Purpose: This study aims to analyze the perception of employees and patients regarding the effectiveness and efficiency of financial management at the Regional Public Service Agency (BLUD) of Mimika District Hospital.

Research/methodology: Using a quantitative descriptive approach, data were collected through Likert-scale questionnaires distributed to all staff involved in financial management at RSUD Mimika and analyzed using descriptive statistics. Additionally, patient satisfaction data were gathered and evaluated based on the SERVQUAL model covering five dimensions: tangibles, reliability, responsiveness, assurance, and empathy.

Results: The financial effectiveness level of RSUD Mimika from 2021 to 2023 was only 23%, indicating that revenue realization reached just a quarter of the target. Efficiency stood at 90.88%, categorized as "less efficient," showing suboptimal budget utilization. The satisfaction level of medical staff was generally moderate, highlighting deficiencies in equipment, communication, and welfare policies. Patient satisfaction was relatively high in core services but moderate in supporting services such as waiting facilities, information clarity, and emergency responsiveness.

Conclusions: Although RSUD Mimika has adopted the BLUD financial model to improve flexibility, the realization of financial targets remains low, and efficiency still needs improvement. Furthermore, employee and patient satisfaction indicates that the implementation of BLUD has not fully translated into improved service quality and operational sustainability.

Limitations: This study is limited to a single institution (RSUD Mimika) and relies solely on perception-based data without triangulation from financial audits or qualitative interviews. Thus, generalizability is restricted, and the analysis may not fully capture systemic or structural financial management challenges across other BLUD hospitals.

Contribution: This research provides empirical insights into the real-world challenges of BLUD implementation in regional hospitals, offering a diagnostic basis for future improvements in health financial governance.