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Analisis Ketersediaan Fasilitas dan Pembiayaan Kesehatan pada Pelaksanaan Jaminan Kesehatan Nasional di Provinsi Bengkulu Yandrizal Yandrizal; Hendarin Hendarin; Desri Suryani
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 4 (2014)
Publisher : Center for Health Policy and Management

The Background: National health assurance program aims to facilitate community access to quality health services. Health financing toward Universal Coverage is a good breakthrough but it can cause negative effects in the form of injustice. Availability of health facilities, health care personel and geographical condition and the broad population dispersion can magnify the problem of inequities between subdistricts and district/city in Bengkulu province, making it appear unequal in health services and financing. Availability of health facilities with inappropriate amount of power impacting the financing needs of the social security in health facilities in the form of capitation and INA-CBG package, and equitable financing analysis needs to be done in the implementation of the national health assurance policy. The purpose: Assesing the availability of facilities and even distribution of financing health and also to equalize of health facilities and drawing up scenarios of possibility of the future in the implementation of the national health insurance in the Province of Bengkulu. Method: This research uses the formative analysis methods designed to assess how the program/policy is being implemented and how it is thought to modify and develop to bring an improvement. Results: The ratio of first-level health facilities (FKTP), which is likely a general practitioner, according to the road map leading to JKN 2012-2019 should achieve the ratio of general practitioners 1: 3000 inhabitants.Currently the average in Bengkulu is 1 per 7.715 inhabitants, thus the need for first- level health facilities in the province of Bengkulu is 590 units. Beginning in 2014, 229 is available until the year 2019, and is still lacking as much as 361 units. Clinics with magnitudes capitation of Rp. 3,000 up to Rp. 4500 is 51.57% and while capitation of Rp. 6,000 is 13.3%. Capitation quantity is uneven financing that have an impact especially on the health of urban areas due to lack of resources. The value of the contract for one year for the number of participants who choose Clinics as FKTP is 763.165 people which is 82,03% of the maximum value of capitation Rp. 6,000, or less Rp9,87M. The average rate on the 7 (seven) Regional public hospitals district and Province for outpatient is between Rp. 150.000 s. d Rp. 350,000 and hospitalization is Rp. 1.000.000,-until Rp. s. 3.700.000,-, compared to the rates based on regulation of the Minister of health RI Number 69 by 2013, the average price of outpatient service and inpatient medical action is very simple and only for mild categories of diseases. Shortage of specialist doctors in Hospital causes unabsorbed INA-CBG package for major treatment action and severe categories of disease. Financial support the Government district/city and Province in the form of program jamkesda 2014 is IDR 38,36 M to pay for the capitation for the poor who are not covered by central government funding and to ensure treatment for kabupaten/ kota that did not cooperate with the BPJS. Incentive specialist doctor/resident is between IDR10 million to 30 million per month, especially the big four specialists from the local government district is another inequalities that is burdensome to the local government; The fulfillment of resources especially General practitioners and dentists in clinics is difficult to materialize given that CPNS (civil servant) formation are very small; the County Government could offer contracts but they can not afford it and it is not worth the lack of capitation. While the fulfillment specialist doctors in Hospitals is also difficult because there is lack of enthusiasm to become specialist CPNS , and the Country Government could not affort contract for them. Fulfillment needs efforts in health facilities first-level, general practitioners, dentists and specialists required a revision of the regulation of the Minister of health no. 69 year 2013 by observing the rate of capitation and INA-CBG¡¯s package for underserved areas away from urban center, or with small population and vast distribution of people. Conclusion: First-level health facilities and the number of personnel in clinics and specialist doctors in the hospital are still lacking, impacting the small capitation and the claim is limited to a minor treatment and mild disease. Regulation of the Minister of health RI Number 69 by 2013 on Standard Rate of health services need to pay attention to differences in geographical situation where Clinics and public hospitals are in the region. Latar Belakang: Program Jaminan Kesehatan Nasional bertujuan mempermudah masyarakat untuk mengakses pelayanan kesehatan yang bermutu. Pembiayaan kesehatan menuju Universal Coverage merupakan terobosan yang baik tetapi dapat menimbulkan dampak negatif berupa ketidakadilan. Ketidamerataan ketersediaan fasilitas kesehatan, tenaga kesehatan dan kondisi geografis serta penyebaran penduduk yang luas dapat memperbesar masalah ketidakadilan antar kecamatan dan kabupaten/kota di Provinsi Bengkulu, sehingga muncul ketidakmerataan pelayanan dan pembiayaan kesehatan. Ketersedian fasilitas kesehatan dengan jumlah tenaga yang tidak sesuai kebutuhan berdampak pada pembiayaan dari Badan Penyelenggara Jaminan Sosial Kesehatan dalam bentuk kapitasi dan Paket INA-CBG¡¯s, maka perlu dilakukan analisis pemerataan pembiayaan pada kebijakan pelaksanaan jaminan kesehatan nasional. Tujuan: Mengetahui ketersediaan fasilitas dan pemerataan pembiayaan kesehatan serta upaya pemerataan fasilitas kesehatan dan menyusun skenario kemungkinan masa mendatang dalam pelaksanaan jaminan kesehatan nasional di Provinsi Bengkulu. Metode: Penelitian ini menggunakan rancangan metode analisis formatif yang dirancang untuk menilai bagaimana program/kebijakan sedang diimplementasikan dan bagaimana pemikiran untuk memodifikasi serta mengembangkan sehingga membawa perbaikan. Hasil: Rasio fasilitas kesehatan tingkat pertama (FKTP) yang disamakan satu dokter umum, Peta Jalan Menuju JKN 2012- 2019 rasio dokter umum 1 : 3000 penduduk, maka rata-rata 1 per 7.715 penduduk, kebutuhan fasilitas kesehatan tingkat pertama di Provinsi Bengkulu sebanyak 590 unit. Awal tahun 2014 yang tersedia 229 sampai tahun 2019 masih kurang sebanyak 361 unit. Puskesmas dengan besaran kapitasi Rp3000,00 s.d Rp4.500,00 sebanyak 51,57% dan Rp6.000,00 sebanyak 13,3%. Besaran kapitasi berdampak tidak merata pembiayaan terutama di Puskesmas yang jauh dari perkotaan karena kekurangan tenaga. Nilai kontrak selama satu tahun jumlah peserta yang memilih Puskesmas sebagai FKTP sebanyak 763.165 jiwa sebesar 82,03% dari nilai maksimal kapitasi Rp6.000,00 atau kurang 9,87M. Tarif rerata pada tujuh Rumah Sakit Umum Daerah Kabupaten dan Provinsi untuk rawat jalan antara Rp. 150.000 s.d Rp640.000,00 dan rawat inap Rp1.000.000,00 s.d Rp3.700.000,00 dibandingkan tarif berdasarkan Peraturan Menteri Kesehatan RI Nomor 69 Tahun 2013, rata-rata tarif pelayanan rawat jalan dan rawat inap merupakan tarif tindakan medis sangat sederhana dan penyakit- penyakit katagori ringan. Kekurangan dokter spesialis di RSUD menyebabkan tidak terserap paket INA-CB¡¯s untuk tindakan besar dan penyakit katagori berat. Dukungan dana Pemerintah Kabupaten/Kota dan Provinsi dalam bentuk program jamkesda tahun 2014 sebesar 38,36 M untuk membayar kapitasi masyarakat miskin bukan penerima bantuan iuran dan menjamin pengobatan bagi kabupaten/kota yang tidak bekerja sama dengan BPJS. Insentif dokter spesialis/residen antara 10 juta s.d 30 juta per bulan terutama spesialis empat besar dari pemerintah daerah kabupaten merupakan ketidakadilan pembiayaan yang menjadi beban daerah. Pemenuhan tenaga terutama dokter umum, dokter gigi di puskesmas sulit terwujud mengingat formasi CPNS sangat kecil, apabila dilakukan kontrak Pemerintah Kabupaten tidak mampu dan tidak sebanding dengan kekurangan kapitasi. Sedangkan pemenuhan dokter spesialis di RSUD juga sulit terwujud karena peminat CPNS untuk dokter spesialis tidak ada dan apabila dilakukan kontrak sebesar insentif Pemerintah Kabupaten tidak mampu. Upaya pemenuhan kebutuhan fasilitas kesehatan tingkat pertama, dokter umum, dokter gigi dan spesialis diperlukan revisi Peraturan Menteri Kesehatan No.69 tahun 2013 tentang tarif dengan memperhatikan kapitasi dan paket INA-CBG¡¯s di daerah tidak diminati atau jauh dari perkotaan, jumlah penduduk kecil serta sebaran yang luas. Kesimpulan. Fasilitas kesehatan tingkat pertama dan jumlah tenaga di puskesmas dan dokter spesialis di rumah sakit masih kurang, berdampak kecilnya kapitasi dan klaim terbatas pada tindakan kecil serta penyakit yang ringan. Peraturan Menteri Kesehatan RI Nomor 69 Tahun 2013 Tentang Standar Tarif Pelayanan Kesehatan perlu memperhatikan geografis dimana Puskesmas dan Rumah Sakit Umum Daerah.

Kajian Literature: Evaluasi Pelaksanaan Program Jaminan Kesehatan Nasional di Indonesia Irwandy Irwandy
Jurnal Kebijakan Kesehatan Indonesia Vol 5, No 3 (2016)
Publisher : Center for Health Policy and Management

ABSTRACTBackground: The National Health Insurance (JKN) in Indonesia, which started on January 1, 2014 has contributed greatly to reform health care systems and financing in Indonesia. As mandated by law, is expected to gradually JKN can become the backbone for achieving Universal Health Coverage in 2019. Until now, there are various studies aimed to evaluate the JKN program that has been expected to provide recommendations for this program.Purposes: The purpose of this research was to conduct the literature review about the implementation of the National Health Insurance program in Indonesia and formulate the recommendations to improve it.Methods: The research was conducted in March 2015 by reviewing the literature on various journals research those have been published during the period January 2014 to March 2015 on the UNHAS website repository. There were 8 Journals found and reviewed in this research.Results: The results showed that at the beginning of JKN program, there are several problems found in the implementation such as the lack of regulations and guidelines related to the implementation of JKN, low coverage of socialization programs to health centers and hospitals, hospital was unprepared to meet the specific requirements for BPJS credentials, the hospital was unsatisfied with the tariffs of INA CBG, and hospital claims is often too late. However, another journal showed that as for the level of patient satisfaction at hospital, 87.7% of respondents are satisfied.Conclusions: During the implementation of JKN Program in Indonesia, there are several problems and challenges. Therefore we need to learn and improve the program based on this experience and research findings. To achieve Universal Health Coverage in 2019 we need to improve the quantity and quality of research in evaluating the implementation of JKN in Indonesia. Keywords: National Health Insurance, Evaluation, Literature Review ABSTRAKLatar belakang: Jaminan Kesehatan Nasional (JKN) di Indonesia yang dimulai sejak 1 Januari Tahun 2014 telah memberikan andil yang besar terhadap reformasi sistem pelayanan dan pembiayaan kesehatan di Indonesia. Sebagaimana diamanatkan Undang-Undang, JKN diharapkan secara bertahap dapat menjadi tulang punggung untuk mencapai Universal Health Coverage di Tahun 2019. Hingga saat ini telah banyak dilakukan berbagai penelitian yang bertujuan mengevaluasi program JKN yang diharapkan dapat memberi masukan dalam upaya perbaikan kedepan.Tujuan: Penelitian ini bertujuan untuk melakukan melakukan kajian literature untuk memperoleh masukan dalam perbaikan implementasi program Jaminan Kesehatan Nasional di Indonesia. \Metode: Penelitian ini dilaksanakan pada Maret 2015 dengan melakukan kajian literature terhadap berbagai hasil penelitan yang telah dipublish selama periode Januari 2014 hingga Maret 2015 pada website repository Universitas Hasanuddin, Makassar yakni sebanyak 8 jurnal penelitian.Hasil: Hasil kajian terhadap beberapa penelitian yang dilakukan menunjukkan bahwa selama penerapan JKN ditemui beberapa kendala yang dihadapi yakni pada awal pelaksanaan masih terkendala dengan belum tersedinya beberapa regulasi dan juknis terkait implementasi JKN, sosialisasi teknis program ke fasilitas pelayanan kesehatan baik Puskesmas dan RS masih rendah, disamping itu masih kurang siapnya beberapa RS dalam memenuhi persyaratan kredensial yang ditetapkan BPJS, besaran tarif INA CBG yang dirasa kurang tepat bagi RS serta klaim RS yang terlambat. Hasil penelitian lain juga memperlihatkan untuk tingkat kepuasan pasien BPJS di salah satu RS telah berada pada kategori baik yakni 87,7%.Kesimpulan: Selama penerapan Program JKN di Indonesia telah ditemukan beberapa faktor pendukung dan penghambat pelaksanaan program JKN. Oleh karena itu diperlukan perbaikan secara terus menerus terhadap pelaksanaan program JKN demi pencapaian Univeral Health Coverage pada Tahun 2019 dengan meningkatkan kuantitas dan kualitas pelaksanaan penelitian dalam mengevaluasi pelaksanaan JKN di Indonesia. Kata Kunci: Jaminan Kesehatan Nasional, Evaluasi, Kajian Literature

Perbedaan Perhitungan Unit Cost dengan Menggunakan Metode Activity Based Costing (ABC) dan Metode Double Distribution (DD) untuk Pasien TB Paru Kategori 2 di Instalasi Rawat Jalan dan Rawat Inap Rumah Sakit Paru Hilfi L; Djuhaeni H; Setiawati EP; Ratna K; Paramita SA
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 3 (2015)
Publisher : Center for Health Policy and Management

Background: Indonesia is at 5th rank of 22 countries that have a high burden of TB and contribute to the number of TB cases in the world amounted to 4.7%. Tuberculosis management is not easy, it requires a long time and a large cost. Currently hospitals determine tariffs based on Double Distribution (DD) Method. Unit cost of health services can also be calculated by Activity Based Costing (ABC) Method, which is based on activities. Objective: To determine the unit cost calculation by ABC method and DD Method of Category 2 pulmonary TB in Outpatient and Inpatient Installation of Lung Hospital. Methods: Descriptive analytic using secondary data and Purposive Sampling methods. The study was conducted at Lung Hospital Bandung during September to December 2013 by using medical records within a period of 2 years in January 2011 to December 2012. Results and Discussion: The calculation of the unit costs averages using the ABC method for category 2 Pulmonary TB patient in outpatient Installation was Rp 611,321; for patient in emergency care unit was Rp 713 852; for hospitalized patients that come through the outpatient installation was Rp 5,037,309 and through emergency care unit was Rp 4,398,415. The unit cost averages using DD methods for category 2 Pulmonary TB in outpatient Installation was Rp 421 621; for patient in emergency care unit was Rp 734 170; for hospitalized patient that come through the outpatient installation was Rp 1,727,213 and through emergency care unit was Rp 1,846,337. The quantity of drugs given to outpatients is for 2 weeks while ALOS for hospitalized patients is 9.2 days.Conclusions: Unit costs calculation using ABC method is more financially profitable for the Hospital than using DD method. Hospital management should have a good recording and reporting system that support integration of inter-service and support units to be able to perform a comprehensive unit cost calculations. Hospital management should conduct periodic evaluation of compliance with SOPs and rational drug use. Latar Belakang: Indonesia menduduki rangking ke-5 dari 22 negara-negara yang mempunyai beban tinggi untuk TB dan memberikan kontribusi jumlah kasus TB di dunia sebesar 4,7%. Penatalaksanaan TB tidak mudah, membutuhkan waktu yang lama dan membutuhkan biaya yang besar. Saat ini berbagai rumah sakit menentukan tarif pelayanan berdasarkan metode DD. Perhitungan biaya satuan pada pelayanan kesehatan dapat juga dilakukan dengan menggunakan metode Activity Based Costing (ABC) yang didasarkan pada aktivitas. Tujuan : Mengetahui perhitungan unit cost dengan metode ABC dan metode DD di Instalasi Rawat Jalan dan Rawat Inap TB Paru Kategori 2 di Rumah Sakit Paru. Metode Penelitian: Deskriptif analitik menggunakan data sekunder dan metoda Pusposive Sample. Penelitian dilakukan di Rumah Sakit Paru Bandung selama bulan September sampai dengan Desember 2013 dengan menggunakan data rekam medis dalam kurun waktu 2 tahun yaitu pada bulan Januari 2011 sampai dengan Desember 2012. Hasil dan Diskusi: Perhitungan biaya satuan rata-rata dengan metode ABC untuk pasien rawat jalan TB Paru Kategori 2 sebesar Rp 611.321; untuk pasien rawat darurat TB Paru Kategori 2 sebesar Rp 713.852; untuk pasien rawat inap yang masuk melalui instalasi rawat jalan sebesar Rp 5.037.309 dan instalasi rawat darurat sebesar Rp 4.398.415. Biaya satuan rata-rata dengan metode DD untuk pasien rawat jalan TB Paru Kategori 2 sebesar Rp 421.621; untuk pasien rawat darurat TB Paru Kategori 2 sebesar Rp 734.170; untuk pasien rawat inap yang masuk melalui instalasi rawat jalan sebesar Rp 1.727.213 dan instalasi rawat darurat sebesar Rp 1.846.337. Banyak nya obat yang diberikan untuk pasien rawat jalan yaitu untuk 2 minggu sedangkan ALOS untuk pasien rawat inap yaitu 9,2 hari. Kesimpulan: Perhitungan biaya satuan dengan menggunakan metode ABC lebih menguntungkan secara financial bagi Rumah Sakit dibandingkan dengan metode DD. Manajemen rumah sakit sebaiknya memiliki sistem pencatatan dan pelaporan yang rapih, terintegrasi antar unit pelayanan dan unit penunjang untuk dapat melakukan perhitungan biaya satuan dengan baik. Manajemen rumah sakit melakukan evaluasi berkala terhadap kepatuhan SOP dan penggunaan obat rasional.

Maksimasi, Free Rider dan Kegagalan Implementasi Kebijakan Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 3 (2012)
Publisher : Center for Health Policy and Management

Jika mempelajari policy making process, kita belajar tentang rational choice theory - bahwa setiap individu dalam organisasi akan mengutamakan kepentingan pribadi mereka. Dalam implementasi, kepentingan dari penduduk sering dikalahkan oleh kepentingan pribadi dari penyelenggara layanan. Jadi implementasi kebijakan sering gagal karena adanya kepentingan pribadi dari penyelenggara layanan. Implementasi kebijakan bagian penting dari policy analysis. Jika kebijakan berhasil dibuat dengan susah payah, tidak selalu berarti kebijakan itu akan terimplementasi begitu saja. Ada banyak tantangan yang membuat kebijakan itu tidak berarti apa-apa - kebijakan di atas kertas - tidak ada implementasinya. Kebijakan yang gagal jika implementasinya tidak ada. Kegagalan implementasi adalah termasuk kegagalan kebijakan. Implementasi adalah ranah dari manajer program. Jika kebijakan ingin berhasil, ia membutuhkan manajer yang efektif. Mereka membuat kebijakan menjadi operasional dan dapat menyajikan layanan kepada penduduk yang membutuhkannya.

Kebijakan untuk Mengatasi Inflasi Biaya Kesehatan Shita Dewi
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 4 (2012)
Publisher : Center for Health Policy and Management

ANALISIS PEMBIAYAAN PROGRAM KESEHATAN IBU DAN ANAK BERSUMBER PEMERINTAH DENGAN PENDEKATAN HEALTH ACCOUNT Dominirsep Dodo, LaksonoTrisnantoro, Sigit Riyarto
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 1 (2012)
Publisher : Center for Health Policy and Management

Background: The degree of Maternal and Child Health (MCH)is still a major problem in health development in Indonesia. Onefactor that may be an obstacle in solving this problem is thelimited cost. In this context, planning and cost utilization areessential to improve so that they can produce a great impactfor the improvement of MCH. Therefore, in-depth informationabout the MCH financing situation in regions as an input todevelop efficient activities in improving MCH status is needed.Objective: To analyze health financing situation of MCH programin 2010 which sourced from government and to make policyrecommendations related to the program in Sabu Raijua District,East Nusa Tenggara Province. The situation in question isavailability, budget planning process, expenditure accuracy,and fund flow rate.Method: This was a descriptive research with a case studystrategy.Result: The total cost of MCH program was IDR 450,787,500.It was not sufficient to provide basic health services forpregnant women from early pregnancy until postpartum period.The budget proportion from the central, provincial, and districtgovernments amounted to 79.63%, 3.56%, and 16.78%,respectively. Cost allocation of the district budget was 0.80%.Planning activities of MCH program was from the district budgetthrough the development planning meeting (Musrenbang).Proposed activities in Musrenbang were dominated by physicalactivities. The cost of MCH program was spent more on directactivities and operational cost in villages and sub districts. Theimplementation of the activities was not supported by facilitiesand adequate human resources. The MCH fund disbursementfrom the central government was conducted in October-November while from the provincial and district governmentswere in July to August.Conclusion: The government’s commitment was still low infinancing MCH program as a priority program due to budgetdecentralization. Musrenbang activities had not demonstratedsignificant impacts on quality activities improvement and budgetallocations from the district budget. Availability of personneland health facilities greatly affected the performance of MCHprogram. Delays in funds disbursement disrupted theimplementation of activities and provided opportunities forcorruption. Therefore, the supervision function must beimproved both internal and external.Keywords: financing, maternal and child health program,health account, budget, government.

Asuransi Kesehatan Sosial dan Biaya Out of Pocket di Indonesia Timur Isak Iskandar Radja; Hari Kusnanto; Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 2 (2015)
Publisher : Center for Health Policy and Management

Background: Social health insurance in Indonesia is carried by social insurance mechanism aims to provide social security protection to the community so their basic health needs can be met adequately. Social insurance is expected to increase access and utilization of health services as well as reducing the risk of out-of-pocket expenditure (OOP) that resulting in catastrophic expenditures and poverty. Objective: To analyze the utilization of inpatient care, health insurance and hospitalization OOP expense ratio based on living area, type of health facility and type of social health insurance in Eastern Indonesia. Methods: This study uses secondary data analysis using Indonesian Family Life Survey East 2012 data. This is a quantitative approach using cross-sectional design, and multivariate analysis using linear regression at 95% confidence level. Results: The use of hospitalization in Eastern Indonesia by insurance users is 54.6%, while those who do not use insurance is 45.4%. A total of 24.6% insurance owner do not use insurance at the time of hospitalization. Multivariate analysis showed no significant difference in the cost of hospitalization OOP based living area and type of health facility. OOP costs of hospitalization for Jamsostek/other members were higher than Askes and Jamkesmas members. Conclusion: The government needs to implement a social health insurance system that is of a better quality and comprehensive in order to protect users from the burden of high health care cost. Latar belakang: Jaminan kesehatan sosial di Indonesia dilakukan dengan mekanisme asuransi sosial bertujuan untuk memberi jaminan perlindungan sosial kepada masyarakat agar dapat terpenuhi kebutuhan dasar hidupnya secara layak, khususnya di bidang kesehatan. Asuransi sosial diharapkan dapat meningkatkan akses dan utilisasi pelayanan kesehatan serta mengurangi resiko pengeluaran biaya out of pocket (OOP) yang bisa berdampak pada pengeluaran katastropik serta kemiskinan. Tujuan: Menganalisis pemanfaatan rawat inap, asuransi kesehatan dan perbandingan biaya OOP rawat inap berdasarkan area tinggal, jenis fasilitas kesehatan dan jenis asuransi kesehatan sosial di Indonesia Timur. Metode: Penelitian ini menggunakan metode analisis data sekunder dengan sumber data Indonesian Family Life Survey East 2012. Pendekatan kuantitatif dengan rancangan cross sectional. Analisis multivariat menggunakan regresi linier pada tingkat kepercayaan 95%. Hasil: Pemanfaatan rawat inap di Indonesia Timur oleh pengguna asuransi sebesar 54,6% sedangkan yang tidak menggunakan asuransi sebesar 45,4%. Sebanyak 24,6% pemilik asuransi tidak menggunakan asuransinya pada saat kunjungan rawat inap. Hasil analisis multivariat menunjukkan tidak ada perbedaan biaya OOP rawat inap yang signifikan berdasarkan area tinggal dan jenis fasilitas kesehatan. Biaya OOP rawat inap pengguna Jamsostek/lainnya ternyata lebih tinggi dari pengguna Askes dan Jamkesmas. Kesimpulan: Pemerintah perlu menerapkan sistem asuransi kesehatan sosial yang lebih bermutu dan komprehensif agar dapat melindungi penggunanya dari beban biaya kesehatan yang tinggi, agar utilisasi asuransi kesehatan lebih berkualitas di masa mendatang.

ANALISIS UNTUK PENERAPAN KEBIJAKAN: ANALISIS STAKEHOLDER DALAM KEBIJAKAN PROGRAM KESEHATAN IBU DAN ANAK DI KABUPATEN KEPAHIANG Iswarno Iswarno; Mubasysyir Hasanbasri; Lutfan Lazuardi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 2 (2013)
Publisher : Center for Health Policy and Management

Background: Maternal, neonatal and child health (MNCH)program is a national priority programs in health development.In 2006 the Ministry of Health to provides the largest budgetallocation to the KIA programs. This policy was taken in orderto accelerate the decline in maternal mortality and infant throughthe implementation of the making pregnancy safer strategy(MPS) with focus on some activities that are considered to becost effective. MNCH sustainability of the program dependson political commitment and support from stakeholders in theregion. Therefore, stakeholder analysis is important for theimplementation of policy to support the MNCH program.Objectives:Assessing the political commitment of the localgovernment to MNCH program in Kepahiang Regency.Methods: This research is a descriptive, qualitative designwith a case study. Unit of analysis is a research MNCH programstakeholder. How do the data with the brainstorming, depthinterviews, reports and documents, and direct observation.Results: Political commitment of the local government tomaternal, neonatal and child health program is still low, this isevidenced by the lack of budget allocation maternal, neonataland child health program. Essentially all stakeholders agreeand support the program. The involvement of local stakeholdersin the process of planning and budgeting programs is still lacking.Coordination among health agencies with key stakeholders inthe planning and budgeting also are not running well, so oftenthere are differencesin understanding the program. Besidesthe quality planning activities are still considered low, and thereis still weak advocacy capacity of health district office.Conclusion: The small budget allocation for the programshows the commitment to maternal, neonatal and child healthprogram of the local government is still low. This problem wasmore due to the quality of the program planning (design) that isnot well-developed. Also the role and involvement ofstakeholders in the planning process is still lacking.Keywords: Stakeholder, MNCH policy

Kebijakan Medik pada Pasien Gagal Ginjal Kronik dengan Hemodialisis di RS Hasan Sadikin Bandung Dewi Marhaeni Diah Herawati; Eko Fuji Ariyanto
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 2 (2014)
Publisher : Center for Health Policy and Management

Background: Prevalence of Chronic Kidney Disease in dialysis’s patients in Indonesia has increased. Some of them occurred with malnutrition inflammation complex syndrome and lead to death. This study aims to determine the intake of protein and energy, and determine factors that cause the low intake of nutrition. Methods: Design of the study was mixed methods using embedded concurrent strategy. Research paradigm was constructivism whereas qualitative research conducted in-depth interviews and observations. Quantitative research has been done with a descriptive approach, observational, using secondary data and perform 24 Hour Recall and Food Frequency Questionnaire (FFQ). The study was conducted at Hemodialysis Unit, Hasan Sadikin Hospital from June to September 2013, with a total sampling. Qualitative and quantitative data analysis has been done, followed by analysis of policy and analysis for policy for establishing a medical policy for chronic kidney disease patients receiving medical hemodialysis. Result: The average protein intake of the patients was 1.32 g/ kg/day. Interval of protein intake of 0.5 g/kg /day (lowest) until 2.8 g/kg/day (highest). 24% of patients had protein intake under 1 g /kg BW/day and 22.8% was above 1.5 g/kg BW/day. Average energy intake was 2001 kcal patient/day (930 kcal/ day - 3196.9 kcal/day). The qualitative analysis resulted in seven themes which causes nutrient low intake. The themes were underlying diseases (such as diabetes mellitus and hypertension), length of dialysis, frequency and number of dialysis, effects of dialysis, body’s response, cost factor, counseling, and education. Most of the respondents felt suffer from anemia and complained of nausea and vomiting. Body responses varied widely among them. Conclusion: Protein intake of dialysis patients as recommended by K/DOQI, but not in accordance with energy intake. Protein and energy intake of Jakeman's holder patients were lower than the recommendation of K/DOQI. The cause of lower intake of nutrients due to the underlying disease, length of dialysis, frequency and number of dialysis, effects of dialysis, body responses, cost factors and lack of counseling and education. Counseling and education of the patient's hospital are needed. The government should encourage medical policy in the management of patients with chronic kidney failure are comprehensive, in primary care, secondary and tertiary. The government must provide competent personnel, facilities and supporting infrastructure, service standards and standard operating procedures are required for each level of service. Latar Belakang: Prevalensi pasien Penyakit Ginjal Kronik (PGK) yang menjalani hemodialisis di Indonesia mengalami peningkatan. Beberapa diantaranya terjadi malnutrition inflammation complex syndrome dan berujung pada kematian. Penelitian bertujuan untuk mengetahui asupan protein dan energi, serta mengetahui faktor-faktor yang menyebabkan rendahnya asupan nutrisi. Metode: Desain penelitian adalah mixed method dengan menggunakan strategi conccurent embedded. Paradigma penelitian adalah constructivisme. Penelitian kuantitatif dengan pendekatan deskriptif, observational menggunakan data skunder dan melakukan 24 Hour Recall dan Food Frequency Questionaire (FFQ). Penelitian kualitatif dilakukan dengan wawancara mendalam dan observasi. Penelitian dilakukan di Unit Hemodialisis Rumah Sakit Hasan Sadikin Bandung bulan Juni-September 2013 dengan total sampling. Dilakukan analisis data kualitatif dan kuantitatif yang diikuti analysis of policy dan analysis for policy untuk merumuskan kebijakan medik pada pasien PGK yang menjalani hemodialisis. Hasil: Rata-rata asupan protein pasien adalah 1,32 gr/kg BB/ Hari. Asupan protein terendah 0,5 gr/kg BB/hari, tertinggi 2,8 gr/kg BB/hari. Asupan protein pada 24% pasien dibawah 1 gr/ kg BB/hari; 22,8% diatas 1,5 gr/kg BB/hari. Rata-rata asupan energi pasien 2001 kkal/hari, asupan terendah 930 kkal/hari, tertinggi 3196,9 kkal/hari. Analisis kualitatif menghasilkan 7 tema yang menjadi penyebab rendahnya asupan nutrisi yaitu penyakit dasar (diabetes mellitus, hipertensi), lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan konseling serta edukasi. Efek dialisis yang paling dikeluhkan adalah anemia, mual dan muntah. Respon tubuh diantara pasien sangat bervariasi. Konseling dan edukasi dari pihak rumah sakit sangat dibutuhkan pasien. Kesimpulan: Asupan protein pasien sesuai rekomendasi K/ DOQI, namun belum sesuai untuk asupan energi. Asupan protein dan energi pasien Jamkesmas lebih rendah dari rekomendasi K/DOQI. Penyebab rendahnya asupan nutrisi disebabkan karena penyakit dasar yang menjadi penyebab PGK, lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan tidak adanya konseling dan edukasi. Pemerintah harus mendorong kebijakan medik dalam penanganan pasien gagal ginjal kronik yang komprehensif, di pelayanan primer, skunder dan tertier. Untuk tercapainya kebijakan medik tersebut pemerintah harus menyediakan tenaga yang kompeten, sarana dan prasarana pendukung, standar dan protap yang dibutuhkan untuk masing-masing level pelayanan.

Mempertimbangkan Kembali Program Eliminasi Malaria 2030 dalam Konteks Indonesia Kristian Wongso Giamto
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 4 (2017)
Publisher : Center for Health Policy and Management

Background: Malaria is one of high burden infectious diseases for tropical-subtropical areas worldwide, such as Indonesia, especially in the eastern Indonesia. Malaria eradication once failed in late 1960s, now re-emerge after a commitment statement of Bill Gates in 2007. Now, Indonesia also targeting malaria elimination in 2030. Objective: To determine the feasibility of Malaria Elimination Program 2030, especially in Indonesia with existing modalities to combat malaria. Methods: This paper uses data, ranging 2000-2016, which selected from MEDLINE journal portal and other sources, which found to be relevant with topics, yet reliable. Results and Discussion: Malaria eradication can not be equalized to smallpox's, which has characteristics those very supportive in putting it to be eradicated (such as no subclinical infection and do not involve vector). Until now, issues of fake antimalarial drugs, forest malaria, financing commitment and healthcare service in rural parts of Indonesia remain unanswered and managed optimally. It also appears that medical advances can not contribute optimally without being supported by strategic policies. Conclusion and Suggestions: With existing modalities and situation, malaria control still difficult to be achieved in Indonesia. This will cause malaria eradication program in 2030 as less realistic target. Malaria eradication as a target may be worth to be reconsidered. Malaria control as target may be a more realistic alternative. More advanced studies regarding obstacles in managing malaria in Indonesia and its solutions are mandatory.

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Contact Name Shita Dewi

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Abstract

Abstract

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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