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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 215 Documents
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The Determinants of Health Consultation Utilization among HIV Patients at Budi Kemuliaan Hospital, Batam, Indonesia Siregar, Dawiyah; Juanita, Juanita; Rochadi, R. Kintoko
Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: HIV and AIDS is a global public health problem. Until the end of 2016, there were more than 36.7 million people living with HIV. HIV & AIDS counseling is a confidential communication between clients and counselors aimed at increasing the ability to deal with stress and make decisions regarding HIV & AIDS. The purpose of this study was to determine the effect of the ability to pay and the environmental factor on consultation health service utilization at Budi Kemuliaan hospital, Batam.Subjects and Method: This was a cross-sectional study was conducted at Budi Kemuliaan Hospital, Batam, from May 8 to June 18, 2018. A sample of 76 HIV patients was selected by systematic random sampling. The dependent variable was the use of consulting service. The independent variables were risk of illness and environment. The data were collected using questionnaires and analyzed by a multiple logistic regression.Results: The use of consultation health service was influenced by the risk of illness (OR = 6.82; p = 0.011) and supportive environment (OR= 4.59; p= 0.028).Conclusions: The use of consultation services is influenced by risk factors for illness and the environment.Keywords: consultation service, the risk of illness, environment, HIV/AIDS patientCorrespondence:Dawiyah Siregar. Department of Administration and Health Policy. Universitas Sumatera Utara, Jl. Universitas No.32, Padang Bulan, Medan Baru, Medan, North Sumatera 20222. Email: dawiyahsrg@gmail.com. Mobile: +6281267500608Journal of Health Policy and Management (2018), 3(2): 76-80https://doi.org/10.26911/thejhpm.2018.03.02.03
Factors Affecting the Quality of Diagnosis Coding and Medical Record at Dr. Moewardi Hospital, Surakarta Maryati, Warsi; Murti, Bhisma; Indarto, Dono
Journal of Health Policy and Management Vol 1, No 2 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Diagnosis coding is atool for identifying and grouping diseases, disorders, symp­toms, and other disease-related outcomes, such as poisoning, adverse effect of drugs and chemicals, injury. Diagnosis code can be used in policy making and costing medical care. Doctors, nurses, coding personnel, and medical record quality, may affect the quality of diagnosis coding. This study aimed to investigate factors that affects the quality of diagnosis coding at Dr. Moewardi Hospital, Surakarta.Subjects and Method: This was an analytic observational using cross sectional design. This study was conducted at Dr. Moewardi Hospital, Surakarta, Indonesia. A total of 250 inpatient medical record document at Dr. Moewardi Hospital were selected for the study bystratified random sampling.The data was analyzed by structural equation modeling (SEM).Results:Sub-specialistic doctor (b = 1.13; 95%CI = 0.06 to 0.33; p = 0.039),civil servant doctor(b = 0.84; 95%CI = 0.06 to 1.62; p =0.034),nurse working ≥ 5 years (b = 1.77; 95% CI = 1.13 to 2.42; p<0.001), significantly increased the quality of medical record. Coding personnel aged ≥40 years (b= 1.70; 95%CI = 0.64 to 2.77; p = 0.002), coding personnelworking ≥5 years (b = 1.70; 95%CI= 0.98 to 2.42; p 0.001), and coding personnel has ≥ 5 times training(b = 2.62; 95% CI = 1.40 to 3.83; p <0.001), significantly increased the quality of diagnosis coding.Conclusion: Sub-specialistic doctor, civil servant doctor, nurse working ≥5 years, significantly increased the quality of medical record. Coding personnel aged ≥40 years, coding personnel working ≥5 years, and coding personnel has ≥ 5 times training, significantly increased the quality of diagnosis coding.Keywords: Quality of diagnosis coding, quality of medical record, doctor, nurse, coding personnel.Correspondence: Warsi Maryati. School of Medical Records and Health, APIKES Citra Medika, Surakarta. Email: warsi_maryati@yahoo.comJournal of Health Policy and Management (2016), 1(2): 61-70https://doi.org/10.26911/thejhpm.2016.01.02.01 
Determinants of Midwife Performance on Antenatal Care in Surakarta and Karanganyar, Central Java Gusti, Titis Eka; Tamtomo, Didik; Murti, Bhisma
Journal of Health Policy and Management Vol 3, No 1 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: A high maternal mortality rate is one of the major health problems in developing countries. Midwives have an important role to reduce maternal mortality rate by looking after a pregnant women and her baby throughout a phase of antenatal care, during labor and birth, and for up to 28 days after the baby has been born. The WHO Expert Committee on Midwifery stated that the competence of the midwife must extend beyond the provision of service at the time of delivery to total antenatal and postnatal care. This study aimed to examine the determinants of midwife performance on antenatal care in Surakarta and Karanganyar, Central Java.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at 25 community health centers in Surakarta and Karanganyar, Central Java, from April to May 2018. A total sample of 200 midwives was selected by simple random sampling. The dependent variable was midwife performance. The independent variables at level 1 of multilevel modeling (MLM) were age, tenure, motivation, knowledge, training, facility, and leadership. Community health center (Puskesmas) was taken as level 2 in the MLM. The data were collected by questionnaire and analyzed by MLM.Results: Longer tenure (b= 1.57; 95% CI= 0.11 to 3.02; p=0.035), provision of training (b=1.92; 95% CI= 0.45 to 3.40; p=0.011), high motivation (b=1.48; 95% CI =-0.13 to 3.09; p=0.072), better knowledge (b=1.61; 95% CI= 0.03 to 3.19; p=0.046), facility (b=1.44; 95% CI= 0.14 to 2.73; p=0.030), strong leadership (b=1.66; 95% CI= 0.18 to 3.13; p=0.028), and age ?27 years (b=2.08; 95% CI= 0.04 to 4.12; p=0.046) were positively associated with better performance of midwives. A large portion of variation in midwives performance was determined at Puskesmas level with ICC= 45.78%.Conclusion: Longer tenure, provision of training, high motivation, better knowledge, facility, strong leadership, and age ?27 years are positively associated with better performance of midwives. Community health center has an important contextual effect on midwife performance.Keywords: midwife, performance, age, tenure, motivation, training, leadership, community health centerCorrespondence:Titis Eka Gusti. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: titisekagusti@gmail.comJournal of Health Policy and Management (2018), 3(1): 11-19https://doi.org/10.26911/thejhpm.2018.03.01.02
Implementation of the Referral System Policy in the National Health Insurance Scheme at Community Health Centers, Ngawi District, East Java Eskawati, Maria Yeny; Murti, Bhisma; Tamtomo, Didik
Journal of Health Policy and Management Vol 2, No 2 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system. Community Health Center is expected to serve as a gatekeeper, such that most of the health problems can be tackled at the Community Health Center. However, anecdotal evidences had shown that the referral system did not run as expected. This study aimed to examine the implementation of the referral system in the National Health Insurance scheme with special attention on  the policy context and resources availability at Community Health Centers in Ngawi, East Java.Subjects and Method: This was a qualitative study conducted in Ngawi, East Java. The institutions under study included 3 Community Health Centers of different strata Geminggar Community Health Center (highest  strata), Ngawi Community Health Center (medium strata), Kasreman Community Health center (lowest strata). The other institution under study was Ngawi District Health Office. The informants for this study included 24 patients of various categories at Community Health Center: subsidy recipients, class I, class II, and class III. The other informants included 1 staff from District Health Office and 6 staff from Community Health Center. The data were collected by in-depth interview, observation, and document review. The data were analyzed by data reduction, presentation, and verification.Results: The policy on the referral system of the National Health Insurance (NHI) was good but its implementation was poor. Outpatient referral was still high because of community ignorance regarding referral system. It was often the case the referral was based on patient request.  The referral system problem also stemmed from the shortage of medical doctors and health equipment at the Community Health Center. Nevertheless, the availability of medicine and funding at Community Health Center were sufficient. The sources of funding included General Allocation Fund (DAU), Special Allocation Fund (DAK), Special Allocation Fund for Operational Affairs (BOK), and capitation. Community Health Center only managed capitation and BOK.Conclusion: There is a need for socialization to the community regarding the current referral system of the National Health Insurance either through the media or the BPJS representative at the Community Health Center. In addition, there is a need for recruitment of doctors with a clear salary regulation, and health equipment upgrade at Community Health Center. Keywords: Referral system, resources, National Health InsuranceCorrespondence: Maria Yeny Eskawati. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Mobile: 082230898979.Journal of Health Policy and Management (2017), 2(2): 102-111https://doi.org/10.26911/thejhpm.2017.02.02.01
Context, Input, Process, Product Analysis in the Implementation of Iron Supplementation Program in Banyumas, Central Java -, Purwati; Tamtomo, Didik; Sulaeman, Endang Sutisna
Journal of Health Policy and Management Vol 1, No 2 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Iron supplementation program has been implemented in Banyumas, District, Central Java, but the prevalence of anemia in pregnant women remains as high as 55.37%. The Banyumas District Health Office has launched an ad hoc (temporary) iron supplementation program, namely Hemafort, in order to reduce anemia prevalence. This study aimed to investigate the factors that determine the effectiveness of the iron supplementation program for pregnant women in Banyumas, Central Java.Subjects and Method: This was a qualitative study with case study approach, and CIPP (context, input, process, product) framework. This study was conducted Wangon II and South Purwokerto Health Centers from October to November 2016. Informants were selected by purposive sampling including midwives, nutritional program managers, pharmacists, head of nutrition section, and pregnant women. The data were collected by in-depth interview, observation, and archival review. The data were analyzed by a multiple case study. The data were validated by data source triangulation.Results: The iron tablets coverage for pregnant women reached 94.88% and 89.26% in 2014 and 2015, respectively, in Banyumas. The minimal target of iron coverage for pregnant women was 90%. There was no local government policy or standard operating procedure (SOP) that regulated the efforts to tackle anemia problems in pregnant women. The number of health personnel in charge of nutrition and their competence were sufficient. But reliable budget to tackle anemia problem did not exist. Spending district budget was an exit strategy to take when there was deficiency in central budget allocation. The number of iron supplementation tablets was not guaranteed.Conclusion: The effectiveness of iron supplementation program for pregnant women depends on the existence of relevant policy, SOP, allocation of sufficient and reliable budget, as well as adequate supply of iron tablets.Keywords: iron supplementation tablets, pregnant women, local government, budgetCorrespondence: Purwati. Faculty of Health Sciences, Muhammadiyah University at Purwokerto, Central Java. Email: watix_1006@yahoo.com. Mobile: +6285735145236.Journal of Health Policy and Management (2016), 1(2): 113-120https://doi.org/10.26911/thejhpm.2016.01.02.06
Informed Consent Reformulation by Health Personnel in Health Services Sari, Dian Lukita; Suryono, Arief; Isharyanto, Isharyanto
Journal of Health Policy and Management Vol 3, No 1 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Informed consent is an approval given after receiving information. The arrangement of informed consent is more emphasized on the medical act, namely the Minister of Health Regulation no. 290 of 2008 on Approval of Medical Measures, whereas in addition to doctors / dentists including health personnel must also obtain the consent of the patient. Article 68 paragraph (6) of Law no. 36 of 2014 on Health Manpower explaines that the procedures for approval of the Health Manpower Act are regulated by Ministerial Regulation, but until now none of it existed. Therefore, it is necessary to reformulate informed consent to provide legal certainty for all health personnel.Subjects and Methods: Normative type study with statute approach that is legislation and conceptual approach, technique of collecting law material with literature study. Technical analysis of legal materials was done by formulating legal principles, formulating legal understanding and formation of legal standards.Results: Urgency of reformed informed consent in health service action for health personnel viewed from the perspective of legislation that is Law no. 36 Year 2009 on Health, Law no. 44 Year 200 on Hospital, Law no. 36 of 2014 on Health Manpower and Regulation of the Minister of Health RI No. 69 of 2014 on Hospital Obligations and Patient Obligations explained that informed consent is provided by health personnel. Urgency due to social interests in the matter of public security as well as social interests concerning the lives of individuals. Urgency of legal certainty that the law can be implemented properly if there is adequate regulation and equal treatment before the law. Ideal informed consent reform as the implementation of Article 68 paragraph (6) of the Law on Health Manpower needs to re-regulate Regulation of the Minister of Health Number 290 Year 2008 regarding Approval of Medical Measures. Reformulation of preliminary consideration and consideration considering the adjusted development of science as well as legal subjects informed consent uniformed into health personnel.Conclusions: The urgency of reformulating informed consent is because in the therapeutic agreement, it is the fulfillment of the principle of consensualism in the agreement; for the social interest in public security matters and concerning the lives of individuals and need the latest regulation for legal certainty for all health personnel. Ideal informed consent reform is the needs to reorganize the Approval of Health Personnel Act by substituting Regulation of the Minister of Health No. 290 Year 2008 on Approval of Medical Measures, by changing the subjects for "Health Personnel".Keywords: informed consent, health service, health personnel.Correspondence:Dian Lukita Sari. Masters Program in Law, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java Email: dtiar02@gmail.com. Mobile: +6285648127557Journal of Health Policy and Management (2018), 3(1): 47-55https://doi.org/10.26911/thejhpm.2018.03.01.07
Path Analysis and Health Belief Model on the Association between Education and Cadre Performance in Tuberculosis Control in Baki Community Health Center, Sukoharjo, Indonesia Ningrum, Dhian Nurayni Sulistyo; Murti, Bhisma; Dharmawan, Ruben
Journal of Health Policy and Management Vol 1, No 1 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The new cases of tuberculosis in 2014 as many as 9.6 million. There are 6 million cases reported findings. The efforts to increase the number of case finding through cooperate community and community health workers. This study aimed to analyze the association of education and health belief model with a performance of cadres in tuberculosis control.Subjects and Method: This was an observational analytic with a cross sectional design. This was conducted in community health center of Baki, Sukoharjo, Indonesia, in April 2016. A total of sample was 90 subjects were selected by random sampling. The data collection used questionnaire. The data were analyzed using path analysis.Results: There was no relationship between education and the performance of cadres in tuberculosis control cases through the perception of vulnerability, perceived seriousness, perceived benefit, perceived barriers and self-efficacy. There was a direct positive relationship between the perception of vulnerability to the performance of cadres in tuberculosis control cases (b = 3.35; 95% CI= 1.43 to 5.27; p=0.001), seriousness (b=2.21; 95% CI=0.43 to 3.9; p = 0.015), benefits (b= 2.11; 95% CI= 0.42 to 3.80; p = 0.014), self-efficacy (b = 2.04; 95% CI= -0.01 to 4.09; p = 0.051), the impulse to act (b = 1.64; 95% CI= 0.06 to 3.22; p= 0.042) with the performance of cadres in the control of tuberculosis cases. There was a direct negative relationship between perceptions of barriers to the performance of cadres in tuberculosis control (b=-4.54; 95% CI= -7.56 to - 1.52); p = 0.003).Conclusion: There is indirect relationship between education and performance of cadres in tuberculosis control cases through the perception of vulnerability, seriousness, benefits, barrier and self-efficacy. There is a direct relationship between construct of health belief model with the performance of cadres in tuberculosis control cases.Keywords: path analysis, education, health belief model, the performance of cadres, tuberculosisCorrespondences: Dhian Nurayni. Sulistyo Ningrum. Faculty of Public Health, Sebelas Maret University, Surakarta. Email: dhiannuraynis@gmail.comJournal of Health Policy and Management (2016), 1(1): 38-43https://doi.org/10.26911/thejhpm.2016.01.01.06 
Analysis of Patient Safety Management in Committee for Quality Improvement and Patient Safety at Sumbawa Hospital, West Nusa Tenggara Sulahyuningsih, Evie; Tamtomo, Didik Gunawan; Joebagio, Hermanu
Journal of Health Policy and Management Vol 2, No 2 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Patient safety is a crucial issue and a focus of policy standard in internationally accredited organizations. The specific committee responsible for quality improvement in patient safety is the committee for quality improvement and patient safety (PMKP). Incidence of malpractice often occurs but are not reported. It indicates that the committee has not worked according to required accreditation standard. This study aimed to analyze patient safety management with the committee for quality improvement and patient safety at Sumbawa Hospital, West Nusa Tenggara. Subjects and Method: This was a qualitative study with phenomenology approach. Nine study participants were selected purposively, consisting of 3 committee members (chairperson, secretary, and patient safety sub-committee), 3 chiefs of ward (pediatrics, internal medicine, and surgery), and 4 nurses or midwives (pediatrics, surgery, ICU/ICCU, and obstetrics).Results: The committee for quality improvement and patient safety has been established at Sumbawa Hospital, West Nusa Tenggara to meet the requirement of hospital accreditation standard. It aimed to improve the quality of services and to assure patient safety. However, its work has not meet the required standard. The lack of knowledge among involving parties, including hospital management, PMKP member, medical professionals was identified as one important obstacle for the implementation of patient safety management. This has led to the incidence of malpractice at the hospital, sub-standard quality of services and patient safety.Conclusion: PMKP has been established at Sumbawa Hospital, West Nusa Tenggara. However, their work have not meet the required standard. The lack of knowledge among involving parties, including hospital management, PMKP, and health professional, has led to the incidence of malpractice at the hospital, sub-standard quality of services and patient safety.Keyword: quality improvement, patient safety management, committeeCorrespondence: Evie Sulahyuningsih. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Mobile: 08786410495.Journal of Health Policy and Management (2017), 2(2): 147-156https://doi.org/10.26911/thejhpm.2017.02.02.06 
Qualitative Study on The Implementation of Public Health Nursing: Objective, Resources, and Work Procedure on Home Care Patients in Surakarta Novitasari, Ratih; Adriani, Rita Benya; Pamungkasari, Eti Poncorini
Journal of Health Policy and Management Vol 2, No 1 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Dynamic changes of disease development call for improvement in health care. In light of this context, public health nursing with home care has an increasing role in the management of diseases. Comprehensive public health nursing requires partnership between healthcare providers, patients, and their environment. In Indonesia the focus of nursing remains on hospital care, while rarely on home care that fulfils the need of the community. This study aimed to examine the implementation of public health nursing, encompassing its objective, resources, and work procedure, on home care patients.  Subjects and Method: This was a qualitative study with case study approach. This study was carried out at PKU Muhammadiyah Hospital, Surakarta, from February to March 2017. The key informants of this study included nurses, home care coordinator, doctors, dieticians, and physiotherapists. Methods of data collection included interview, observation, and archival review. Data were analyzed in stages normally employed in case study.Results: The objectives of home care have generally been understood by most health providers. On the other hand the objectives of home care have not well-understood by the families of the patients, leading to inconsistency with the objective. There is a need to increase resources necessary for the nurses, particularly improvement in competency, as well as case selection, review, planning, coordinating, and evaluation. Likewise, collaboration between health care provider, patients, and their families, need to be improved in order to maximize home care.Conclusion: There is a need to strenghten commitment of all parties involved in home care. The objectives of home care need to be understood by all parties. Hospitals are expected to have stronger responsibility with both work procedure in order to deliver optimal health care. By doing so, the public health nursing with home care will be able to fulfil the need of the community.Keywords: home care, objective, resources, work procedureCorrespondence: Ratih Novitasari, Masters Program in Public Health, Sebelas Maret University, Surakarta. Email: ratih.noph@yahoo.com Mobile: +6285649524070Journal of Health Policy and Management (2017), 2(1): 56-66https://doi.org/10.26911/thejhpm.2017.02.01.05
BPJS Barrier to Strategic Purchasing of Primary Care Service at Public and Private Health Facilities in Subulussalam, Aceh Darma, Satria; Juanita, Juanita; Rochadi, R. Kintoko
Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Strategic purchasing plays an important role in the cost structure and competitiveness of small and large businesses. Managing Board of Social Insu-rance (BPJS) has implemented strategic purchasing of health services in the National Health Insurance (JKN) scheme. Strategic purchasing is important to provide quality products and services at low costs. Strategic purchasing of health service has five critical criteria: (1) what is to purchase; (2) to whom it is for; (3) whom it is from; (4) what is the price; (5) how to purchase it. This study aimed to assess BPJS barrier to strategic purchasing of primary care service at public and private health facilities in Subulussalam, Aceh.Subjects and Method: This was a qualitative study conducted in Subulussalam, Aceh, from February to July 2015. A total of 12 key informants for this study, including BPJS administrators and hospital managers. The theme was strategic purchasing of health service. The data were collected by in-depth interview, direct observation, and document review. The data was analyzed by thematic analysis.Results: BPJS administered the same standards of strategic purchasing health service from the public and private health providers. However, there were some unresolved problems: (1) BPJS faced difficulty to select primary care providers independently; (2) Illegal use of other members JKN card to get health service; (3) Redundant claims from the primary care providers; (4) Claim of inpatient days exceeding the maximum allowable limit; (5) Delay in non-capitations reimbur-sement payment to primary care provider; (6) Inequitable distribution of health manpower across health facilities.Conclusion: BPJS has implemented strategic purchasing of primary care services with the same standards applied to public and private primary care providers. However, there remain some problems of purchasing health services that call for immediate corrective actions, including routine monitoring, explanation of delay, advocacy, equitable distribution of health manpower.Keywords: strategic purchasing, primary care service, health facility, BPJS.Correspondence: Satria Darma. Department of Health Policy and Administration, Universitas Sumatera Utara, North Sumatera. Email: s4tria.darma@yahoo.com. Mobile: 085260077824.Journal of Health Polic and Management (2018), 3(2): 81-91https://doi.org/10.26911/thejhpm.2018.03.02.04

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