrelationship among the three main pillars of auditing: financial accountability, regulatory compliance, and performance effectiveness through the Value for Money framework (3E: Economy, Efficiency, and Effectiveness). The methodology employed is descriptive qualitative research using document analysis techniques on Audit Reports (Laporan Hasil Pemeriksaan/LHP) and regional financial management regulations. The findings reveal an “accountability paradox,” where the achievement of an Unqualified Opinion (Wajar Tanpa Pengecualian/WTP) does not fully correlate with the absence of corruption practices or improvements in public welfare. The study identifies procurement of goods and services as well as grant expenditures as areas particularly vulnerable to non-compliance. Furthermore, the effectiveness aspect of budgeting is often neglected due to the predominantly administrative focus of audits. This article recommends transforming the role of Government Internal Supervisory Apparatus (APIP) into strategic partners, strengthening auditor independence, and integrating information technology–based audits to mitigate maladministration risks and ensure tangible economic benefits for society.

Changes in intergovernmental fiscal transfer policies and the increasing emphasis on spending efficiency in Indonesia have encouraged regional governments to strengthen fiscal independence through the optimization of locally generated revenues, particularly local taxes. This study aims to evaluate local tax performance as a strategic instrument for supporting regional fiscal autonomy and fiscal resilience under fiscal decentralization. The analysis focuses on regional governments in Lampung Province during Fiscal Years 2019–2023. Using a descriptive quantitative research design, this study employs secondary data obtained from audited regional financial reports. The analytical framework applies a value for money approach to assess local tax effectiveness, complemented by growth ratio analysis to examine revenue dynamics over time. The findings indicate that local tax performance varies considerably across regions, revenue growth remains volatile, and fiscal resilience is more likely to emerge in regions where effectiveness and growth are relatively balanced. Overall, the results suggest that strengthening fiscal autonomy requires not only achieving revenue targets but also ensuring stable and sustainable local tax performance.