The aim of hospital management development is to improve the quality and efficiency of hospital services, especially to become self reliance. To prepare it, the hospital should be self autonomous ("swadana''). The objective of this study was to explore the management impact of self autonomous implemented at District Hospital (type C). The interviews with hospital staffs (medical and non medical personels), director and patients (inpatients and outpatients) were conducted in this study. Four self autonomous district hospitals were chosen (Pasar Rebo Jakarta, Sumedang West Java, Pali Middle Java and Jombang East Java). Descriptive analysis was conducted in this study. The results of this study showed that the efficiency of output measured by BOR, LOS. BTO, TOI were increased, as well as the number of outpatient visits, inpatient admissions and supporting facilities visits. The everage of the hospital staff income was increased particularly after it was added by non material incentives. After being self autonomous, the quality of services, physical performances and satisfaction of patiens were better than before.