Jurnal Kebijakan Kesehatan Indonesia : JKKI
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Edisi Khusus Seri 1 Analisis Biaya untuk Pembiayaan Kesehatan
Get PDFSelamat berjumpa kembali.Pada bulan Agustus lalu telah diselenggarakan Forum Nasional Kebijakan Kesehatan Indonesia ke VI di Padang, Sumatera Barat, yang dihadiri pula oleh Menteri Kesehatan Republik Indonesia, Prof. dr. Nila Moeloek. Forum tersebut diikuti oleh 450 peserta dan menampilkan 90 hasil penelitian dari seluruh penjuru Indonesia yang tentunya diharapkan bermanfaat bagi para hadirin. Materi presentasi dapat dilihat di situs http://kebijakankesehatanindonesia. net/ Dalam rangka membantu agar semakin banyak dari antara kita terpapar dengan hasil-hasil penelitian tersebut, maka JKKI akan memuat beberapa artikel penelitian terpilih untuk disajikan dalam beberapa seri edisi khusus. Seri pertama akan memuat topik- topik terkait analisis biaya untuk pembiayaan kesehatan.Sebagaimana kita ketahui, selama puluhan ta- hun sistem penetapan tarif di rumah sakit dan di fasilitas pelayanan kesehatan di Indonesia dilakukan berdasarkan perkiraan biaya yang dihitung dan ditetapkan secara ‘tradisional’ sehingga banyak me- ngandung unsur ‘good-enough approximations’. Ter- lebih lagi, berapa pun besarnya tarif yang dikenakan biasanya akan dibayar oleh pengguna, baik oleh pasien (out-of-pocket), pemerintah, mau pun oleh asuransi kesehatan atau kombinasi dari ketiga unsur ini. Tetapi dalam sistem Jaminan Kesehatan Nasio- nal, hal ini tentu saja tidak lagi sesuai karena rumah sakit dan fasilitas pelayanan kesehatan dibayar dengan jumlah yang telah ditentukan. Masalah timbul ketika ternyata penggantian biaya oleh BPJS disi- nyalir rata-rata berada di bawah tarif pelayanan. Ke- tidakpuasan dan terhambatnya pelayanan seringkali menjadi ujungnya.Untuk mengatasi hal ini tentu saja ada beberapa hal yang harus berubah. Pertama, kita harus berhenti melakukan kesalahan menyamakan ‘biaya’ dengan ‘tarif’, karena kedua hal ini berbeda. Kedua, kita harus mengetahui dengan tepat berapa biaya yang dikeluar- kan untuk suatu pelayanan. Ketiga, kita harus men- cari cara untuk melakukan efisiensi biaya tanpa mengorbankan mutu pelayanan.Hal ini memerlukan keahlian akuntansi biaya (cost accounting). ‘Good-enough approximations’ tidak bisa lagi menjadi norma di bidang pelayanan kesehatan. Akuntansi biaya akan dapat melakukan penghitungan yang mendekati akurat untuk biaya- biaya tetap (fixed costs) dan biaya-biaya variabel (variable costs) suatu pelayanan. Kami katakan “mendekati akurat” karena sangat sulit melakukan penghitungan biaya yang 100% akurat. Namun, ini tidak berarti bahwa proses penghitungan biaya dan proses penetapan strategi efisiensi biaya harus dise- rahkan sepenuhnya kepada seorang akuntan biaya (cost accountant), karena keterlibatan para profes- sional kesehatan sangat diperlukan. Keterlibatan para professional kesehatan dalam proses analisis biaya kesehatan akan membantu para professional kese- hatan menyadari apa cost drivers suatu pelayanan dan mereka dapat melakukan inovasi dalam proses pelayanan yang tidak hanya menurunkan biaya tetapi juga mempertahankan mutu pelayanan dan memper- hatikan keselamatan pasien.Dalam edisi kali ini, kami pilihkan beberapa artikel terkait analisis biaya yang semoga dapat menjadi pelajaran bagi pembaca.Selamat membaca
Evaluasi Implementasi Public Private Mix Pengendalian Tuberkulosis di Kabupaten Ende Provinsi Nusa Tenggara Timur Tahun 2012
No full textgovernmental organizations in the implementation of quality DOTS known as Public Private Mix (PPM). Ende has executed the implementation of PPM DOTS approach involving government hospitals, private hospitals and private clinics since 2010, but the program has never been evaluated to determine the problem and found a solution to improve the performance of the TB control program in Ende. Objectives: To evaluate the implementation of the Public Private Mix (PPM) for TB control in Ende Methods: This study used a qualitative design, with descriptive case study approach, to describe the implementation of PPM for TB control in Ende, a district of East Nusa Tenggara Province. Result and Discussion: PPM implementation of TB control in Ende not run optimally, this showed by the low performance of the TB control program that is low TB case detection rate (CDR) 10% in the last three years. Factors - factors that inhibited the implementation of PPM for TB control are shortage of human resources, insufficient budget, lack of logistics and facilities infrastructures of TB DOTS unit and dependence on donor resources, the absence of operational guidelines governing cooperation mechanisms, the lack of commitment of the government and partners in the implementation of PPM control TB, lack of communication and coordination between PPM network, caseholding of TB patients. Conclusion: Implementation of PPM TB Control has not been optimal as it has not improve the performance of the TB control program in the district of Ende yet. Latar belakang: Salah satu komponen strategi stop TB adalah melibatkan seluruh penyedia layanan pemerintah, swasta, lembaga swadaya masyarakat dalam pelaksanaan DOTS yang berkualitas yang dikenal dengan Public Private Mix (PPM). Kabupaten Ende sejak tahun 2010 telah melaksanakan pendekatan PPM dalam pelaksanaan DOTS yang melibatkan rumah sakit pemerintah, rumah sakit swasta dan balai pengobatan swasta, namun belum pernah dilakukan evaluasi untuk mengetahui permasalahan dan ditemukan solusi untuk memperbaiki kinerja program pengendalian TB di Kabupaten Ende. Tujuan Penelitian: Untuk mengevaluasi implementasi Public Private Mix (PPM) pengendalian TB di Kabupaten Ende. Metode Penelitian: Penelitian ini menggunakan rancangan kualitatif, dengan pendekatan studi kasus deskriptif, untuk menggambarkan pelaksanaan PPM pengendalian TB di Kabupaten Ende Provinsi Nusa Tenggara Timur. Hasil dan Pembahasan: Implementasi PPM pengendalian TB di Kabupaten Ende belum berjalan optimal, ini terlihat dari masih rendahnya kinerja program pengendalian TB yaitu rendahnya angka penemuan kasus TB (CDR) 10% dalam kurun waktu tiga tahun terakhir. Faktor – faktor yang menghambat implementasi PPM pengendalian TB adalah keterbatasan sumber daya manusia, anggaran, logistik TB dan sarana prasarana unit DOTS serta ketergantungan sumber daya terhadap pihak donor, tidak adanya pedoman operasional yang mengatur mekanisme kerjasama, kurangnya komitmen pemerintah maupun mitra dalam implementasi PPM pengendalian TB, kurangnya komunikasi dan koordinasi antara jejaring PPM dalam menjaga keteraturan dan keberlangsungan pengobatan penderita TB.Kesimpulan: Implementasi PPM Pengendalian TB belum berjalan optimal karena belum dapat meningkatkan kinerja Program Pengendalian TB di Kabupaten Ende
Evaluasi Koordinasi Pelayanan Kesehatan Lintas Provinsi pada Masa Tanggap Darurat Bencana Gunung Merapi Tahun 2010
Get PDFBackground: Natural disasters influence human health and prosperity. The increasing tendency for natural disaster has become a priority in the disaster management in Indonesia. Gunung Merapi erupted on October 26, 2010. The eruption continued until November 2010. The disaster led to huge life tolls and injuries. It also caused substantial and extensive dam- ages and losses in four main regions, Sleman Regency in the Province of DI Yogyakarta, Magelang, Klaten, and Boyolali Regencies in the Province of Central Java. The data issued on December 13, 2010 reported 388 life tolls, 2.786 inpatient inju- ries, 62.923 outpatients injuries, and up to 21.338 refugees. To anticipate the spread of negative effects on the victim health due to Gunung Merapi eruption, the Provincial Health Office of DIY and Central Java had cross-provincial coordination, orga- nization, communication, and leadership.Method: A qualitative research was conducted using case study design. Subjects of the study were informants who played important roles in the coordinative process in the Prov- ince of DI Yogyakarta and Central Java. The data were col- lected by means of document investigation, direct observa- tion, and in-depth interviews. Data validity was checked by means of source, method, and data triangulation. Results: To realize an effective and efficient healthcare dur- ing the emergency response period after Gunung Merapi erup- tion, an integrated command organization was established to involve the two provinces – DI Yogyakarta and Central Java. The organization had daily coordination meetings by means of direct communication in terms of meetings and indirect com- munication using teleconference. Information could be received and transmitted quickly by means of sms gateway and email. Leadership applied during the emergency response period was command in nature, rather than authoritarian style. Conclusion: Cross-provincial healthcare coordination during the emergency response period after Gunung Merapi eruption in 2010 worked in a sufficiently effective way, since no ex- traordinary cases occurred at that time. Latar Belakang: Bencana alam selalu mempengaruhi kesehat- an dan kesejahteraan manusia. Bencana alam yang terus meningkat telah menjadi sebuah prioritas penanganan bencana di Indonesia. Pada tanggal 26 Oktober 2010, Gunung Merapi mengalami erupsi dan berlanjut sampai dengan awal Novem- ber 2010. Jumlah korban yang meninggal maupun luka-luka cukup banyak, serta menyebabkan kerusakan dan kerugian yang meluas di empat wilayah yaitu kabupaten Sleman di Provinsi DI Yogyakarta, Kabupaten Magelang, Klaten dan Boyolali di Provinsi Jawa Tengah. Informasi yang diperoleh pada tanggal 13 Desember 2010, data meninggal dunia 388 orang, rawat inap sejumlah 2.786 orang, rawat jalan 62.923 orang dan jumlah pengungsi sampai 21.338 orang. Untuk mengantisipasi meluasnya dampak negatif terhadap kesehatan yang ditimbulkan akibat erupsi Gunung Merapi, Dinas Kesehatan Provinsi DIY dan Jateng melaksanakan koordinasi, pengorgani- sasian, komunikasi dan kepemimpinan. Metode Penelitian: Penelitian kualitatif dengan rancangan studi kasus. Subyek penelitian adalah informan yang memiliki peranan penting dalam proses koodinasi di Provinsi D.I. Yog- yakarta dan Jateng. Pengumpulan data menggunakan studi dokumentasi, observasi langsung, dan wawancara mendalam. Validitas data menggunakan triangulasi sumber, metode, dan data.Hasil Penelitian: Untuk mencapai pelayanan kesehatan yang efektif dan efisien pada masa tanggap darurat bencana Gunung Merapi, dibentuk organisasi komando terpadu yang melibatkan dua Provinsi yaitu DI. Yogyakarta dan Jateng, melaksanakan koordinasi melalui rapat harian menggunakan komunikasi langsung dengan pertemuan dan tidak langsung dengan tele- conference. Penerimaan dan pengiriman informasi cepat melalui sms gateway dan email. Gaya Kepemimpinan yang diterapkan pada masa tanggap darurat bersifat komando dan tidak otoriter. Kesimpulan: Koordinasi pelayanan kesehatan lintas provinsi pada masa tanggap darurat Gunung Merapi tahun 2010 berjalan cukup efektif, karena pada saat itu tidak terjadi kasus KLB
Analisis Penetapan Prioritas Program Upaya Kesehatan Dasar (Puskesmas) pada Tingkat Pemerintah Daerah (Studi Eksploratif di Kota Bogor Tahun 2013)
Get PDFBackground: A policy is a set of conceptual proposed action in order to achieve certain goals. Some health indicators in Bogor city government has increased but some has decreased or only slightly increased. Method: The study is qualitative methods, and the informants are District health office, Puskesmas, Regional Secretary of Bogor City and Regional Representative Council of Bogor City. We cross check the data by conducting document review and observation . Results: The main actors in setting program priorities are Bogor District health office using evidence-based policy . Support is dominated by an elite group of executive government which is the City Health Office . The elite in legislative also has major effect in the form of budget determination . Overview of the process reveals that any identified problem and issues of the health center depends on the areas of concern. The process of prioritization of primary health care programs in the health center in the city of Bogor using the top-down approach. Furthermore, the Bogor district health office is also coordinating and disseminate at the level of higher government organizers. Prioritization output of primary health care programs in health centers vary in accordance with their respective problems working areas. The program remains in accordance with the basic policy of mandatory basic health centers to run the affairs of primary health care . Conclusions: human resources, support and demand is the necessary input to the priority-setting process, howoever a larger portion of health office still affect prioritization. Bottom- up approach needs to be done on the basis of the data. Kebijakan adalah serangkaian konsep tindakan yang diusulkan dalam rangka mencapai tujuan tertentu. Beberapa indikator pembangunan kesehatan pemerintah daerah Kota Bogor mengalami peningkatan namun ada pula yang mengalami penurunan atau meningkat tetapi tidak signifikan. Metode: metode kualitatif dengan Informan ; Dinkes Kota, Puskesmas, Sekda Kota Bogor, DPRD Kota Bogor. Cross cek data dengan melakukan telaah dokumen dan observasi. Hasil: Input;aktor utama dalam penetapan prioritas program adalah Dinas Kesehatan Kota Bogor dengan evidence base policy. Dukungan didominasi oleh kelompok elit eksekutif pemerintah adalah Dinas Kesehatan Kota. Kelompok elit legislative juga memberikan pengaruh, dalam bentuk penetapan anggaran. Gambaran proses : Identifikasi masalah dan isu tergantung pada permasalahan Puskesmas. Proses penetapan prioritas program pelayanan kesehatan dasar pada Puskesmas di Kota Bogor menggunakan metode top down. Selanjutnya dinas pula yang melakukan koordinasi dan sosialisasi pada level penyelenggara pemerintahan yang lebih tinggi. Output penetapan prioritas program pelayanan kesehatan dasar pada Puskesmas berbeda-beda sesuai dengan permasalahan masing-masing wilayah kerjanya. Program tetap sesuai dengan kebijakan dasar Puskesmas menjalankan urusan wajibnya primary health care. Kesimpulan: SDM, dukungan dan tuntutan merupakan masukan bagi proses penetapan prioritas dengan porsi Dinkes lebih besar mempengaruhi penetapan prioritas. Pendekatan bottom up perlu dilakukan dengan berdasar pada data
EVALUASI KEBIJAKAN JAMINAN PERSALINAN DI PROVINSI DAERAH ISTIMEWA YOGYAKARTA TAHUN 2012
Get PDFBackground: The Ministry of Health made a breakthroughthrough delivery care scheme as one solution to reducing theMMR and IMR called Jampersal. This policy is a deliveryassurance scheme intended for all pregnant women and newmothers in Indonesia who are not covered by any insuranceyet. Delivery care assurance scheme consist prenatal care,postnatal care including family planning postpartum andnewborn care. This program also applied in the special regionof Yogyakarta as one of the program in improving the health ofmothers and children. During the implementation in Yogyakarta,the program still has some obstacles.Objective: This study aimed to evaluate the delivery careassurance policy in the province of Yogyakarta.Methods: The research design used case study design. Theresearch was conducted in the province of Yogyakarta. whichThe sampling technique used was stratified sampling. The unitof analysis in this study is the health districts / municipalities,general hospitals, health centers and private practice midwiveswho administer Jampersal. Data collected by in-depthinterviews.Results: The result of this research shows that there aremany problems in terms of input, process and output. In termsof input, the problems are related to human resources, financial,means and policy. In terms of process, the problems are relatedto socialization, regulations of patient, process of claiming,referral system and funding. In terms of output, the problem isrelated to overcrowding, patient refusal, and complains fromthe consumer.Conclusion: This program is a good program for reduction ofinfant and maternal mortality rates, but still needs someimprovement. Improvements are needed in terms ofstrengthening cross-sector coordination, socialization of theprogram should be optimized, stregthening the electronic-basedreferral system, strengthening the commitment and motivationof personnel and improvement of health infrastructures.Keywords: Delivery Care Assurance Policy, Policy Evaluation
Faktor-Faktor yang Mempengaruhi Tidak Terlaksananya Manajemen Terpadu Balita Sakit di Puskesmas Sentani Kota Kabupaten Jayapura Tahun 2013
Get PDFBackground: According to Riset Kesehatan Dasar (Riskesdas) year 2010, the infant mortality rate per 1,000 live births was 36-41 and under five mortality rate per 1,000 live births was amounted at 62-64 . Based on the profile of Jayapura District Health Office in 2009 , the infant mortality rate per 1,000 live births was 12.99 and the maternal mortality rate per 1,000 live births was 6 and the prevalence of malnutrition among children under five years was 3.20 % . Based on the data collected from the regular reports done by Provincial Health Offices throughout Indonesia in the National Summit of Child Health Programs in 2010 , the number of health centers implementing integrated management of childhood illness (IMCI) until the end of 2009 was amounted to 51.55 % , but not all health centers were able to implement IMCI approach for various reasons , among others : lack of health personnel having trained IMCI; the health personnel has been trained but the infrastructure was not yet ready; lack of commitment or policy of the leadership of the health center , and others. Objective: The objectives of the research were to analyze further the factors affecting the implementation failure of Integrated Management of Childhood Illness ( IMCI ) in Sentani Health Center, Jayapura. Method: The research was qualitative method. The research population were the DHO officers and health center staff who have been involved in IMCI service, while the samples taken were 5 informants . The sampling technique was non- random purposive sampling. Result: The results showed that IMCI was not implemented in Sentani health centers due to the unbalance number of officers who deal with infants / toddlers; due to double jobs done by IMCI-trained personnel, the trained personnel were moved to different health centers; or the trained personnel continued their education. IMCI failed to be implemented in the health center was also due to the termination of procuring IMCI supporting facilities at Sentani health center by Jayapura District Health Office, and lack of quality of the facilities for handling infants / toddlers provided by Jayapura District Health Office . IMCI was failed to be implemented in the health center which is also caused by the absence of Sentani policy (implementation guidance and technical advice) regarding the implementation of IMCI in health centers . Others factor for IMCI not being implemented in Sentani health center was due to the limited funds from the local budget which could not support all activities of the organization of IMCI such as training , supervision and evaluation to the officers . Conclusion: IMCI in health centers Sentani is not implemented due to the factors of human resources, infrastructure , policies , budgets , officers’ habits, patient satisfaction towards the conventional methods (non IMCI), as well as the lack of supervision by District Health Office on the IMCI implementation in the health center. Latar belakang: Menurut Riset Kesehatan Dasar (Riskesdas) tahun 2010, angka kematian bayi per 1000 kelahiran hidup adalah sebesar 36-41 dan angka kematian balita per 1000 kelahiran hidup adalah sebesar 62-64. Berdasar profil Dinas Kesehatan Kabupaten Jayapura tahun 2009, angka kematian bayi per 1000 kelahiran hidup adalah sebesar 12,99 dan angka kematian ibu per 1000 kelahiran hidup adalah sebesar 6 serta prevalensi gizi kurang pada anak balita adalah 3,20%. Menurut data laporan rutin yang dihimpun dari Dinas Kesehatan Propinsi seluruh Indonesia melalui pertemuan nasional program kesehatan anak tahun 2010, jumlah Puskesmas yang melaksanakan MTBS hingga akhir tahun 2009 sebesar 51,55%, namun belum seluruh Puskesmas mampu menerapkan pendekatan MTBS karena berbagai sebab, antara lain : belum adanya tenaga kesehatan yang sudah terlatih MTBS, sudah ada tenaga kesehatan terlatih tetapi sarana dan prasarana belum siap, belum adanya komitmen atau kebijakan dari pimpinan Puskesmas, dan lain-lain. Tujuan: untuk menganalisis faktor-faktor yang mempengaruhi tidak terlaksananya Manajemen Terpadu Balita Sakit (MTBS) di Puskesmas Sentani Kabupaten Jayapura Metode: adalah metode kualitatif. Populasi dalam penelitian adalah petugas Dinas Kesehatan Kabupaten dan petugas Puskesmas yang pernah terlibat dalam pelayanan MTBS, sedangkan sampel yang diambil adalah sebanyak 5 orang informan. Cara pengambilan sampel yang digunakan adalah Non random sampling dengan teknik purposive sample. Hasil: penelitian menunjukkan bahwa tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan tidak seimbangnya jumlah petugas yang menangani bayi/balita sakit dikarenakan petugas terlatih MTBS melaksanakan tugas rangkap, petugas terlatih pindah tugas dan atau petugas terlatih melanjutkan pendidikan. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan terhentinya pengadaan sarana penunjang pelaksanaan MTBS dari Dinas Kesehatan Kabupaten Jayapura kepada Puskesmas Sentani dan tidak berkualitasnya sarana/fasilitas penanganan bayi/balita yang diberikan oleh Dinas Kesehatan Kabupaten Jayapura. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan tidak adanya kebijakan (petunjuk pelaksanaan dan petunjuk teknis) mengenai pelaksanaan MTBS di Puskesmas. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan dana yang bersumber dari dana APBD tidak dapat menunjang seluruh kegiatan MTBS berupa penyelenggaraan pelatihan, supervisi hingga evaluasi terhadap petugas. Kesimpulan: MTBS di Puskesmas Sentani tidak terlaksana dikarenakan faktor SDM, sarana prasarana, kebijakan, anggaran, kebiasaan petugas, kepuasan pasien terhadap metode konvensional, serta terhentinya supervisi dari Dinas Kesehatan Kabupaten terhadap pelaksanaan MTBS di Puskesmas
Analisis Kesiapan Penerapan Kebijakan Badan Layanan Umum Daerah (BLUD) Puskesmas di Kabupaten Kulon Progo (Studi Kasus di Puskesmas Wates dan Puskesmas Girimulyo II Kabupaten Kulon Progo)
Get PDFBackground: Some community health centers in Kulon Progo Regency had managed to meet their own operational needs without depending upon the subsidiary from the local govern- ment. However, bureaucratic problems often led to difficulties in realizing the funds. Long and exhausting bureaucratic pro- cedures and lack of flexibility in the fund use had delayed the public health services at the health centers. Implementation of the Local Public Service Agency (BLUD) at the Health Centers was a proposed solution for the problem. The Health Services that served as BLUD could use the budget/local income to support operation of the health facilities (i.e. flexibility in the fund use) without prior deposit to the local government ac- count. The purpose is to slim down the bureaucratic chains, thus allowing the Health Centers to improve their performance. This way, they could be more productive, effective, efficient, and ready to exercise the Social Security Agency (BPJS) in 2014. Of course, implementation of the policy requires active roles of the stakeholders and supporting conditions at the Health Centers. The study was conducted based on the facts, that all of the Health Centers in Kulon Progo Regency would implement the Local Public Service Agency (BLUD), as speci- fied by the Ministry of Domestic Affairs’ Regulation (Permendagri) No. 61/2007 on the Technical Guides for Finan- cial Management of BLUD. Objectives: To analyze to what extent the Health Centers were ready for the implementation of the Local Public Service Agency (BLUD) in Kulon Progo Regency. Methods: The research was a qualitative approach, using descriptive analytical method and case study design to as- sess the facts on readiness of the Health Centers to apply the BLUD policy. The analysis involved technical and administra- tive requirements of the Health Centers, analysis on the stake- holder roles, and analysis on the real situations at Wates and Girimulyo II Health Centers in Kulon Progo Regency. The re- search used purposive sampling technique, while the data were collected by means of in-depth interviews, observation, and library study. Results: Wates and Girimulyo II Health Centers in Kulon Progo were not fully prepared with technical requirements for the implementation of Health Center BLUD Policy: The increasing rate of earning during the last three years is not complemented by the result of evaluationservice performance thatwas not optimal.Health Centers in Kulon Progo were ready with admin- istrative requirements for the implementation of Health Center BLUD Policy.Stakeholders in Kulon Progo Regency also sup- ported the policy implementation, as evident from the analysis that the stakeholders played important roles and interests but were not ready with supporting regulation for Health Center BLUD Policy. However, the study found that the real conditions at the Health Centers were not ready to support BLUD, as evident from lack of commitment from the Health Centers, inad- equate financial management system, and inadequate human resources for financial management at the Health Centers. Conclusion: Overall, The Health Center in Kulon Progo has not been fully ready to implement BLUD, it must be supported by regulation and adequate resources. Latar Belakang: Beberapa Puskesmas di Kabupaten Kulon Progo sudah bisa mencukupi kebutuhan operasionalnya tanpa tergantung subsidi dari Pemda, namun untuk pencairan dananya sering kali tidak tepat waktu karena masih terkendala alur birokrasi. Alur birokrasi yang terlalu panjang dan tidak adanya fleksibilitas dalam penggunaan dana menghambat kelancaran pelayanan pada puskesmas. Penerapan kebijakan BLUD Pus- kesmas merupakan solusi untuk mengatasi permasalahan tersebut. Puskesmas BLUD, dana/pendapatan puskesmas bisa digunakan langsung untuk operasional (fleksibilitas penggunaan dana) tanpa disetor ke pemda, sehingga bisa memotong rantai birokrasi pemda dan dengan demikian puskesmas dapat meningkatkan kinerja pelayanannya secara produktif, efektif, dan efisien dan siap menyongsong diberlakukannya program BPJS Tahun 2014. Dibutuhkan peran stakeholder dan suasana di puskesmas yang mendukung kesiapan penerapan kebijakan ini. Penelitian ini dilakukan berdasarkan kenyataan, seluruh Puskesmas di Kabupaten Kulon Progo akan menerapkan Badan Layanan Umum Daerah (BLUD) sesuai dengan Peraturan Men- teri Dalam Negeri (Permendagri) No. 61 Tahun 2007 tentang Pedoman Teknis Pola Pengelolaan Keuangan Badan Layanan Umum Daerah. Tujuan: Menganalisis dan mengetahui sejauh mana kesiapan penerapan kebijakanBLUD Puskesmasdi Kabupaten Kulon Progo. Metode:Dalam penelitian ini, peneliti menggunakan jenis penelitian kualitatif dengan metode analisis deskriptif dengan rancangan studi kasus untuk menggambarkan keadaaan serta menggali secara luas kesiapan penerapan kebijakan BLUD Puskesmas, dengan menganalisis kesiapan persyaratan teknis dan administratif Puskesmas, analisis peran stakeholder, meng- analisis suasana yang ada di Puskesmas Wates dan Girimulyo II dalam kesiapan penerapan kebijakan BLUD Puskesmas diKabupaten Kulon Progo. Pengambilan sampel pada penelitian ini dilakukan secara purposive sampling. Metode pengumpulan data diperoleh dengan wawancara mendalam (indepth inter- view), observasi dan pemanfaatan dokumen. Hasil:Puskesmas Wates dan Girimulyo II di Kabupaten Kulon Progo belum siap sepenuhnya dengan persyaratan teknis, hal ini ditunjukkan dengan tingkat pendapatan puskesmas yang meningkat dalam tiga tahun terakhir tetapi hasil evaluasi kinerja pelayanan puskesmas belum optimal. Puskesmas telah siap dengan persyaratan administratif ditunjukkan dengan keleng- kapan dokumen BLUD Puskesmas. Stakeholder di Kabupaten Kulon Progo mendukung dalam penerapan kebijakan BLUD Puskesmas, ditunjukkan dari hasil analisis yang menunjukkan tingkat pengaruh dan kepentingan stakeholder yang cukup tinggi tetapi belum sepenuhnya siap dengan regulasi BLUD Puskesmas. Suasana yang terlihat pada Puskesmas kurang mendukung, dilihat dari komitmen puskesmas yang masih ku- rang, sistem pengelolaan keuangan puskesmas yang belum mendukung dan bendahara puskesmas yang belum terlatih pengelolaan keuangan BLUD. Kesimpulan: Secara keseluruhan kesiapan penerapan kebijakan BLUD Puskesmas di Kabupaten Kulon Progo belum sepenuhnya dilaksanakan, perlu segera ditindaklanjuti dengan regulasi yang mendukung dan kecukupan sumber daya
PROBLEM DAN TANTANGAN PUSKESMAS DAN RUMAH SAKIT UMUM DAERAH DALAM MENDUKUNG SISTEM RUJUKAN MATERNAL DI KABUPATEN KARIMUN PROVINSI KEPRI TAHUN 2012
Get PDFBackground: Strengthening referral system is a method toaccelerate decrease of maternal mortality rate. The main factorsaffecting referral system are facilities, staff, team work, andbudget that need seroius attention from all stakeholdersinvolved in the program of maternal health. By strengtheningthe system of maternal health the problem and the challenge ofhealth center to support of maternal referral can be addressed.Objective: The study aimed to evaluate referral system ofmaternal health at District of Karimun Province of KepulauanRiau.Method: This was a qualitative case study undertaken atKarimun Hospital and 2 health centers with high maternal andinfant mortality rate, i.e. Meral and Moro Health Center thatwere located at both urban and rural areas. Data were obtainedthrough in-depth interview, focus group discussion,observation, checklist and document study.Result: The result of the study showed there was limitation ofresources at primary health service such as facilities andequipments and hospital limited ability to provide comprehensiveemergency neonatal and obstetric management despite beingoperated 24 hours. There were lack of team coordicationacross referral levels involving district health office, hospitaland health centers, incomplete standard operating procedures,weak information system and bypassing referral procedure.Community participation in referral system was very highthough some labor was assisted by traditional childbirthattendants. This condition was mainly due to cultural factors/reasons.Conclusion: There are some problems and challenges in bothprimary health service and hospitals to support maternalreferral system in Karimun District. Some policies are requiredas a first step toward better referral system in Karimun District,for instance accelerating a functioning CMOC hospital,strengthening the teamwork across referral system, andestablishing SOP for maternal cases including its referralprocedures.Keywords: Problem, Challenge, Maternal referral system,Health Center, Distric Goverment Hospital
DAMPAK KEBIJAKAN PELAYANAN KESEHATAN GRATIS TERHADAP KEPUASAN PASIEN DALAM MENERIMA PELAYANAN KESEHATAN PUSKESMAS DI KOTA AMBON
Get PDFBackground: The Mayor of Ambon City, in order to improvethe welfare of society especially the health sector has made apolicy too free basic health services costs at health centersand its network for all communities. In implementing this policy,there are many problems both tecnical and operational.Objectives: The objective of this research was to determinethe performance of officers in providing free health servicesto the public in accordance with the level of satisfaction interms of free health care.Methods: This research is descriptive analysis with aqualitative approach and conducted at five sub districtcoordinator public health services.Research data obtained byin-depth interviews and focused group discussion.For dataanalysis,qualitative techniques were used, that is, narrativeinterpretations, conclusions and data validation by triangulationtechniques.Results: The results show that on giving free services,officerdoes not show any improvement in their performance. Thiswas the result of the absence of incentives or specialcompensation for them. Material and non material compensationis expected to increase work motivation. Supporting facilitiessuch as logistics and health facilities should be prepared toimprove provision of free services, thus in turn increasingpatient’s satisfaction.Keywords: Free Health Services Policy, Performance,Incentive and Compensation, Patient Satisfaction
Pengaruh Kepemilikan Jaminan Kesehatan Masyarakat Miskin terhadap Status Kelahiran dan Kejadian Stunting pada Baduta Indonesia (Analisis Data IFLS 1993 – 2007)
Get PDFBackground. One of the policies to address health and nutrition issues is Health Insurance Program for the Poor (ASKESKIN) imposed by the Decree of the Minister of Health of the Republic of Indonesia number 1241/MENKES/SK/XI/2004 as mandated by National Social Security System. However, coverage is still low, which is expected to have an impact on the birth status and nutritional status of children under-two years old. Objective. To prove that membership of a health insurance for the poor (ASKESKIN) has effect on birth status and the incidence of stunting of children under-two years old in Indonesia. Method. The research is using the positivist paradigm, the data is analysed using cross- sectional study based on Indonesian Family Life Survey (IFLS) in 1993-2007. The samples were all children under two years who were randomly netted in IFLS1 (1993) until IFLS4 (2007), with inclusion criteria biological children, living with parents, single live birth and birth, the data available on birth weight, gestational age, anthropometry. Univariate, bivariate and logistic regression mutivariat using 3 sets of data to identify the effect of health insurance ownership to birth weight (n = 3956), gestational age (n = 4998) and the incidence of stunting (n = 4504). Results. Ownership of health insurance affects LBW, preterm and stunting. Children under two years old from family that have health insurance other than ASKESKIN are protected from LBW (OR, 95 % CI = 0.61; 0.43 to 0.88). However, there was no difference risk of LBW among children under two years old from families with ASKESKIN and those without any health insurance. (OR, 95 % CI = 0.92; 0.52 to 1.61) (model 1). Children from ASKESKIN family has a risk factor for the prevalence of preterm (OR, 95 % CI: 1.74; 1.14 to 2.66) (model 2). Children from families that have health insurance other than ASKESKIN are protected from stunting (OR, 95 % CI = 0.78, 0.62 to 0.98), but there is no difference in risk of stunting among children from families with ASKESKIN compared to children from famililies that do not have health insurance (OR, 95 % CI = 1.01; 0.69 to 1.47) (model 3). Conclusion. Policy makers need to evaluate the Community Health Insurance Program (ASEKSKIN). The Maternal Children Health and Nutrition intervention was done with less emphasis on promotive and preventive efforts. People utilize curative measures only when problems occur in relation to the health and nutrition of mothers and children. Latar belakang. Salah satu kebijakan untuk mengatasi masalah kesehatan dan gizi adalah Program Jaminan Pemeliharaan Kesehatan bagi Masyarakat Miskin (PJKMM) yang diberlakukan dengan Surat Keputusan Menteri Kesehatan Republik Indonesia (SK Menkes RI) No. 1241/Menkes/SK/XI/ 2004 sebagai amanat UU No. 40/2004 tentang Sistem Jaminan Sosial Nasional (SJSN). Namun cakupannya masih rendah, yang diperkirakan berdampak pada masih tingginya masalah riwayat kelahiran dan status gizi baduta. Tujuan. Membuktikan pengaruh kepemilikan jaminan kesehatan masyarakat miskin terhadap status kelahiran dan kejadian stunting baduta Indonesia. Metode. Penelitian menggunakan paradigma positivist dengan pendekatan crossectional study berdasarkan data Indonesia Family Life Survey (IFLS) tahun 1993-2007. Sampel adalah seluruh bayi dan baduta yang secara random terjaring dalam IFLS1 (1993) sampai IFLS4 (2007), dengan kriteria inklusi anak kandung, tinggal dengan orang tua, lahir hidup dan lahir tunggal, tersedia data berat lahir, umur kehamilan, antropometri. Analisis univariat, bivariat dan regresi logistik mutivariat menggunakan 3 set data untuk mengidentifikasi pengaruh kepemilikan Jaminan kesehatan terhadap berat lahir (n=3956), umur kehamilan (n=4998) dan kejadian stunting (n=4504). Hasil. Kepemilikan jaminan kesehatan berpengaruh terhadap BBLR, prematur dan stunting. Bayi dari keluarga peserta jaminan kesehatan Non-ASKESKIN terproteksi dari BBLR (OR;95% CI= 0,61; 0,43-0,88). Namun tidak ada perbedaan risiko BBLR antara bayi dari keluarga peserta Askeskin dan yang tidak memiliki jaminan kesehatan (OR;95% CI =0,92; 0,52-1,61) (model 1). Kepemilikan ASKESKIN sebagai faktor risiko kejadian prematur (OR, 95% CI: 1,74; 1,14-2,66) (model 2). Anak dari keluarga peserta jaminan kesehatan Non-ASKESKIN terproteksi dari kejadian stunting (OR;95% CI =0,78; 0,62-0,98), namun tidak ada perbedaan risiko stunting antara anak dari keluarga peserta ASKESKIN dengan anak dari keluarga yang tidak memiliki jaminan kesehatan (OR;95% CI =1,01; 0,69-1,47) (model 3). Kesimpulan. Penentu kebijakan perlu melakukan evaluasi pada program Jaminan Kesehatan Masyarakat (keluarga miskin), karena intervensi KIA dan Gizi yang dilakuan kurang menekankan pada upaya promotif dan prefentif, sehingga utilisasi masyarakat lebih pada upaya kuratif bila terjadi masalah Kesehatan dan Gizi pada ibu dan anak