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Journal of Health Policy and Management
Published by Universitas Sebelas Maret
ISSN : -     EISSN : 25490281     DOI : -
Core Subject : Health,
Medicine & Pharmacology Public Health
Journal of Health Policy and Management (JHPM) is an electronic, open-access, double-blind and peer-reviewed international multidisciplinary and integrative journal, focusing on health policy, health system, and healthcare management. It began its publication on October 21, 2015. The journal is published twice yearly. It aims to improve the design and implementation of health policies, health systems, and healthcare management, primarily in low- and middle-income countries. JHPM analyzes policy initiatives and healthcare systems and provides evidence-based research to guide policymaking and management decision-making.
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Articles 8 Documents
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Search results for , issue "Vol 4, No 3 (2019)" : 8 Documents clear
Accreditation Status and Other Factors Affecting Patient Satisfaction in Hospital Sulistyo, Siwi Anggraini; Tamtomo, Didik; Sulaeman, Endang Sutisna
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Hospital accreditation is a systemic assessment to measure service quality according to standards. Hospital services focus on meeting patient needs and satisfaction. This study aimed to determine the status of accreditation and other factors that influence the satisfaction of hos­pitalized patients in the hospital.Subjects and Method: This was a cross sectional study conducted in four hospitals in Sleman, Yogyakarta, from March to April 2019. A sample 200 inpatients were selected for this study by proportional random sampling. The dependent variable was patient satisfaction. The independent variables were accreditation status, service quality, length of care, source of funds, employment, age, and gender. The data were collected by questionnaire and analyzed by path analysis.Results: Patient satisfaction was directly and positively affected by age >18 years old (b = 2.34; 95% CI= 0.33 to 2.50; p= 0.023), gender (b = 1.02; 95% CI = 0.08 to 1.96; p = 0.034), length of care> 3 days (b= 0.99; 95% CI= 0.043 to 1.95; p= 0.041), independent funding sources (b= 1.50; 95% CI= 0.47 to 2.53; p= 0.004), good service quality (b = 3.42; 95% CI = 2.31 to 4.53; p <0.001), and good ac­cre­ditation status (b = 3.33; 95% CI = 2.12 to 4.54; p<0.001). Satisfaction is directly and ne­gatively influenced by work (b = -1.37; 95% CI = -2.32 to -0.41; p = 0.005). Patient satisfaction was in­fluenced indirectly and positively by accreditation status through good service quality (b = 0.70; 95% CI = -0.04 to 1.96; p = 0.037). Patient satisfaction was influenced indirectly by age> 18 years thro­ugh service quality (b = 1.50; 95% CI = 0.49 to 2.50; p = 0.036).Conclusion: Patient satisfaction was influenced directly and positively by age> 18 years, male sex, length of care >3 days, independent fund sources, good service quality and good accreditation status. Patient satisfaction is influenced directly and negatively by work. Patient satisfaction was in­directly affected by age >18 years and good accreditation status.Keywords: Patient satisfaction, accreditation status, path analysisCorrespondence: Siwi Anggraini Sulistyo, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: siwianggraini@ymail.com. Mobile: 082­330049892Journal of Health Policy and Management (2019), 4(3): 139-149https://doi.org/10.26911/thejhpm.2019.04.03.01
Does Health Center Have Contextual Effect on Midwife Performance? Multilevel Analysis Evidence from East Kalimantan, Indonesia Rahmadani, Latifah Nur; Budihastuti, Uki Retno; Poncorini, Eti
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The maternal mortality rate (MMR) which is still high has now become the priority in order to find its solution. Midwives play a very significant role in making efforts to reduce MMR through antenatal care (ANC) services. The performance of midwives directly influences the quality of service and health outcomes in the public health centers. The performance of midwives in ANC can be seen based on the coverage of K1 and K4. This study aimed to determine the contextual effect of public health centers and other factors that influence the performance of midwives in antenatal care services.Subjects and Method: This study was conducted using observational analytic with cross sectional approach. It was done in 25 health centers in Samarinda, East Kalimantan in April-May 2019. The number of samples was 180 midwives selected using the total sampling technique. The dependent variable is the performance of the midwife. The independent variables include age, knowledge, tenure, training, workload, incentive, supervision, and motivation. The data were collected by questionnaire and analyzed by multilevel multiple logistic regression.Results: Midwife performance was influenced by age >45 years (b = -2.48; 95% CI = -4.53 to -4.34; p = 0.018), good knowledge (b = 1.35; 95% CI = 0.38 to 2.31; p = 0.006), tenure ≥13 years (b = 1.89; 95% CI = -0.07 to 3.86; p = 0.059), training ≥2 (b = 1.30; 95% CI = 0.29 to 2.30; p = 0.011), heavy workload (b = -1.30; 95% CI = -2.27 to -0.34; p = 0.008), incentive (b = 1.74; 95% CI = 0.30 to 3.18; p = 0.018), supervision (b = 1.12; 95% CI = 0.19 to 2.05; p = 0.017), and high motivation (b = 1.42; 95% CI = 0.45 to 2.38; p = 0.004). There was no contextual influence of public health center on the performance of midwives in antenatal care services (ICC = <1%).Conclusion: Age, knowledge, tenure, training, workload, incentives, supervision, and motivation are associated with midwives performance. There is no contextual influence of public health centers on the performance of midwives.Keywords: work performance, midwife, contextual effect, antenatal careCorrespondence: Latifah Nur Rahmadani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: latifahnr8@gmail.com. Mobile: 085250118907.Journal of Health Policy and Management (2019), 4(3): 150-160https://doi.org/10.26911/thejhpm.2019.04.03.02
Determinants of the Difference between Actual Cost and Indonesian Case Based Groups (INA-CBGs) Reimbursement for Birth Delivery at Hospitals in Mataram, West Nusa Tenggara Sulaeman, Endang Sutisna; Ismiana, Baiq Holisatul; Tamtomo, Didik
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Health is the part of the economic and social development of the state. The application of the BPJS Health national social security system in Indonesia is one of the government's efforts to provide health financing protection for all citizens and prevent catastrophic health expenditures. Hospitals as providers of secondary or tertiary health services often suffer losses because the payment system from BPJS Kesehatan uses a case-based payment method or INA-CBGs. This study aimed to examine the factors that influence the difference in rates between INA-CBGs rates and real hospital rates in labor cases.Subjects and Method: This was an analytic observational study with a cross-sectional design.  The study was carried out in Mataram and Siti Hajar Mataram Islamic hospitals, Mataram, West Nusa Tenggara, in May 2019. A sample of 200 postpartum women was selected by stratified random sampling. The dependent variable was the difference between real cost and INA-CBGs reimbursement. The independent variables were the type of hospital, class of treatment, type of birth delivery, length of stay, and severity disease. The data were collected from the medical record and analyzed by a multiple linear regression run on Stata 13.Results: Difference between real cost and INA-CBGs tariff of birth delivery reimbursement was negatively affected by type III of class treatment (b = -390,725; 95% CI= -790,082 to 8,631; p= 0,055), section caesarean (b= -1,429,648; 95% CI= -1,811,275 to -1,048,022; p <0.001), length of stay (b= -211,912; CI (95%) = -427,786 to 3,960; p = 0.054), moderate severity (b= -114,028; 95% CIi= -507,057 to 279,000; p = 0.568), and the high level of severity (b = -1,735,612; CI (95%) = -3,482,347 to 11,123; p = 0.051). The INA-CBGs rate difference and RS real rates of labor cases decreased due to the classification of private hospitals (b = 281,021; CI (95%) = -73,054 to 635,097; p = 0,119), treatment class II (b = 8,736; CI (95 %) = -392,068 to 409,541; p = 0.966).Conclusion: The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases would increase if it serves treatment class III, type of cesarean delivery, care days which are longer, and moderate or severe severity. The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases can decrease in services at private hospitals and serve treatment classes II.Keywords: INA-CBGs rates, hospital real rates, labor costs.                                                                            Correspondence: Baiq Holisatul Ismiana. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Jawa Tengah, Indonesia. Email: baiqholis26@gmail.com. Mobile: +6287739031046.Journal of Health Policy and Management (2019), 4(3): 161-169https://doi.org/10.26911/thejhpm.2019.04.03.03
Factors Affecting The Cost Gap Between INA CBGs Tariff and Hospital Tariff for Patients with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java Ariwardani, Betty Nurizky; Tamtomo, Didik Gunawan; Murti, Bhisma
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Dengue Hemorrhagic Fever (DHF) has a high cost burden. Payment for hospital treatment was paid by Health insurance (BPJS) with a case based payment method in the era of the National Health Insurance. This method allowed the hospital to gain profit or loss. This study aimed to analyze the factors that influence the differences in Indonesian Cased Based Groups (INA CBGs) with the medical service costs for DHF in dr. Soeroto hospitals, Ngawi Regency.Subjects and Method: This study used an observational analytic study with a cross-sectional approach conducted at dr. Soeroto Hospital, Ngawi Regency, East Java in September - October 2019. A sample of 200 subjects was selected by using simple random sampling. The dependent variable was the difference in rate. The independent variables were class of care, length of stay, age, blood transfusion, comorbidity and complications. Data analysis was using multiple linear regression with Stata 13.Results: INA CBG rates (mean= Rp 6,120,000; SD= Rp 2,330,000) was lower than the cost of hospital treatment (mean= Rp 7,070,000; SD= Rp 4,650,000). There is a negative relationship between the difference in rates and it was statistically significant on the length of stay (b= 0.73; Cl 95%= -1,131,915 to -329,501; p= <0.001), patients? age (b= 0.41; Cl 95%= -707,099 to -110,293; p= 0.008), blood transfusion action (b= 0.79; Cl 95%= -1,549,446 to -34,190; p= 0.041), and comorbidity (b= 1.14 ; Cl 95%= -1,817,112 to -474,641; p= 0.001). While there was a statistically insignificant relationship between classes of care (b= 0.42; Cl 95% = -931,443 to 82,607; p= 0.100) and complication (b= 0.34; Cl 95%= -1,093,208 to 408,223; p= 0.369).Conclusion: Difference in INA CBG rates and hospital medical service costs were affected by the class of care, length of stay, age, blood transfusion, comorbidity and complications.Keywords: INA-CBG?s rates, hospital rates, care cost, dengue hemorrhagic fever.Correspondence: Betty Nurizky Ariwardani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: bettyna175@gmail.com. Mobile: 082233243164.Journal of Health Policy and Management (2019), 4(3): 204-213https://doi.org/10.26911/thejhpm.2019.04.03.08
The Association between Nurse Characteristics, Supervision, and Nurse Compliance at Madani Hospital in Medan, North Sumatera Nurhandini, Astri; Zulfendri, Zulfendri; Ashar, Taufik
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The disease pain scale related to the health service in Madani Hospital was more than 1.5% in 2017. Nurse compliance with standard precaution has been proved to reduce the incidence of diseases related to health services. This study aimed to analyze characteristics and normative, formative and restorative supervision which influence the level of nurse compliance with standard precaution.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at Madani hospital in Medan, North Sumatera. A sample of 89 nurses in inpatient wards was selected by total sampling. The dependent variable was nurse compliance. The independent variables were nurse characteristics, normative, formative, and restorative supervisions. The data were collected by questionnaire and analyzed by multiple logistic regression.Results: The level of nurse compliance with standar precaution was good (66.3%). Nurse compliance with standar precaution increased with gender (OR= 4.71; 95% CI= 1.14 to 19.85; p= 0.032), normative supervision (OR= 6.00; 95% CI= 19.74 to 1.83; p= 0.001), and restorative supervision (OR= 25.23; 95% CI=2.90 to 219.35; p= 0.001).Conclusion: Gender and the implementation of normative and restorative supervision will increase the level of nurse compliance with standard precaution.Keywords: Nurses compliance, normative, formative, restorative supervisionCorrespondence: Astri Nurhandini. Department of Hospital Administration, Universitas Sumatera Utara. Email: nurhandiniastri@gmail.com. Mobile: 08116099983.Journal of Health Policy and Management (2019), 4(3): 170-175https://doi.org/10.26911/thejhpm.2019.04.03.04
Determinants of Cost Differences Between Indonesian- Case Based Groups Tariff and Hospital Tariff for Stroke Patients: A Path Analysis Evidence from UNS Teaching Hospital Sukoharjo, Central Java Wulandari, Dewi; Indarto, Dono; Tamtomo, Didik
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: In the scheme of the National Health Insurance System, the hospital must adapt to the newer financial system by regularly doing quality and cost assurance. Stroke, a catastrophic disease, has a high financial impact on hospital cost. This study aimed to examine the determinants of cost differences between Indonesian Case-Based Groups (INA-CBGs) dan hospital tariff for stroke patients in UNS Teaching Hospital, Sukoharjo.Subjects and Method: An analytic observation was performed in this study from April to May 2019 by with used the cross-sectional design. Recruitment of 113 stroke patients was determined using a fixed disease sampling. The dependent variable was the cost difference. The independent variables were the length of stay, intensive care use, medicine tariff, severity level, and type of class treatment. The data were obtained from the hospital medical record and analyzed by path analysis.Results: Medicine tariff was the strongest factor that influenced the difference of tariff (r=-0.65; p<0.001). Medicine tariff (b= -3.57; 95% CI= -4.34 to -2.80; p<0.001) and type of class treatment (b= 1508.70; 95% CI= 247.54 to 2769.87; p= 0.019) were directly influenced the difference of tariff. Length of stay (b= 122.18; 95% CI= 89.52 to 154.84; p<0.001), intensive care use (b= 1161.50; 95% CI= 844.01 to 1478.99; p<0.001), severity level (b= 375.58; 95% CI= 143.27 to 607.90; p= 0.002) positively influenced the difference of tariff through medicine tariff. Severity level also influenced medicine tariff (b=375.58), length of stay (b=1.55), and intensive care use (b=0.16).Conclusion: The UNS Hospital cost for stroke patients exceeds the INA-CBGs tariff, which is influenced by medicine tariff and intensive care use.Keywords: INA-CBG?s tariff, hospital tariff, stroke, UNS teaching hospital.Correspondence: Dewi Wulandari. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: dewulan0023@gmail.com.Mobile: 085335705757.Journal of Health Policy and Management (2019), 4(3): 176-181https://doi.org/10.26911/thejhpm.2019.04.03.05
Multilevel Analysis on the Contextual Effect of Community Health Center on Health Workers Performance Wardhani, Anindyah Tri Lhaksmi Kusuma; Tamtomo, Didik; Budihastuti, Uki Retno
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: One of the high maternal mortality rates is caused by bleeding factors. The imple­mentation of preventive effort that is less than optimal as well as the ability, understanding, and compliance of health personnel with Standard Operating Procedures (SPO) is still lacking and not in accordance with professional standards, allegedly a factor that affects the Maternal Mortality Rate (MMR). The performance of midwives in accordance with the SPO would have an impact on reducing mortality and improving the welfare of mothers and babies. This study aimed to analyze the factors that influence the performance of midwives in the early detection of bleeding.Subjects and Method: This was a cross sectional study conducted at 25 public health centers in Banyuwangi, East Java, from February to May 2019. A total sample of 200 midwives was selected for this study by simple random sampling. The dependent variable was midwife performance. The independent variables were training, skill, leadership style, incentive, work motivation, age, and human source. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression run on Stata 13. Results: Midwife performance increased with training (b= 1.46; 95% CI= 0.48 to 2.42; p= 0.003), skill (b= 2.32; 95% CI= 1.28 to 3.36; p= 0.001), high motivation (b= 1.66; 95% CI= 0.71 to 2.61; p= 0.001), incentive >Rp 1,000,000 (b= 2.59; 95% CI= 1.53 to 3.65; p= 0.001), positive leadership style (b= 1.95; 95 % CI= 0.93 to 2.96; p= 0.001), and human source>8 midwives (b= 1.05; 95% CI= 0.08 to 2.02; p= 0.033). Midwife performance decreased with age ?35 years (b= -1.16; 95% CI= -2.16 to -0.16; p= 0.023). Community health center had strong contextual effect on midwife performance with ICC= 25.74%.Conclusion: Midwife performance increases with training, skill, high motivation, incentive >Rp 1,000,000, positive leadership style, and human source>8 midwives. Midwife performance decreases with age ?35 years. Community health center has strong contextual effect on midwife performance.Keywords: work performance, midwives, multilevel analysisCorrespondence: Anindyah Tri Lhaksmi Kusuma Wardhani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: anin­dyah­tri@­gmail.com. Mobile: +6285258917339.Journal of Health Policy and Management (2019), 4(3): 182-194https://doi.org/10.26911/thejhpm.2019.04.03.06
Disparity in Health Care Utilization by Income Level and Insurance Status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia Nugroho, R. Haryo; Murti, Bhisma; Suryono, Arif
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Ideal equity in health is defined as each individual has the same opportunity to get the best health and not be harmed in the process of obtaining the health services. Communities with different socio-economic status should receive the same health services according to their needs, including equal access rights in the utilization of health services. Nowadays, the quality health services cannot be enjoyed equally by the Indonesian. The purpose of this study was to examine disparity in health care utilization by income level and insurance status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia.Subjects and Method: This study was an observational analytic study with a cross-sectional design. The study was conducted at PKU Muhammadiyah Gamping Hospital, Sleman Yogyakarta. 200 subjects were selected using simple random sampling. The dependent variable was the frequency of use of health services. The independent variables were the health insurance (BPJS) status, patient income, patient education level, and residence. The data were collected by questionnaire and analyzed by a multiple linear regression.Results: Frequency of health care utilization decreased with health insurance membership status (b= -4.49; 95% CI= -1.53 to -0.60; p <0.001) and longer distance (b= -7.33; 95% CI= -0.07 to -0.04; p<0.001). Frequency of health care utilization increased with patient age (b= 10.20; 95% CI= 0.06 to 0.09; p<0.001), family income (b= 3.30; 95% CI= 0.00 to 0.01; p = 0.001), and residence (b= 3.11; 95% CI= 0.33 to 1.47; p= 0.002).Conclusion: Frequency of health care utilization decreases with health insurance membership status and longer distance. Frequency of health care utilization increases with patient age, family income, and residence.Keywords: disparity, health insuranceCorrespondence: R. Haryo Nugroho. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: haryo_sleman@yahoo.co.id.Journal of Health Policy and Management (2019), 4(3): 195-203https://doi.org/10.26911/thejhpm.2019.04.03.07

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