Hospital Civil Liability for Healthcare Worker Negligence in Indonesia: A Systematic Review of Doctrinal Gaps and Reliance-Based Accountability

Hospital civil liability for healthcare worker negligence constitutes a central and contested issue in Indonesian health law, particularly following the enactment of Law Number 17 of 2023 concerning Health. Article 193 of this Law imposes institutional liability on hospitals for all losses caused by the negligence of their health human resources, marking a significant paradigm shift from individual to institutional accountability. This systematic literature review examines the theoretical and normative frameworks employed in existing scholarship to analyse this liability, identifies their limitations, and determines whether a conceptual framework based on patient reliance has been developed in the existing literature. Following PRISMA 2020 guidelines, a systematic search of Google Scholar, Garuda, and ResearchGate identified 130 records, of which 22 studies published between 2019 and 2025 were included in the final synthesis. Results demonstrate that 68.2% of studies applied vicarious liability as their primary framework, 27.3% applied corporate liability, and none employed patient reliance or a trust-based theoretical framework. Two persistent limitations were identified: (1) the structural inadequacy of vicarious liability in the context of non-employment healthcare worker arrangements, and (2) the absence of a philosophical foundation explaining why the hospital's institutional representations generate a duty of care to individual patients. This review concludes that a significant conceptual gap exists in Indonesian health law scholarship, and that the development of a Reliance-Based Institutional Liability model — grounded in Fuller and Perdue's reliance interest principle and integrated with Articles 193, 1365, and 1367 of applicable legislation — represents a necessary and original doctrinal contribution to Indonesian health law.