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Faktor-Faktor yang Mempengaruhi Biaya Obat Pasien Kanker Payudara di Rumah Sakit di Indonesia Diah Ayu Puspandari; Ali Ghufron Mukti; Hari Kusnanto
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 3 (2015)
Publisher : Center for Health Policy and Management

Background: Currently non communicable disease becomes one of the ten major diseases in Indonesia. Cancer chemotherapy reported as the ninth rank out of ten major diseases, and shared as the ten most expensive hospital cost. Drugs expenditures are clearly the main source of cost pressure. Drug cost of breast cancer is important for benefit package design. Objectives: The research need to know on what are the influencing factors of drug cost for breast cancer during hospitalization in Indonesia, and the drug cost based on the selected factors. Research Methodology : The design of research was a cross sectional descriptive analysis using health facilities costing study that was conducted in Indonesia in 2011. The drug cost was calculated as a cost of illness based on a provider’s perspective. Results: Determinant factors for drug cost in breast cancer were age, length of stay, ICU, drugs availability and hospital location. The most expensive was the drug cost for patient at age 40 - <70. Drug cost for patient with ICU care found 1,8 times higher. Hospitals who had a drug supply problems were lower in cost. Hospital in Java had a lower cost. Conclusions: Age, length of stay, ICU, drugs availability and hospital location were the determinant factors of drug cost for hospitalized breast cancer patient. Drug cost for in-patient that was based on actual cost was Rp. 2,545,881,- . Drug cost for out patient care was Rp 9,127,824,-. The total drug cost per patient per year was calculated as Rp 11,673,705,- and the total drug cost for all patient per year was Rp 150,415,869,362,-. These factors will be useful for drug cost estimation purpose and for benefit package design. Latar belakang: Saat ini penyakit tidak menular merupakan salah satu dari 10 penyakit terbesar di Indonesia. Kemoterapi kanker dilaporkan di urutan ke 9 pada pasien rawat inap, serta di posisi ke 10 penyakit termahal. Biaya obat adalah komponen biaya kesehatan dengan proporsi signifikan. Biaya obat kanker payudara diperlukan dalam penentuan paket benefit JKN. Tujuan: Mengetahui faktor apa saja yang mempengaruhi biaya obat pada pasien kanker payudara di rumah sakit, dan memperoleh besaran biaya obat berdasarkan faktor-faktor yang mempengaruhinya. Metode Penelitian: Penelitian merupakan desain analisis deskriptif cross sectional menggunakan hasil studi pembiayaan fasilitas kesehatan yang dilaksanakan di Indonesia pada tahun 2011. Biaya obat dihitung sebagai cost of illness dari sisi pemberi layanan. Hasil: Variabel yang berpengaruh terhadap biaya obat adalah umur, lama dirawat, penggunaan ICU, gangguan ketersediaan obat dan lokasi rumah sakit. Biaya obat pada usia 40 -<70 tahun tertinggi. Biaya obat di ICU lebih tinggi 1,8 kali. Rumah sakit dengan gangguan ketersediaan obat lebih rendah biaya obatnya. Biaya obat di luar pulau Jawa lebih mahal. Kesimpulan: Umur, lama dirawat, penggunaan ICU, gangguan ketersediaan obat dan lokasi rumah sakit adalah faktor yang mempengaruhi biaya obat pasien kanker payudara di rumah sakit. Biaya obat rawat inap berdasarkan biaya aktual, hasilnya menunjukkan besaran Rp754.243,00 per pasien. Biaya obat untuk rawat jalan diperoleh sebesar Rp9.127.824,00. Total biaya obat per pasien per tahun adalah Rp9.882.067,00 sehingga biaya obat seluruh pasien per tahun sebesar Rp118.723.158.312,00. Faktor tersebut bermanfaat untuk estimasi biaya dan penentuan paket pengobatan pasien kanker di era JKN.

KEBIJAKAN NASIONAL DALAM KONTEKS LOKAL: TANTANGAN IMPLEMENTASI KEBIJAKAN DESA SIAGA DAN RUJUKAN PELAYANAN KESEHATAN DI KABUPATEN KEPULAUAN YAPEN PAPUA Yosef Maing; Supriyati Supriyati; Deni Kurniadi Sunjaya
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background:One of the policies in health to achieve IndonesiaSehat 2010 was the development of desa siaga that wasbased on Decree of Ministry of Health number 564/MENKES/SK/VIII/2006 regarding the guidance on the implementation ofDesa Siaga. Desa Siaga is a community based health effortthat involved community self funding agency such as PKK,religious organization, and private sector.Method:This was a qualitative descriptive research that usedexplanatory analysis with case study design. The researchinformant was district government, health office, communityleaders and public figure as well as health care provider. Thedata was collected with interview, observation anddocumentation. Data analysis was conducted with case studyanalysis.Result: This research showed that the implementation of DesaSiaga was with top–down method that used social mobilizationapproach. The district government and community was verymuch supporting the policy of Desa Siaga. Difficult geographiclocation, limited human resources in health and limited fundingwere the main obstacles in the implementation of Desa Siagapolicy and health service referral. The main problem of referralimplementation was transportation and funding. The readinessof community and village aparatur to assist the poor communitywas still very minimum.Conclusion: This research proven that Desa Siaga programwas very important for community in the district of Yapenarchipelago. Nevertheless, difficulties in geographiccondition,limited human resources in health as well as limited fundinghas resulted in difficulties in the implementation of Desa Siagapolicy and health service referral in the district of Yapenarchipelago. The regional and central government have notbeen able to respond to the needs of Desa Siaga.Keyword: Policy Implementation, Desa siaga, Papua.

Evaluasi Besaran Alokasi DAK Bidang Kesehatan Subbidang Pelayanan Kefarmasian Tahun 2011 – 2012 Risca Ardhyaningtyas; Laksono Trisnantoro; Retna Siwi Padmawati
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 3 (2014)
Publisher : Center for Health Policy and Management

Background: In this era of decentralization , access and provision of drugs for people in the local area is the responsi- bility of local governments. Because the limitations of the local budget, the central government is obliged to guarantee the availability of drugs in the area. Financing sources of drugs from central and local government have not reached the stan- dard of WHO i.e. 2 dollars per capita. To cover demand of financing drug, a Specific Allocation Fund (DAK) proposed state budget that funds given to certain areas to fund special activities that are regional affairs and in accordance with na- tional priorities. General criteria to consider certain areas (re- gional fiscal capacity), specific criteria (regional characteris- tics) and technical criteria (policy formulation from Ministry of Health). Since drug financing is allocated in DAK in 2010, there is a need to evaluate the drug financing at the local level. The purpose: to evaluate the amount of DAK for Pharma- ceutical services in 2011 and 2012. Methods: The study used secondary data from 2010 and 2011 consist of 6 (six) factors: fiscal capacity, character of the area, population number, proportion of poverty , local bud- get for drugs and prediction for the remaining stock of the drug. The analysis statistics uses chi-square and multiple regression. Qualitative interviews is conducted with manag- ers of pharmacy in 2 districts with high financial capability. Results: Result from multiple regression test of the 6 factors used in the allocation of SAF 2011 and 2012 shows only 3 factors that really affects the allocation which are the number of population, the poor and the prediction of the remaining stock of the drug . However, the highest factor is the popula- tion. Result for qualitative with 2 respondents shows that since they got DAK they reduced local budget for drugs, because the drug financing is sufficient from DAK. Conclusion: local sense of ownership towards the health budget in the area is low resulting in reliance on the central health budget. The effeciency of the central budget causes reduction of health budget both in central and local level. Latar belakang: Dalam era desentralisasi ini, akses dan penyediaan obat bagi masyarakat di daerah menjadi tanggung jawab pemerintah daerah. Namun keterbatasan anggaran daerah maka pemerintah pusat berkewajiban menjamin ketersediaan obat di daerah. Sumber pembiayaan obat di daerah melalui APBN dan APBD belum mencapai standar WHO, 2 dol- lar per kapita. Untuk menutupi kekurangan pembiayaan obat, diusulkan DAK yaitu dana APBN yang diberikan kepada daerah tertentu untuk mendanai kegiatan khusus yang merupakan urusan daerah dan sesuai dengan prioritas nasional. Daerah tertentu mempertimbangkan kriteria umum (kemampuan fiskal daerah), kriteria khusus (karakteristik daerah) dan kriteria teknis (rumusan kebijakan Kementerian Kesehatan). Sejak kebijakan obat melalui DAK pada tahun 2010, perlu dilakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian tahun 2011 dan 2012. Tujuan: tujuan penelitian ini adalah melakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian 2011 dan 2012. Metode: Penelitian menggunakan data sekunder 2010 dan 2011 yang terdiri 6 faktor yaitu; kemampuan fiskal, karakter wilayah, jumlah penduduk, penduduk miskin, anggaran obat dalam APBD dan prediksi sisa stok obat untuk pengalokasian DAK 2011 dan 2012. Uji analisis menggunakan chi square dan multipel regresi. Kualitatif dengan wawancara pengelola farmasi di 2 kabupaten dengan kemampuan keuangan tinggi. Hasil: Dari uji multiple regresi terhadap 6 faktor yang digunakan dalam pengalokasian DAK 2011 dan 2012 hanya 3 yang mempengaruhi alokasi yaitu jumlah penduduk, penduduk miskin dan prediksi sisa stok obat. Namun yang paling tinggi adalah jumah penduduk. Untuk kualitatif pada 2 responden, sejak mendapat DAK terjadi pengurangan anggaran obat di APBD, karena pembiayaan obat cukup dengan DAK. Kesimpulan: daerah belum memahami ownership anggaran kesehatan di daerah sehingga masih mengandalkan anggaran dari pusat, dimana ketidakstabilan anggaran pusat dengan ef isiensi menyebabkan pemotongan merata anggaran kesehatan di pusat dan daerah.

Evaluasi Manfaat Program Jaminan Kesehatan Daerah bagi Masyarakat Kota Yogyakarta Rohadanti Rohadanti; Sigit Riyarto; Retna Siwi Padmawati
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 2 (2012)
Publisher : Center for Health Policy and Management

Background: The Program of Community Health Insurance Scheme (Jamkesda) in Yogyakarta Municipality is organized by the Technical Unit Regional Health Insurance Provider (UPT PJKD) with funds from the municipal budget. The rules about membership, benefits and amount of Jamkesda are appointed in the Mayor Regulation. There has been no comprehensive research about benefits and the perceived difficulty when using Jamkesda. Therefore, this research aims to determine this issue. Methods: This was an observational study using quantitative and qualitative methods. The quantitative respondents (n= 154) were selected accidentally when the patients were being treated at two hospitals in Yogyakarta and were based on the recapitulation of the claims in the previous month. The qualitative respondents (n = 10) were selected by purposive sampling for patients with chronic illnesses and with very high claims. Data collection was taken by questionnaire and guide- line for in-depth interviews to Jamkesda participants who had been treated in the two hospitals. Results: The respondents perceived that Jamkesda was beneficial despite objecting to 51.30% of the cost sharing. Therefore, in in-depth interviews five respondents expressed that they had to borrow money to pay for it. A total of 61.04% respondents used a letter of recommendation from Department of Social, Labor and Transmigration (those with no health insurance). Difficulty in handling the identity of membership was only experienced by 16.23%, while 78.57% had no prob- lem in it. Those who found difficulty were looking for a solution to the government administrator as RT/RW, parliaments, NGOs and neighbors. Around 78.57% of respondents did not under- stand about the Jamkesda service limit; they only knew infor- mation relating to their current interests. A total of 89.61% respondents knew that Jamkesda was an aid. All respon- dents in in-depth interview and around 73.38% respondents paid the cost sharing more than 10% of total claims. From the total household expenditure, almost all (99.35 %) were cata- strophic as the health spent more than 40% of their household expenditure whereas 73.38% earned below the minimum wage income. Conclusion: High cost sharing can result in large catastrophic expenses. Therefore, there is a need for reassessing the Jamkesda benefit package in order that the financial protec- tion of household can be achieved.Latar Belakang: Program Jaminan Kesehatan Daerah (Jam- kesda) Kota Yogyakarta diselenggarakan oleh Unit Pelaksana Teknis Penyelenggara Jaminan Kesehatan Daerah (UPT PJKD) dengan sumber dana berasal dari APBD Kota Yogyakarta. Aturan tentang kepesertaan, benefit dan besarannya terdapat dalam Peraturan Walikota. Belum ada penelitian yang kompre- hensif tentang manfaat dan kesulitan yang dirasakan masya- rakat dalam menggunakan Jamkesda Kota Yogyakarta maka penelitian ini bertujuan untuk mengetahui hal tersebut. Metode: Penelitian ini adalah penelitian observasional dengan metode kuantitatif dan kualitatif. Responden kuantitatif (n=154) dipilih secara accidental ketika pasien sedang berobat di dua rumah sakit di Yogyakarta dan didasarkan pada rekapitulasi klaim pada bulan sebelumnya. Responden kualitatif (n=10) dipilih dengan purposive sampling yaitu pasien dengan penyakit kro- nis dan yang mempunyai klaim sangat tinggi. Pengumpulan data menggunakan kuesioner dan pedoman wawancara men- dalam kepada peserta Jamkesda yang sedang atau telah dira- wat di dua RS tersebut. Hasil: Responden merasakan manfaat Jamkesda walaupun 51,30% merasa keberatan dengan besar cost sharing, se- hingga sebagian responden pada wawancara mendalam me- nyatakan mengutang untuk membayarnya. Sebanyak 61,04% responden menggunakan surat rekomendasi Dinas Sosial Tena- ga Kerja dan Transmigrasi untuk berobat karena tidak memiliki jaminan kesehatan. Kesulitan dalam pengurusan identitas kepe- sertaan hanya dialami oleh 16,23%, sedangkan 78,57% merasa mudah dalam pemanfaatannya. Masyarakat yang merasa kesu- litan pada wawancara mendalam, mencari solusi kepada pe- ngurus RT/RW, anggota DPRD, LSM dan tetangga. Sekitar 78,57% responden tidak memahami batasan pelayanan Jam- kesda dan hanya mengetahui informasi yang berhubungan dengan kepentingan mereka saat itu. Sebanyak 89,61% res- ponden mengetahui bahwa Jamkesda hanya bersifat bantuan. Semua responden pada wawancara mendalam serta 73,38% responden membayar cost sharing lebih dari 10% total klaim dari pengeluaran rumah tangga, hampir semua (99,35% res- ponden) mengalami pengeluaran katastrofik yakni pengeluaran biaya kesehatan lebih dari 40% pengeluaran rumah tangga setelah dikurangi pengeluaran kebutuhan pokok padahal 73,38% masyarakat berpenghasilan di bawah UMR. Kesimpulan: Cost sharing yang besar dapat berakibat pe- ngeluaran katastrofik sehingga perlu dikaji kembali benefit pack- age Jamkesda agar perlindungan terhadap keuangan rumah tangga dapat dicapai.

PELAKSANAAN KEBIJAKAN BANTUAN OPERASIONAL KESEHATAN DI KABUPATEN OGAN ILIR, SUMATERA SELATAN Asmaripa Ainy
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 1 (2012)
Publisher : Center for Health Policy and Management

ABSTRACTIntroduction: The Ministry of Health of Indonesia Republichas issued a policy on health operational fund (BOK) to increasethe access of service in health centers based on a decree ofthe Minister of Health Number 494/Menkes/SK/IV/2010 updatedthrough the regulation of the Minister of Health Number 210/Menkes/Per/I/2011 dated 31st January 2011 on the technicalguidelines for BOK. Ogan Ilir District has supported that policythrough a decree issued by the head of health office Number440/337/DKES/III/2011 and 440/22/DKES/III/2011, which eachregulates the forming of the management of Jamkesmas,Jampersal, and BOK as well as budget managers. This studyaimed to analyze the implementation of BOK policy in Ogan IlirDistrict.Methods: This study was an analysis of policy. The primarydata were obtained through direct observation and in-depthinterviews to 4 informants: Head of Ogan Ilir Health Office,management staff at Ogan Ilir Health Office, Head of IndralayaHealth Center and management staff at Indralaya Health Center.The secondary data were obtained through review of BOKdocuments.Results: BOK in Ogan Ilir had been implemented in 2010 throughthe social assistance and in April 2011 by co-administration bythe health office. The organizing of BOK referred to thetechnical guideline from the Ministry of Health. Financialmanagement referred to the financial management guidelinefrom the Directorate General of Nutrition and Maternal andChild Health. Disbursement of BOK began from proposing Planof Actions (POA) from health centers to health office to verifythe funds and then proposing disbursement to KPPN. The fundfor implementing program could be taken from BOK treasurer.The allocation of BOK at health centers was adjusted for thenumber of working areas, population, program coverage andgeographical conditions. BOK was prioritized for healthpromotion such as: maternal and child health, nutrition, bodymass index measurement, and communicable diseases. PerApril-June 2011, the fund for secretariat had been disbursedabout 40% used for dissemination, training and transport forhealth center treasurer. Reporting of BOK conducted fromhealth center to health office was on every date 5 thenforwarded to the province and to the Ministry of Health everymonth via online, as well as a written report to KPPN.Conclusion: The implementation of BOK in Ogan Ilir referredto the policy of the Ministry of Health and was followed upwith the policy of district health office. POA proposal is decisivedin the disbursement of BOK so it is recommended to the headof Ogan Ilir District Health Office to routinely ensuredissemination about BOK and guide all health centers inpreparation of POA for implementing policy effectively.Keywords: financing policy, health operational fund, healthcenter

Penerapan Pola Pengelolaan Keuangan Badan Layanan Umum (PPK-BLU) Pada Program Kesehatan Jiwa Masyarakat Puskesmas di Kabupaten Sleman Karmijono Pontjo Widianto; Laksono Trisnantoro; Ratna Siwi Padmawati
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 2 (2015)
Publisher : Center for Health Policy and Management

Background: The decision of the Minister of Home Affairs No. 61 of 2007 on Technical Guidelines for Financial Manage- ment of Public Service Board seems to bring another option in the management of health centers which have existed as a Technical Implementation Unit (UPT) oh health department. The entire budget for health centers through the health departmen is able to follow the system of Financial Management of Re- gional Public Service Agency (PPK-BLUD) that provides flex- ibility in the implementation of the budget, including the revenue and expenditure management, cash management, and pro- curement of goods / services, and gives opportunity to hire a professional/non-civil servants and gives the opportunity for a performance based remuneration. Promotive and preventive health centers functions to encourage community empower- ment. That function is realized in each program activity called Public Health Efforts (SMEs); one of which is the Community Mental Health program (Keswamas). Objective: To describe the impact of the financial manage- ment of health centers using PPK-BLUD in the implementation of the SME program, in this case the community mental health program. Methods: This study used a case study design and descrip- tive analysis. Results: (1). There is no difference in principle on program management Keswamas before and after the BLUD. (2) The type of community mental health program activities carried out by the health center after BLUD status is the same as before the status as BLUD (3). Budgeting activities of community mental health programs in health centers after the BLUD status is the same as before the BLUD status (4). Human resources in- volved in the implementation of community mental health pro- grams in health centers after the BLUD status is as the same as before the BLUD status (5). The involvement of members of the management team is not specifically for community mental health program, but also other programs at the health center. Conclusion: There is no difference in the management of health centers in Sleman after PPK-BLUD, because not all of the flexibility or independence as PPK-BLUD is utilized by health centers and health authorities to create activities / new, more innovative programs and to solve existing health problems. An understanding of the PPK-BLUD is adequate but not encour- age health authorities and health centers to create a more innovative activities in solving the problems that occur. Knowl- edge and understanding of the PPK-BLUD supported by the courage to innovate is essential for health centers and health department leaders in order to take advantage of being PPK-BLUD to improve the quality of public services in order to improve the health of society. Management of health centers with PPK-BLUD is needed to provide flexibility of budget man- agement in the era of the National Health Insurance. Latar Belakang: Keputusan Menteri Dalam Negeri Nomor 61 tahun 2007 tentang Pedoman Teknis Pengelolaan Keuangan Badan Layanan Umum Daerah yang seolah-olah memunculkan pilihan lain dalam hal pengelolaan puskesmas yang selama ini berstatus sebagai Unit Pelaksana Teknis (UPT) dinas kesehatan. Seluruh penganggaran puskesmas yang selama ini melalui dinas kesehatan, menjadi dapat mengikuti sistem Pola Pengelolaan Keuangan Badan Layanan Umum Daerah (PPK-BLUD) yang memberikan fleksibilitas dalam rangka pelaksanaan anggaran, termasuk pengelolaan pendapatan dan belanja, pengelolaan kas, dan pengadaan barang/jasa serta diberikan kesempatan untuk mempekerjakan tenaga profesional non PNS dan kesem- patan pemberian imbalan jasa kepada pegawai sesuai dengan kontribusinya. Fungsi puskesmas promotif dan preventif yang berorientasi pada pemberdayaan masyarakat. Fungsi tersebut diwujudkan dalam setiap kegiatan program Upaya Kesehatan Masyarakat (UKM); salah satunya adalah program Kesehatan Jiwa Masyarakat (Keswamas). Tujuan: Menggambarkan dampak pengelolaan keuangan pus- kesmas dengan PPK-BLUD pada pelaksanaan program UKM dalam hal ini program kesehatan jiwa masyarakat Metode: Penelitian ini menggunakan rancangan studi kasus dan analisis deskriptif. Hasil: (1). Belum ada perbedaan pada pengelolaan program Keswamas sebelum dan setelah Era BLUD. (2) Jenis kegiatan program kesehatan jiwa masyarakat yang dilaksanakan oleh puskesmas setelah berstatus BLUD bertambah dibanding sebelum berstatus sebagai BLUD (3). Penganggaran kegiatan program kesehatan jiwa masyarakat di puskesmas setelah berstatus BLUD sama seperti sebelum berstatus BLUD (4). SDM yang terlibat dalam pelaksanaan kegiatan program kese- hatan jiwa masyarakat pada puskesmas setelah berstatus BLUD sama seperti sebelum berstatus BLUD (5). Keterlibatan anggota Tim sebagai pengelola kesehatan jiwa masyarakat tidak secara khusus menangani program namun juga menjalan- kan program lain di puskesmas. Kesimpulan: Belum ada perbedaan pengelolaan puskesmas di Kabupaten Sleman setelah diterapkan PPK-BLUD, karena belum semua keleluasaan atau kemandirian yang diberikan se- bagai PPK-BLUD dimanfaatkan oleh puskesmas maupun dinas kesehatan untuk menciptakan kegiatan/program baru yang lebih inovatif dan dapat menyelesaikan permasalahan kesehatan yang ada. Pemahaman tentang PPK-BLUD telah cukup namun belum mendorong dinas kesehatan dan puskesmas untuk berani menciptakan kegiatan yang lebih inovatif dalam menyelesaikan permasalahan yang terjadi. Pengetahuan dan pemahaman tentang PPK-BLUD yang didukung dengan keberanian berino- vasi sangat penting bagi pimpinan puskesmas dan dinas kese- hatan sebagai pembina puskesmas, agar dapat memanfaatkan status sebagai PPK-BLUD untuk meningkatkan mutu pelayanan pada masyarakat dalam rangka meningkatkan derajat kesehatan masyarakat. Pengelolaan puskesmas dengan PPK-BLUD sa- ngat dibutuhkan untuk memberikan kemudahan pada puskes- mas dalam pengelolaan anggaran dalam era Jaminan Kesehat- an Nasional.

EVALUASI KEBIJAKAN BEROBAT GRATIS DI KABUPATEN TANJUNG JABUNG TIMUR PROPINSI JAMBI Hendriyanto Julita Hendrartini Juanita
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 2 (2013)
Publisher : Center for Health Policy and Management

Background: In the decentralized era, local government haswider authority to decide policies relevant with local needs.For this reason the Regent of Tanjung Jabung Timur District in2005 issued a decree on free medication at the health centerand secondary health center. However there are problemswith the sources and allocation of budget to support the decree.Besides, there is also a problem with target of the programfunded by the government. Therefore there should be anevaluation to find out facts for future improvement.Objective: The study aimed to identify mechanisms of funding,relevance of target and efficiency of the policy.Method: This was an explanatory case study which usedquantitative and qualitative approaches. Analysis units of thestudy were local government, health center and secondaryhealth center; and the subject were members of localparliament, head of health office, head of local planning council,head of health centers, staff of health centers/secondary healthcenters and the community. The size of samples to measuretarget relevance was determined using stratified sampling;qualitative method was determined using purposive sampling.Data were obtained through questionnaire, in-depth interviewand document checklist. Data were analyzed qualitatively andquantitatively in proportion.Result: Local government of Tanjung Jabung Timur allocatedbudget in the form of operational fund of health centers, drugallocation and incentives. The realization of budget was delayedso that health centers used alternative financial resources,i.e. budget of health insurance for poor community. Operationalfund did not give much support for free medication when therewas no clear cut distinction between users of health insurancefor poor communities and free medication. This caused overlapin budgeting which might end in inefficiency. The authority didnot do monitoring and supervision appropriately. Users of freemedication were mostly non poor communities. Poorcommunities utilized free medication at secondary healthcenters more frequently than at health centers.Conclusion: The local government of Tanjung Jabung TimurDistrict had not implemented good health insurance principlesin health financing to support free medication policies. Therewas misallocation of funding because more non – poorcommunities used the service. This increased the potential ofinefficiency in government budget utilization.Keywords: free medication policy, health financing, budgetefficiency

Pengaruh Kepemilikan Jaminan Kesehatan Masyarakat Miskin terhadap Status Kelahiran dan Kejadian Stunting pada Baduta Indonesia (Analisis Data IFLS 1993 – 2007) Demsa Simbolon
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 2 (2014)
Publisher : Center for Health Policy and Management

Background. 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.

Faktor-Faktor yang Mempengaruhi Rawat Inap Ulang Pasien Skizofrenia pada Era Jaminan Kesehatan Nasional di Rumah Sakit Jiwa Grhasia Pemda DIY Suri Herlina Pratiwi; Carla Raymondalexas Marchira; Julita Hendrartini
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 1 (2017)
Publisher : Center for Health Policy and Management

ABSTRACTBackground: The implementation of National Health Insurance (JKN) applies a quality and cost control system services aimed at improving the efficacy and effectivity of health insurance with managed care principle. Readmission is used as an indicator for effectivity and technical competence of a hospital. The increasing cases of readmission, specifically in schizophrenia patients, leads to an increase in health care costs in the hospital. The aim of this study is to know the determinant factors of readmission of schizophrenia patients.Methods: This study was a non-experimental research using a case control study plan. The study was conducted in Grhasia Mental Hospital. The samples were 53 groups of readmission and 53 group of non-readmission. The respondents were the schizophrenia patients and their caregivers. The data collecting used questionnaire and in-depth interview.Result: Bivariate analysis showed the incidence of readmission of schizophrenia patients to some risk factors as follows: (1) Marriage OR 2.822; CI95% 1.082 – 7.630; p-value 0.018; (2) Work OR 2.709; CI95% 1.063 – 7.106; p-value 0.021; (3) Medication Adherence OR 14.692; CI95% 5.245 – 42.221; p-value <0.001; (4) Caregiver Level of Knowledge OR 8.571; CI95% 2.213 – 47.927; p-value 0.0003. Multivariate analysis showed that risk factors affecting incidence of readmission of schizophrenic patients are medication adherence (OR13.556, CI95% 5.037 - 36.480; p-value <0.001) and caregiver level of knowledge (OR 7.175; CI95% 1.628 – 31.605; p-value 0.009).Conclusion: Determinant factors of the readmission of schizophrenia patients are the lack of medication adherence of the patients and caregiver’s lack of knowledge. Demographic factors (age, gender, marital status, education, and job) and ownership of health insurance are not statistically significant to the readmission of schizophrenia patients. Keywords: schizophrenia, readmission, medication adherence, caregiver level of knowledge, national health insurance ABSTRAKLatar Belakang: Implementasi Jaminan Kesehatan Nasional (JKN) menerapkan sistem kendali mutu dan biaya pelayanan bertujuan untuk meningkatkan efisiensi dan efektifitas jaminan kesehatan dengan prinsip managed care. Readmission sebagai dimensi mutu efektivitas dan kompetensi teknis rumah sakit. Meningkatnya kasus readmission pasien skizofrenia di rumah sakit meningkatkan biaya pelayanan kesehatan. Tujuan penelitian ini adalah mengetahui faktor-faktor yang mempengaruhi rawat inap ulang (readmission) pada pasien skizofrenia.Metode: Penelitian ini merupkan studi non eksperimental menggunakan rancangan case control study. Penelitian dilakukan di RSj Grhasia. Jumlah sampel 53 pasien kelompok readmission dan 53 pasien pada kelompok non readmission. Responden penelitian ini adalah pasien skizofrenia dan caregiver. Pengumpulan data dengan kuesioner dan wawancara mendalam.Hasil: Analisis bivariat menunjukkan kejadian readmission terhadap faktor resiko perkawinan diperoleh nilai OR 2,822, CI 95% 1,082-7,630, p-value 0,018; pekerjaan diperoleh nilai OR 2,709, CI 95% 1,063-7,106, p-value 0,021; kepatuhan minim obat diperoleh nilai OR 14,692, CI 95% 5,247-42,221, p-value <0,001; tingkat pengetahuan caregiver diperoleh nilai OR 8,571, CI 95% 2,213-47,927, p-value 0,0003. Hasil analisis multivariat menunjukkan bahwa faktor resiko yang berpengaruh terhadap kejadian readmission pasien skizofrenia adalah kepatuhan minum obat (OR 13,556, CI 95% 5,037-36,480, p-value <0,001) dan tingkat pengetahuan caregiver (OR 7,175, CI 95% 1,628- 31,605, p-value 0,009).Kesimpulan: Faktor-faktor yang mempengaruhi readmission pasien skizofrenia adalah kepatuhan minum obat dan tingkat pengetahuan caregiver. Faktor demografi (usia, jenis kelamin, status perkawinan, pendidikan dan pekerjaan) tidak bermakna secara statistik terhadap readmission pasien skizofrenia. Kata Kunci: skizofrenia, readmission, kepatuhan minum obat, pengetahuan caregiver, jaminan kesehatan.

Analisis Unit Penanganan Keluhan terhadap Keberhasilan Program JKN di Puskesmas Banjarbaru Tahun 2015 Lenie Marlinae; Fauzie Rahman; Maman Saputra; Vina Yulia Anhar
Jurnal Kebijakan Kesehatan Indonesia Vol 5, No 1 (2016)
Publisher : Center for Health Policy and Management

Background: Public health center (Puskesmas) aims to provide health services for the society overall. Efforts are being made to achieve the health service overall is with the implementation of the program JKN. Problems encountered in the implementation of JKN by BPJS health is not optimal socialization. This research aims to analyze and provide solutions in solving problems of public complaints against the implementation of JKN in Puskesmas of Banjarbaru. Methods: The study design used qualitative approach with descriptive design. The research subject is the people who have an important role in the supply unit handling complaints against the implementation of the program JKN Banjarbaru, its the Head of Puskesmas Banjarbaru, doctors, midwives, and health promotion staff at the health center Banjarbaru, and one patient at the health center. Results: Patients still have difficulties in complaints related health services provided by health centers Banjarbaru. Patients can only file a complaint in one direction through the suggestion box. Conclusion: Complaint handling should be done quickly and accurately. It also requires two-way communication in determining the solution of health care problems. Therefore we need a unit for handling complaints against the implementation of the program at the health center JKN Banjarbaru. Complaints handling unit is expected to be the link between health care providers with users of health care services. It is instrumental in improving the quality of health care provided Banjarbaru health center. Latar belakang: Puskesmas bertujuan untuk memberikan pelayanan kesehatan kepada masyarakat secara menyeluruh. Upaya yang dilakukan untuk mencapai pelayanan kesehatan secara menyeluruh adalah dengan pelaksanaan program JKN. Masalah yang dihadapi dalam pelaksanaan JKN oleh BPJS Kesehatan adalah sosialisasi yang belum optimal. Penelitian ini bertujuan untuk menganalisis dan memberikan solusi pemecahan permasalahan keluhan masyarakat terhadap pelaksanaan JKN di Puskesmas Banjarbaru. Metode: Rancangan penelitian menggunakan pendekatan kualitatif dengan desain deskriptif. Subjek penelitian adalah orang-orang yang memiliki peranan penting dalam penyediaan unit penanganan keluhan terhadap pelaksanaan program JKN di Puskesmas Banjarbaru, yaitu Kepala Puskesmas Banjarbaru, dokter, bidan, dan staff promosi kesehatan di Puskesmas Banjarbaru, serta salah seorang pasien di Puskesmas Banjarbaru. Hasil: Diketahui pasien masih kesulitan dalam menyampaikan pengaduan atau keluhan terkait pelayanan kesehatan yang diberikan oleh Puskesmas Banjarbaru. Pasien hanya bisa menyampaikan keluhan secara satu arah melalui kotak saran. Kesimpulan: Penanganan keluhan seharusnya dilakukan dengan cepat dan akurat. Selain itu juga memerlukan komunikasi dua arah dalam penentuan solusi masalah pelayanan kesehatan. Oleh karena itu diperlukan unit penanganan keluhan terhadap pelaksanaan program JKN di Puskesmas Banjarbaru. Unit penanganan keluhan ini diharapkan mampu menjadi penghubung antara pemberi pelayanan kesehatan dengan pengguna jasa pelayanan kesehatan. Hal ini berperan dalam peningkatan mutu pelayanan kesehatan yang diberikan Puskesmas Banjarbaru.

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Abstract

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Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name Shita Dewi

Contact Email -

Phone -

Journal Mail Official jkki.fk@ugm.ac.id

Editorial Address -

Location Kab. sleman, Daerah istimewa yogyakarta INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Shita Dewi

Contact Email
-

Phone
-

Journal Mail Official
jkki.fk@ugm.ac.id

Editorial Address
-

Location
Kab. sleman,

Daerah istimewa yogyakarta

INDONESIA