Faculty of Public Health Journal Universitas Indonesia
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THE DETERMINANT OF OUTPATIENT HEALTH SERVICES UTILIZATION FOR ELDERLY PATIENT IN INDONESIA (SUSENAS 2017 DATA ANALYSIS)
Get PDFABSTRAKIndonesia has entered an aging population as showed by the number of elderly population which has reached more than 7% of the population. Basically, the increase in the elderly population will also increase the number of illnesses, because the more a person ages, the physical condition will decrease and be more susceptible to disease. This research is a quantitative study that aims to determine the determinants of outpatient health service use for Indonesian elderly in 2017. This research used secondary data from the 2017 National Socio-Economic Survey (Susenas) results with the unit of analysis is people aged ≥ 60 years who had health complaints. The analytical method used is logit regression analysis. The results showed that gender, education, employment status, residential area, health insurance ownership, economic status, and disruption of activity due to illness had a p-value of 0,000 < 0,05 which means that it was significantly associated with the utilization of outpatient health services. The most dominant variable is the disruption of activity due to illness. The government can issue policies related to efforts to register each elderly person into health insurance through optimizing a healthy Indonesian program with a family approach. The government is expected to be more assertive in monitoring and evaluating elderly health services by considering factors that support the elderly in utilizing health services to achieve healthy aging and active aging. ABSTRAKIndonesia telah memasuki populasi menua yang ditunjukkan dengan angka populasi lansia yang sudah mencapai angka lebih dari 7% jumlah penduduk. Pada dasarnya kenaikan populasi lansia juga akan meningkatkan angka keluhan kesehatan dan kesakitan, karena semakin bertambah usia seseorang maka kondisi fisiknya akan menurun dan lebih rentan terhadap penyakit. Penelitian ini merupakan penelitian kuantitatif yang bertujuan untuk mengetahui determinan pemanfaatan pelayanan kesehatan rawat jalan pada lansia sakit di Indonesia tahun 2017. Data yang digunakan adalah data sekunder dari hasil Survei Sosial Ekonomi Nasional (Susenas) tahun 2017 dengan unit analisis yaitu individu dengan usia ≥ 60 tahun yang mempunyai keluhan kesehatan. Metode analisis yang digunakan adalah analisis regresi logit. Hasil penelitian menunjukkan bahwa jenis kelamin, pendidikan, status pekerjaan, wilayah tinggal, kepemilikan jaminan kesehatan, status ekonomi, dan gangguan aktivitas akibat sakit mempunyai nilai P-value 0,000 < 0,05 yang berarti berhubungan secara signifikan dengan pemanfaatan pelayanan kesehatan rawat jalan. Pemerintah diharapkan dapat lebih tegas dalam memonitoring serta mengevaluasi pelayanan kesehatan lansia dengan mempertimbangkan faktor yang mendukung lansia dalam memanfaatkan pelayanan kesehatan agar tercapainya healthy ageing dan active ageing
Analisis Kesiapan Rumah Sakit Umum Daerah Kramat Jati Menjadi Health Promoting Hospital Tahun 2017
Get PDFABSTRAKKesiapan Rumah Sakit Umum Daerah (RSUD) Kramat Jati menjadi Health Promoting Hospital (HPH) sangat penting berdasarkan Standar Promosi Kesehatan Rumah Sakit Kementerian Kesehatan Republik Indonesia Tahun 2011. Oleh karena itu tujuan dari penelitian ini untuk mengetahui kesiapan RSUD Kramat Jati menjadi Health Promoting Hospital, dilakukan dengan pendekatan kualitatif. Hasil penelitian menunjukkan dari enam (6) standar promosi kesehatan rumah sakit, satu (1) standar promosi kesehatan rumah sakit telah terpenuhi oleh RSUD Kramat Jati, sementara lima (5) standar promosi kesehatan rumah sakit belum terpenuhi. Penyusunan kebijakan teknis untuk pelaksanaan HPH oleh Dinas Kesehatan, diseminasi HPH, optimalisasi peran unit khusus, penambahan sumber daya manusia, pelaksanaan pendidikan pelatihan khusus, kegiatan pemberdayaan dan pengorganisasian masyarakat serta penelitian lanjutan dalam penilaian komponen standar promosi kesehatan rumah sakit adalah saran-saran yang diusulkan pada penelitian ini. ABSTRACTThe readiness of Regional General Hospital (RSUD) of Kramat Jati to become Health Promoting Hospital (HPH) is very important based on Health Promotion Standard of Ministry of Health Republic of Indonesia Year 2011. Therefore, the purpose of this research is to know the preparedness of RSUD Kramat Jati become Health Promoting Hospital, done by qualitative approach. The results showed that from six (6) standard of hospital health promotion, one (1) standard of hospital health promotion has been fulfilled by RSUD Kramat Jati, while five (5) standard of health promotion of hospital have not been fulfilled. Preparation of technical policies for the implementation of HPH by the Dinas Kesehatan, dissemination of HPH, the optimization of special unit roles, the addition of human resources, the implementation of special training education, empowerment activities and community organizing as well as further research in the assessment of standard components of hospital health promotion are proposed suggestions in this research
Analisis Keterlambatan Pengajuan Klaim Obat Kronis BPJS Kesehatan di Rumah Sakit BaliMed Karangasem
Get PDFABSTRAKSkema pembayaran BPJS Kesehatan kepada Rumah Sakit menggunakan skema pembayaran INACBG dan non INACBG. Skema pembayaran non INACBG digunakan salah satunya untuk pelayanan obat kronis. Rumah Sakit BaliMed Karangasem sebagai salah satu mitra BPJS Kesehatan juga melayani pelayanan obat kronis yang akan dibayar oleh BPJS Kesehatan dengan skema pembayaran non INACBG. Pada Bulan September 2018, rumah sakit belum melakukan penagihan klaim obat kronis yang telah dilayani kendati jumlah di tahun sebelumnya nominal tagihan klaim obat kronis tidak melebihi 10% dari total klaim selama satu tahun namun hal ini harus tetap ditagihkan untuk mengurangi beban pembiayaan rumah sakit. Penelitian ini merupakan penelitian kualitatif dengan melakukan brainstorming bersama unit-unit terkait untuk kemudian digambarkan menjadi diagram fishbone untuk mencari akar permasalahan. Hasil analisa akar permasalahan adalah belum adanya kewenangan yang diberikan oleh direktur kepada tim atau orang untuk bertanggung jawab dalam proses pengajuan klaim. Proses yang melibatkan banyak unit ini memerlukan perhatian serta pengaturan khusus sehingga dengan adanya penunjukan dari direktur maka teknis alur serta perancangan sistem informasi yang memudahkan proses penyiapan klaim obat kronis menjadi lebih efektif dan efisien bisa dirancang. ABSTRACTThe BPJS Health payment scheme to hospitals uses the INACBG and non INACBG payment schemes. One non-INACBG payment scheme is used for chronic drug services. BaliMed Hospital Karangasem as one of the BPJS Health partners also serves chronic medicine services to be paid by BPJS Kesehatan with a non-INACBG payment scheme. In September 2018, the hospital has not collected chronic drug claims that have been served despite the amount in the previous year the chronic drug claim bill did not exceed 10% of the total claim for one year but this must still be billed to reduce the burden of hospital financing. This research is a qualitative research by brainstorming with related units to be described as a fishbone diagram to find the root cause. The results of the root cause analysis are the absence of the authority given by the director to the team or person to be responsible for the claim submission process. The process involving many of these units requires special attention and regulation so that with the appointment of directors the technical flow and design of information systems that facilitate the process of preparing chronic drug claims can be more effectively and efficiently designed
AN ANALYSIS ON THE PREPAREDNESS FOR IMPLEMENTING THE MINIMAL STANDARDS FOR SERVICE IN THE HEALTH FIELD AT DEPOK CITY IN 2017
Get PDFAbstract. Health is one of the fundamental rights for every person, therefore it must be provided by the government. To guarantee the quality and type of health services, the Minimal Standards for Services (SPM) must be established. This includes the SPM for the productive age healthcare services (SPM BKUP). This type of healthcare is important since it covers about 60-70% of the current population. In this research, we analyzed the discrepancy between the reality and the ideal in the implementation of the SPM BKUP qualitatively through in-depth interviews, focus group discusions, and studying the related documents. We discovered that in Depok City 10 of the 13 indicators for implementation were incomplete. These were the Noncommunicable diseases (NCDs) risk factor conseling, technical trainings for the screening officer and web-based surveillance, NCDs integrated services, recording and reporting, monitoring and evaluation, communication, the attitude of the implementer, manpower, facilities, and funding. And that the other three indicators, incentives for the implementers that reached the target, standard operational procedures for the implementation of the SPM BKUP, and a specialized team for the implementation. Therefore, Depok City was only minimally prepared to implement the SPM.Abstrak. Kesehatan adalah hak yang sangat mendasar bagi manusia, untuk itu negara harus hadir dalam pemenuhannya. Dalam era otonomi daerah, Standar Pelayanan Minimal (SPM) bidang kesehatan menjadi jaminan penyelenggaraan pelayanan kesehatan dengan jenis dan mutu pelayanan dasar yang sama. Salah satu jenis layanan dasar adalah SPM bidang kesehatan pada usia produktif (SPM BKUP). Jenis layanan dasar ini bernilai strategis bagi kinerja Pemerintah Daerah, karena berdasarkan BPS (2017) komposisi penduduk usia produktif menempati proporsi 60-70% dari seluruh jumlah penduduk dan nilai strategis bagi pengendalian Penyakit Tidak Menular (PTM) karena bentuk skrining. Analisis kesiapan ditujukan untuk melihat seberapa besar jarak antara kondisi ideal dengan kenyataan yang sebenarnya. Penelitian ini menggunakan metode kualitatif dengan teknik WM, FGD dan telaah dokumen terkait. Hasil penelitian didapatkan 10 dari 13 indikator kesiapan implementasi, belum lengkap dimiliki Kota Depok, meliputi konseling faktor risiko PTM, Pelatihan teknis petugas skrining dan surveilans berbasis web, pelayanan terpadu PTM, pencatatan pelaporan, monitoring evaluasi, komunikasi, sikap pelaksana, ketersediaan SDM, fasilitas dan dana. Sementara 3 indikator yang belum sama sekali dimiliki yaitu insentif bagi pelaksana yang mencapai target, SOP pelaksanaan SPM BKUP dan Tim penanggung jawab penyelenggaraan SPM BKUP. Kesimpulan didapatkan bahwa Kota Depok memiliki kesiapan yang minimal dalam rangka implementasi SPM BKUP.
Computerized Physician Order Entry (CPOE) in Reducing Medication Error: A Narrative Review
Get PDFABSTRACT Medication error leads to death and injury every day, causing lower quality of life and spend almost 1% of total global health expenditure. One of the solution of to prescribing error is using technology such as Computer Physician Order Entry (CPOE). This study purpose is to assess the use of CPOE in reducing medication error. The research method is a review of the narrative literature using systematic research, with 14 included studies. CPOE systems in hospitals were found to be capable of reducing medication errors especially in prescribing and administrative stage. However, CPOE system can be associated with new types of medication error, therefore, CPOE system must considered human factor, tailored according to the need of the hospital, and continuous training to reduce medication error
Metode Pendekatan Top-down dan Bottom-up: Strategi Marketing Penetapan Harga di Pelayanan Kesehatan
Get PDFABSTRAK Pendahuluan: Bauran marketing terdiri dari product, price, place dan promotion. Penetapan harga pada pelayanan kesehatan merupakan bauran penting yang dapat dilakukan melalui metode pendekatan top-down maupun bottom-up. Tujuan dari makalah ini adalah meninjau perbedaan antara metode pendekatan top-down dengan bottom-up pada penetapan harga pelayanan kesehatan. Metode: Tinjauan literatur ini dilakukan pada bulan Desember tahun 2018. Penelitian terkait dengan pendekatan top-down dengan bottom-up pada penetapan harga di bidang layanan kesehatan dicari dengan menggunakan kata kunci yang valid, termasuk top down approach, bottom-up approach dan costing melalui PubMed, Science Direct dan EBSCO. Hasil & Diskusi: Sebanyak 10 makalah dipilih untuk tinjauan literatur. Hasilnya didapatkan pendekatan top-down dilakukan apabila ingin melihat biaya dalam skala produk yang besar dan memperkirakan biaya pada jangka yang lebih panjang, pendekatan bottom-up dilakukan apabila ingin kita ingin menilai seberapa banyak variasi biaya yang diperlukan dalam aktivitas produksi. Pendekatan top-down akan menghasilkan varian biaya yang lebih merata dan tidak memiliki banyak varian, sedangkan bottom-up akan menghasilkan varian biaya yang bersifat individu dan sangat kompleks. Kesimpulan: Dengan memahami metode pendekatan top-down dan bottom-up dalam perhitungan biaya, maka administrator memiliki dasar yang kuat dalam penetapan harga, perhitungan margin keuntungan serta budgeting biaya marketing, serta strategi marketing yang dapat dilakukan untuk meningkatkan akses masyarakat terhadap layanan kesehatan, sehingga diversifikasi pendapatan dapat dilakukan dan rumah sakit dapat bertahan pada era JKN. ABSTRACT Introduction: The marketing mix consists of product, price, place and promotion. Pricing in health services is an important mix that can be done through the top-down and bottom-up approach. The purpose of this paper is to review the differences between the top-down and bottom-up approaches to pricing health services. Method: This literature review is conducted in December 2018. Research related to the top-down and bottom-up approaches to pricing health services is sought by using valid keywords, including top down approaches, bottom-up approaches and costing through PubMed, Science Direct and EBSCO. Results & Discussion: A total of 10 papers were selected for the literature review. The result is that a top-down approach is carried out if you want to see large product-scale costs and estimate costs in the longer term, a bottom-up approach is done if we want to assess how much variation in costs is needed in production activities. The top-down approach will produce cost variants that are more evenly distributed and do not have many variants, while bottom-up will produce cost variants that are individual and very complex. Conclusion: By understanding the method of top-down and bottom-up approach in calculating costs, the administrator has a strong basis in pricing, calculation of profit margins and marketing cost budgeting, and marketing strategies that can be done to increase public access to health services, so that income diversification can be done and hospitals can survive in the JKN era
Penerapan Lean Thinking untuk Mereduksi Waktu Boarding Pasien IGD ke Rawat Inap di RSUD Koja Tahun 2017
Get PDFABSTRAKPelaksanaan Program Jaminan Kesehatan Nasional (JKN) menyebabkan peningkatan kunjungan pasien IGD dan angka pasien boarding sehingga terjadi penumpukan (stagnasi) pasien di IGD. RSUD Koja telah menerapkan manajemen tempat tidur dalam rangka mereduksi waktu boarding pasien IGD tetapi belum optimal, sehingga dilakukan upaya untuk membantu mereduksi waktu boarding pasien IGD ke rawat inap dalam rangka perbaikan yang berkelanjutan sesuai prinsip lean thinking. Penelitian operasional ini mencakup intervensi dengan siklus PDCA (plan, do, check, action). Hasil penelitian menunjukkan penerapan lean thinking dapat mereduksi waktu boarding pasien IGD ke rawat inap dari rata-rata 4 jam 45 menit 18 detik (34,92 %) menjadi 3 jam 25 menit 59 detik (68,25 %) dan menurunkan aktivitas non value added sebesar 2,02% (dari 93,16% menjadi 91,14%). Delapan jenis waste yang teridentifikasi dapat dieliminasi kecuali waste jenis waiting. Dalam rangka perbaikan yang berkelanjutan selanjutnya manajemen tempat tidur perlu ditetapkan sebagai persyaratan standard kerja untuk menuju waktu boarding rata-rata menjadi 1 jam 45 menit 45 detik dengan aktivitas non value added kurang dari 89,83% di masa mendatang. ABSTRACTThe implementation of the National Health Insurance Program (Program JKN) affects the increased number of patients to emergency unit and boarding patients that resulting crowding in the emergency unit. Koja Hospital has implemented bed management in order to reduce the boarding time of emergency unit patients but has not succeeded, so an effort to help reducing the boarding time of emergency unit patients to inpatient in order to continuous improvement was done using the lean thinking principle. This research uses operational research method and intervention with PDCA (Plan, Do, Check, Action) cycle. The study revealed that lean thinking approach could reduce the boarding time of emergency unit patients to hospitalization from the average of 4 hours 45 minutes 18 seconds (34.92%) to 3 hours 25 minutes 59 seconds (68.25%) and decrease the activity of non value added at 2.02% (from 93.16% to 91.14%). Eight types of waste identified can be eliminated except waiting. In order to continuous improvement, bed management should be set as standardized work for the goal of average boarding time of 1 hour 45 minutes 45 seconds with non value added activities less than 89.83% in the future
Obesity as Type 2 Diabetes Common Comorbidity: Study of Type 2 Diabetes Patients’ Eating Behaviour and Other Determinants in Jakarta, Indonesia
No full textObesity is one of the comorbidities widely occurred among type 2 diabetes patients. It is one of the most modifiable risk factors for the prevention of other comorbid conditions such as diabetic nephropathy and cardiovascular disease. The aim of this study was to recognize eating behaviour, physical activity, and other related factors, also their correlation with obesity as comorbidity among type 2 diabetes patients. Using cross-sectional design, data were collected from purposively selected 133 members of “PROLANIS” in Jatinegara Primary Health Care, East Jakarta. Food intake was assessed by 1x24 hours food recall and FFQ, physical activity by GPAQ. The result showed 63,9% of adult with type 2 diabetes were obese (BMI ≥25 kg/m2), fat intake was higher than recommendation (30,77±9,06%), but mean energy intake was insufficient compared to energy requirement (62,06±23,67%). The prevalence of obesity among adults with type 2 diabetes is found associated with nutrition knowledge, level of education, and length of suffering type 2 diabetes. Nutrition education is important to reduce the prevalence of obesity among adults with type 2 diabetes
Risk Adjustment of Capitation Payment System: What Can Indonesia Adopt from other Countries?
Get PDFAbstractCapitation calculation in Indonesia is not adjusted by individual and aggregate risk. Without risk adjustment, capitation rates are likely to overpay or underpay primary care. This study aimed to review risk-adjusted capitation payment in other countries for evaluation of capitation payment system in Indonesia. The conduct and reporting of this systematic review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study used comprehensive electronic search in five databases: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Search results from five databases in April 2018, yielded a total 19 titles that will continue to review the full article and at the end, 4 articles included for systematic review. Based on risk adjustment of capitation payment system in UK, USA, Canada and Sweden, Indonesia may initiate the use of risk adjustment based on the distribution of age and sex. Then Indonesia can develop risk adjustment based on diagnosis and socioeconomic factors to create more fair and accurate capitation rates for primary care. AbstrakPerhitungan kapitasi di Indonesia belum disesuaikan berdasarkan risiko individu dan agregat. Tanpa penyesuaian risiko, rate kapitasi cenderung untuk membayar lebih atau kurang fasilitas kesehatan tingkat pertama. Studi ini bertujuan untuk meninjau sistem pembayaran kapitasi di negara lain sebagai dasar evaluasi untuk sistem pembayaran kapitasi di Indonesia Penyusunan systematic review ini menggunakan rekomendasi dari Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studi ini mengumpulkan artikel dari lima database yaitu: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Hasil pencarian dari lima database pada bulan April 2018, didapatkan 19 judul artikel yang akan dilanjutkan untuk ditinjau secara menyuluruh, dan akhirnya didapatkan 4 artikel yang akan diikutsertakan dalam systematic review. Berdasarkan penyesuaian risiko sistem pembayaran kapitasi di UK, USA, Canada dan Swedia, Indonesia dapat memulai sistem pembayaran kapitasi berdasarkan penyesuiaan distribusi umur dan jenis kelamin. Selanjutnya Indonesia dapat mengembangkan sistem pembayaran kapitasi berdasarkan diagnosis dan sosioekonomi untuk menciptakan rate kapitasi yang lebih adil dan akurat untuk fasilitas kesehatan tingkat pertama
IMPLEMENTATION OF CONTROL POLICY OF DIPHTHERIA OUTBREAK AND OUTBREAK RESPONSE IMMUNIZATION (ORI) IN KOTA DEPOK, 2017
Get PDFABSTRACTDiphtheria is a contributor to an outbreak (KLB) for some regions in Indonesia, included West Java Province. Diphtheria cases had increased through 2015 - 2016, the cases increased from 59 cases to 153 cases. Depok City became one of the contributors of diphtheria cases that have fluctuating incidents. Disease trends have decreased in 2013-2015 but then increased in 2016 to 8 cases. This study discusses policy implementation, viewed from policy sources, resource arrangements, the characteristics of implementing agencies, bureaucratic structures, communications, the influence of dispositions and socio-economic and political circumstances in control of Diphtheria Outbreak and Outbreak Response Immunization (ORI) in Depok City in 2017. This type of research is qualitative research with descriptive design, through in-depth interviews and document review. The results showed that the limited resources, especially human resources, the lack of cross-sectoral concern and social environment factors, including the rejection of some community for vaccination, became a challenge in controlling the Diphtheria Outbreak and Outbreak Response Immunization (ORI) in Depok City. It is expected that policy implementers can commit to working together, and taking into the influential factors in policy implementation, as well as government support in providing halal and safe vaccines and research on bioterrorism can also be done as solving cases of diphtheria fluctuating annually. ABSTRAKDifteri menjadi penyumbang kejadian luar biasa (KLB) bagi sebagian wilayah di Indonesia, tidak terkecuali wilayah Provinsi Jawa Barat. Kejadian difteri pada tahun 2015 dan 2016 terekam naik, yakni meningkat dari 59 kasus menjadi 153 kasus. Kota Depok menjadi salah satu penyumbang kasus yang memiliki angka kejadian yang fluktuatif. Tren penyakit sempat menurun pada 2013-2015, namun kemudian naik pada tahun 2016 menjadi 8 kasus. Penelitian ini membahas tentang implementasi kebijakan, dilihat dari sumber kebijakan, pengaturan sumber daya, karakteristik instansi pelaksana, struktur birokrasi, komunikasi, pengaruh disposisi dan keadaan sosial-ekonomi dan politik dalam pengendalian Kejadian Luar Biasa (KLB) difteri dan Outbreak Response Immunization (ORI) di Kota Depok tahun 2017. Jenis penelitian ini adalah penelitian kualitatif dengan desain deskriptif, melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa masih terbatasnya sumber daya terutama SDM, kurangnya kepedulian lintas sektor dan faktor lingkungan sosial, yakni adanya penolakan dari masyarakat untuk vaksinasi, menjadi tantangan dalam pengendalian Kejadian Luar Biasa (KLB) difteri dan Outbreak Response Immunization (ORI) di Kota Depok. Diharapkan, kepada implementor kebijakan dapat berkomitmen untuk bekerja sama dengan baik, dan memperhatikan faktor-faktor yang berpengaruh dalam implementasi kebijakan, serta dukungan pemerintah dalam menyediakan vaksin yang halal dan aman serta penelitian mengenai bioterorisme juga dapat dilakukan sebagai pemecahan kasus difteri yang fluktuatif setiap tahunnya