Garuda - Garba Rujukan Digital

Formulasi Rancangan Kebijakan Ketenagaan Dokter Umum di Kabupaten Blitar Agung Dwi Laksono; Widodo J. Pudjirahardjo; Iwan M. Mulyono
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 2 (2012)
Publisher : Center for Health Policy and Management

Background: The medical doctor ratio in the Regency of Blitar is far below the normative ratio (1: 2,500). From the number of physicians working in health institutions, it is clear that not only the present ratio (1: 12,125) but the distribution in every dis- trict is also uneven. Based on these two findings, this re- search aims to formulate a manpower policy draft for medical doctors in Blitar Regency. With reference to regency and na- tional level policy, the draft will take into consideration: the community demographic characte-ristics, the number of Puskesmas visitation, the number of Puskesmas, geographic characteristics, infrastructure, health programs of Blitar Re- gional Health Office, the availability of medical doctors and the fiscal potency of Blitar Regency. Methods: This is a policy research consisted of several stages i.e. identifying public issues, formulating public issues, analyzing public issues, deciding criteria and alternative poli- cies, and forecasting and determining target and priority. Con- ducted from February until June 2008, the research location was the Blitar Regency. Information sources are regency and national level policy documents and also policy actors (policy- makers and policy-implementers). Results: The result shows four basic estimations for medical doctors’ manpower requirement which can be applied in Blitar Regency. Those are the number of population, the number of Puskesmas, the number of districts and the total visitation of each Puskesmas. It was settled and approved by all policy actors that the population number should be the basis for estimating medical doctor’s manpower requirement. Pursuant to this calculation, 454 medical doctors are projected for the year 2009, up to 470 physicians in the year 2018. Blitar Re- gency policy actors predict the increasing fiscal potency of the regency following the trend of the past five years. The prediction includes the increasing percentage of health bud- get. Derived from the Focus Group Discussion, the policy ac- tors stated only 10 medical doctors for every two years could be provided by the Blitar regional government. Conclusion: The recommendations are: formulating medical doctor’s policy implicitly should include medical doctor’s facilitatiye character; using ideal ratio adapting to Blitar regency’s recent condition and fiscal ability; using a strategy of appointing medical doctor’s from the regency’s PTT (tempo- rary assigned doctors) and making an incentive pattern with regard to Blitar Regency region mapping.Latar Belakang: Rasio dokter di Kabupaten Blitar adalah masih jauh di bawah rasio normatif (1:2,500). Dari jumlah dokter yang bekerja di lembaga kesehatan, terlihat jelas bahwa tidak hanya rasio saat ini (1:12,125) tetapi distribusi di setiap kecamatan juga tidak merata. Berdasarkan dua temuan ini, penelitian ini bertujuan untuk merumuskan rancangan kebijakan tenaga dok- ter di Kabupaten Blitar. Mengacu pada kebijakan tingkat kabupaten dan nasional, rancangan ini akan mempertimbang- kan: karakteristik demografi masyarakat, jumlah visitasi Pus- kesmas, jumlah Puskesmas, karakteristik geografis, infrastruk- tur, program kesehatan Dinas Kesehatan Kabupaten Blitar, ke- tersediaan dokter dan potensi fiskal Kabupaten Blitar. Metode: Penelitian ini merupakan penelitian kebijakan yang terdiri dari beberapa tahap, yaitu mengidentifikasi isu-isu publik, merumuskan isu-isu publik, menganalisis isu-isu publik, memu- tuskan kriteria dan alternatif kebijakan, serta meramalkan dan menentukan target dan prioritas. Lokasi penelitian adalah di Kabupaten Blitar yang dilaksanakan mulai Februari hingga Juni 2008. Sumber informasi adalah dokumen kebijakan di tingkat kabupaten dan nasional serta pelaku kebijakan (pembuat kebi- jakan dan pelaksana kebijakan). Hasil: Penelitian ini menunjukkan empat estimasi dasar untuk kebutuhan tenaga dokter yang dapat diterapkan di Kabupaten Blitar. Empat estimasi dasar tersebut adalah jumlah penduduk, jumlah Puskesmas, jumlah kecamatan dan visitasi total di setiap Puskesmas. Semua pelaku kebijakan telah menyelesaikan dan menyetujui bahwa jumlah penduduk harus menjadi dasar untuk memperkirakan kebutuhan tenaga dokter. Berdasarkan perhi- tungan ini, 454 dokter telah diproyeksikan untuk tahun 2009, hingga 470 dokter yang diproyeksikan pada tahun 2018. Pelaku kebijakan di Kabupaten Blitar memprediksi meningkatnya poten- si fiskal Kabupaten yang mengikuti tren dari lima tahun terakhir. Prediksi tersebut meliputi peningkatan persentase anggaran kesehatan. Berdasarkan hasil dari diskusi kelompok terarah, pelaku kebijakan menyatakan bahwa untuk setiap dua tahun hanya 10 dokter dapat disediakan oleh pemerintah daerah Kabupaten Blitar. Kesimpulan: Rekomendasi yang diajukan dalam penelitian ini adalah: secara implisit merumuskan kebijakan dokter harus mencakup karakter fasilitas dokter, menggunakan rasio yang ideal yang sesuai dengan kondisi dan kemampuan fiskal Kabu- paten Blitar sekarang, menggunakan strategi penunjukkan dok- ter PTT dan membuat pola insentif yang berkaitan dengan pemetaan wilayah Kabupaten Blitar.

HUBUNGAN ANTARA REALISASI DANA BANTUAN OPERASIONAL KESEHATAN DENGAN INDIKATOR GIZI KIA DI KABUPATEN/KOTA PROVINSI JAWA TENGAH TAHUN 2012 Ulma Putri Septyantie Malik Cahyadin
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Health Operational Fund (HOF) is a grant fromcentral government through the Ministry of Health. The goal isto help local governments for implementing health servicesbased on Minimum Service Standards (MSS) in the field ofhealth to accelerate the achievement of the MillenniumDevelopment Goals (MDGs). Health development policies in2010-2014 are directed to enable availability of fundamemntalhelalth access that cheap and affordable especially for thelower-middle gorups. This is indicated by increasing lifeexpectancy, infant mortality and maternal mortality. One of thehealth priority programs is Nutrition Program and the Maternaland Child Health (MCH).Methods: This research is quantitative research. Analysismethod uses a simple regression. Research data are secondarydata in 2012 of 35 districts/cities in Central Java Province.Results: The realization of Health Operational Fund (HOF) issignificant ( Sig.0,000 < ±=1%) on neonatus first visit/KN1, therealization of Health Operational Fund (HOF) is significant (Sig.0,000 < ±=1%) on assistance by skilled health personnel/Pn, and the realization of Health Operational Fund (HOF) issignificant ( Sig.0,000 < ±=1%) on children weighing or D/S.Coefficient of determination (r ²) is 0.629 for the effect of HOFon KN1, 0.636 for the effect of HOF on Pn, and 0.690 for HOFon D/S. The result of classical assumptions shows that residualvariables are normally distributed, despite heteroscedasticityand despite autoccorelation.Conclusion: HOF has positive effect and significant on KN1,HOF has positive effect and significant on Pn, and HOF haspositive effect and significant on D/SKey Words: HOF, MCH Nutrition, Simple Regression, CentralJava

Persepsi Pimpinan Unit Pelaksana Teknis Pusat dan Dinas Kesehatan Provinsi terhadap Implementasi Peraturan Pemerintah Nomor 7 Tahun 2008 di Provinsi Daerah Istimewa Yogyakarta Budi Sartono; Laksono Trisnantoro; Dwi Handono Sulistyo
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 4 (2012)
Publisher : Center for Health Policy and Management

Background: Since regional autonomy there is a separation and the incorporation of several government agencies in the area. Government agencies are not coordinating plans with the provincial health department. In order for the planning and implementation of effective and efficient interconnection among agencies is required in an area. Government regulation No. 7 of 2008 requires each agency coordinating the vertical area of ??the planning phase to reporting. Objectives: Knowledgeable perception of the relationship of decentralization with central technical unit leader and provincial health authorities on the implementation of government regulation No. 7 of 2008 in the special province of Yogyakarta. Methods: This type of study is a qualitative descriptive exploratory design to design. The subjects of this study is the leader in the central technical unit and the provincial chief medical officer DIYogyakarta. Data collection interviews with in-depth interviews using a guide and recorded into the cassette. Result: Authority element was found that vertical agencies in the area is still always follow all policies of central and did not dare carry out / make their own policy. Elements information that the provincial health department does not know the contents of the proposed activities and funding UPT central. Element of the capacity was found that each agency has been supported by sufficient human resources to carry out their duties, Accountability elements was found that provincial health authorities and UPT centers perform in a way different. Conclusion: Coordination as has not been implemented properly. This was due to him not the leadership of the provincial health department and the center of the government regulation No. 7 of 2008, This can be seen from the authority of the provincial health department had to implement the coordination has not been implemented and a sense of seniortitas to wait for the coordination and operational guidelines. The absence of information about the activities of the division in each of the UPT central to the provincial health department. Support staff with a good capacity of the provincial health department has been owned and UPT center. UPT accountability mechanism is different centers. Latar Belakang: Sejak otonomi daerah terjadi pemisahan dan penggabungan beberapa instansi vertikal di daerah. Instansi vertikal tidak melaksanakan koordinasi perencanaan dengan dinas kesehatan propinsi. Supaya perencanaan dan pelaksanaan kegiatan efektif dan efisien diperlukan adanya interkoneksi antar instansi disuatu daerah. PP nomor 7 tahun 2008 mewajibkan setiap instansi vertikal didaerah melaksanakan koordinasi dari tahap perencanaan sampai pelaporan. Tujuan: Diketahuinya hubungan desentralisasi dengan persepsi pimpinan unit pelaksana teknis pusat dan dinas kesehatan provinsi terhadap implementasi PP nomor 7 tahun 2008 di Provinsi Daerah Istimewa Yogyakarta. Metode: Jenis penelitian yang digunakan adalah kualitatif dengan design rancangan deskriptif eksploratif. Subyek penelitian ini adalah pimpinan UPT Pusat di Provinsi D.I.Yogyakarta dan Kepala Dinas Kesehatan Provinsi DIY. Pengumpulan data dengan wawancara menggunakan panduan wawacara mendalam dan direkam kedalam kaset. Hasil: unsur otoritas didapatkan bahwa instansi vertikal yang ada di daerah masih selalu mengikuti seluruh kebijakan dari pusat serta tidak berani melaksanakan/membuat kebijakan sendiri. Unsur informasi didapatkan bahwa dinas kesehatan propinsi tidak mengetahui isi kegiatan dan dana yang diusulkan UPT pusat, Unsur kapasitas didapatkan bahwa masing-masing instansi sudah didukung dengan kemampuan SDM yang cukup untuk melaksanakan tugasnya, Unsur akuntabilitas didapatkan bahwa dinas kesehatan propinsi dan UPT pusat melaksanakan dengan cara yang berbeda. Kesimpulan: Koordinasi sebagaimana belum dilaksanakan sebagaimana mestinya. Hal tersebut disebabkan karena tidak tahunya pimpinan dinas kesehatan propinsi dan UPT pusat terhadap PP nomor 7 tahun 2008, hal ini dapat dilihat dari Kewenangan yang dimiliki dinas kesehatan provinsi untuk melaksanakan koordinasi belum dilaksanakan dan adanya rasa senioritas untuk melakukan koordinasi serta menunggu adanya Juklak. Belum adanya pembagian Informasi mengenai kegiatan dimasing-masing UPT pusat kepada dinas kesehatan propinsi. Dukungan staf dengan kapasitas yang baik sudah dimiliki dinas kesehatan propinsi dan UPT pusat. Mekanisme akuntabilitas UPT Pusat berbeda beda.

EFEKTIFITAS DAN EFISIENSI PEMANFAATAN DANA BANTUAN OPERASIONAL KESEHATAN DENGAN PENERAPAN METODE ANALYTIC HIERARCHY PROCESS Kasman Makkasau
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 1 (2012)
Publisher : Center for Health Policy and Management

Background: Millennium Development Goals (MDGs) is a globalcommitment that must be realized by all countries by 2015,to accelerate the goal then the health ministries of BantuanOperasional Kesehatan (BOK) in helping the distric implementappropriate health services by improving the performance ofSPM Puskesmas and networks as well as Upaya KesehatanBersumber Masyarakat (UKBM) in carrying out preventive andpromotive health services. Utilization of funds is an authorityof the BOK clinic, it is necessary for an effective method indetermining program priorities. Along with the progress of scienceand technology in the field of public health and medicine,has provided a wide range of alternatives that can be used tosolve the health problems that occur in the community today.Objective: to determine the utilization of funds BOK interventionis most effective, with metodogi analitic using a modelsystem of decision makers using AHP.Methods: Analytic Hierarchy Process (AHP) is a model approachthat provides an opportunity for planners and programmanagers in health to be able to build the ideas or the ideasand define problems that exist in a way to make assumptionsand then get the desired solution.Results: Based on the analysis by using the AHP model, it canproduce an alternative to the use of program funds BOK highlyeffective in community health centers. By using the AHP modelthen any program that will be implemented with clearly definedpriorities, compared to using Hanlon, Delbeq and PEARL whichhas been used by the manager of health programs in ProvinceWest Sulawesi in Indonesia.Conclusion: It is recommended to use the AHP method indetermining the intervention/program BOK utilization of fundsand benefit the most effective and acceptable to all stakeholders.Keywords: Analytic Hierarchy Process, Program BOK

Kebijakan Penggunaan Batas Wilayah Epidemiologi dalam Pengendalian Penyakit Malaria (Studi Kasus di Puskesmas Kokap II Kabupaten Kulon Progo, DIY) Sutjipto Sutjipto; Hari Kusnanto; Laksono Trisnantoro; Lutfan Lazuardi; Indwiani Astuti
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 2 (2015)
Publisher : Center for Health Policy and Management

Background: There are 396 endemic districts from the total of 495 districts in Indonesia, with an estimated 45% of the population live in the areas that are at risk of infected malaria disease. Kulon Progo Regency is one of regencies in Yogyakarta (DIY), which until now has not declared elimination of malaria. PHC Kokap II located in Kokap sub-district, is the largest contributor of positive malaria cases in Kulon Progo regency due to the potential for outbreaks of malaria, during the period 1997-2004, when the number of malaria positive patients in the PHC Kokap II ranged between 26% - 55% of patients of the total positive malaria cases in Kulon Progo. This study aims to produce epidemiological information that is important in the region of PHC Kokap II associated with the distribution and determinants of malaria that affects the possibility of local transmission. Methods: The study design was a descriptive study, to get an overview of the distribution and determinants of malaria. The observation unit is the population in the form of correlation studies population and a time series. To determine the pattern of malaria transmission we use secondary data between 2009- 2012 malaria cases. Malaria incidence patterns were analyzed by person, place and time. To determine the clusters of malaria we use clustering analysis with the data of malaria cases in the region PHC Kokap II year 2012. To determine the spread of malaria in the cross-border area between PHC Kokap II and PHC Kaligesing we use secondary data year 2010-2012. Results: In the area of PHC Kokap II, we found import cases every year. Even more, in the year 2009 the proportion of import cases was 82% compared with all patients that were found malaria positive. Clusters of malaria is in the west region of PHC Kokap II, which is bordering to the Subdistrict Kaligesing, Purworejo, Central Java Province. Region PHC Kokap II is an area of high vulnerability, the potential to get the risk of transmission of imported cases of malaria is due to the entry of patients or infective vectors from high transmission areas to low transmission. Conclusion: The focus of malaria transmission in the area of PHC Kokap II is at the western part bordering the sub-district Kaligesing, Purworejo. PHC Kokap II is the region of high vulnerability. Policies need to be made use of epidemiological boundaries in the malaria control program in the cross-border region. Latar belakang: Di Indonesia masih terdapat 396 Kabupaten endemis dari 495 Kabupaten yang ada, dengan perkiraan seki- tar 45% penduduk berdomisili di daerah yang berisiko tertular malaria. Kabupaten Kulon Progo merupakan salah satu kabupa- ten di Daerah Istimewa Yogyakarta (DIY), yang sampai saat ini belum dinyatakan eliminasi. Wilayah Puskesmas Kokap II yang berada di Kecamatan Kokap, merupakan penyumbang terbesar penderita positip malaria untuk wilayah Kabupaten Kulon Progo diantaranya karena potensi terjadinya KLB malaria, selama periode tahun 1997-2004, range jumlah penderita positip ma- laria di wilayah Puskesmas Kokap II berkisar antara 26% - 55% penderita positip malaria di Kabupaten Kulon Progo. Pe- nelitian ini bertujuan untuk menghasilkan informasi epidemiologi yang penting di wilayah Puskesmas Kokap II terkait dengan distribusi dan determinan penyakit malaria yang sangat berpe- ngaruh terhadap kemungkinan terjadinya penularan setempat. Metode: Rancangan penelitian ini adalah studi deskriptif untuk mendapatkan gambaran distribusi dan determinan penyakit malaria, unit pengamatan adalah populasi dalam bentuk studi korelasi populasi dan rangkaian berkala. Untuk mengetahui pola penularan malaria digunakan data sekunder kasus ma- laria tahun 2009-2012, dianalisis pola kejadian malaria menurut orang, tempat dan waktu. Untuk mengetahui kluster penderita malaria dilakukan analisis klustering menggunakan data kasus malaria di wilayah Puskesmas Kokap II tahun 2012. Untuk mengetahui penyebaran penderita malaria di daerah lintas batas antara Puskesmas Kokap II Kabupaten Kulon Progo dan Pus- kesmas Kaligesing Kabupaten Purworejo digunakan data sekunder tahun 2010-2012. Hasil: Di wilayah Puskesmas Kokap II setiap tahun selalu dike- temukan kasus import, bahkan dalam tahun 2009 kasus import proporsinya adalah 82% dibandingkan dengan seluruh pen- derita positif malaria yang diketemukan. Kluster penderita ma- laria berada di bagian barat wilayah Puskesmas Kokap II, yaitu berbatasan langsung dengan Kecamatan Kaligesing Kabupaten Purworejo, Provinsi Jawa Tengah. Wilayah Puskesmas Kokap II merupakan daerah vulnerebilitas tinggi, potensial untuk menda- patkan risiko penularan kasus import karena masuknya pende- rita malaria atau vektor yang infektif dari daerah penularan tinggi ke penularan rendah. Kesimpulan: Fokus penularan penyakit malaria di wilayah Puskesmas Kokap II berada pada wilayah bagian barat berba- tasan dengan wilayah administratif Kecamatan Kaligesing, Ka- bupaten Purworejo. Puskesmas Kokap II adalah wilayah vulnerabilitas tinggi, perlu dibuat kebijakan penggunaan batas wilayah epidemiologi dalam program penanggulangan malaria di wilayah lintas batas.

DAMPAK KEBIJAKAN PELAYANAN KESEHATAN GRATIS TERHADAP KEPUASAN PASIEN DALAM MENERIMA PELAYANAN KESEHATAN PUSKESMAS DI KOTA AMBON Lintje Sintje Corputty Hari Kusnanto Lutfan Lazuardi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 2 (2013)
Publisher : Center for Health Policy and Management

Background: The Mayor of Ambon City, in order to improvethe welfare of society especially the health sector has made apolicy too free basic health services costs at health centersand its network for all communities. In implementing this policy,there are many problems both tecnical and operational.Objectives: The objective of this research was to determinethe performance of officers in providing free health servicesto the public in accordance with the level of satisfaction interms of free health care.Methods: This research is descriptive analysis with aqualitative approach and conducted at five sub districtcoordinator public health services.Research data obtained byin-depth interviews and focused group discussion.For dataanalysis,qualitative techniques were used, that is, narrativeinterpretations, conclusions and data validation by triangulationtechniques.Results: The results show that on giving free services,officerdoes not show any improvement in their performance. Thiswas the result of the absence of incentives or specialcompensation for them. Material and non material compensationis expected to increase work motivation. Supporting facilitiessuch as logistics and health facilities should be prepared toimprove provision of free services, thus in turn increasingpatient’s satisfaction.Keywords: Free Health Services Policy, Performance,Incentive and Compensation, Patient Satisfaction.

Monitoring Pelaksanaan Kebijakan Bantuan Operasional Kesehatan di Daerah Terpencil, Perbatasan, dan Kepulauan Dominirsep Ovidius Dodo
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 2 (2014)
Publisher : Center for Health Policy and Management

Background: Currently, health development efforts are focused on achieving the MDG targets through several priority programs such as health insurance expansion; equitable access to health services in Remote Areas, Borders, and Islands (DTPK Areas); increase of promotion – preventive measures, and response to diseases. One of the strategic steps taken by the government to achieve that goal is by issuing Health Operational Assistance Policy (BOK). In recent years, increase in budget for health has occurred at the central level. Although on one hand the increment has not reached 5 % of total the state budget, on the other hand the budget absorption is low, i.e. not reaching 100 %. Most budget absorption takes place within the last quarter of the fiscal year. This indicates that there are serious problems in the implementation of the health system, one of which is inefficiencies. This phenomenon also occurs in the implementation of BOK policy. The proportion of BOK funds has increased in recent years, but the amount absorption does not reach 100 %. This of course would cumulatively affect the achievement of health system performance. Objective: This study aimed to explore the implementation of BOK policy at the primary health care level, identifying the factors that contribute to inefficiencies in the implementation of BOK policy, and assess the effectiveness of BOK policy in achieving the target of minimum services standard of health (SPM). Methods: This study was a descriptive study using a case study research strategy. The location was in Sabu Raijua Regency, East Nusa Tenggara Province while the research period was from June to August 2013. Results and Discussion: BOK Fund is the only source of funds to finance the implementation of preventive and promotion programs at health center level. There is no fund allocated by local government (APBD) due to its limited amount and high allocation to finance other sectors. The study identified several factors contributing to inefficiency in the use of BOK funds in the DTPK area, including the limited number and quality of human resources in health centers to run the programs. The result are dual task that implies a high workload (service/ care and administrative); delay of Technical Guide issuance and its subsequent socialization by the central government and district health offices to primary health centers; poor management capacity of health authorities in the implementation of the BOK fund due to varied understanding of the allocation of BOK fund; lack of data or evidence use in developing activity plans, and delays in disbursement of funds which resulted in the accumulation of funds to be disbursed in the 4th quarter of a fiscal year. Other findings also show that there was no significant change in the coverage of services and programs at the health center level when compared to the national target of SPM. Conclusions: The implementation of BOK policy has yet to show significant impact on the improvement of health system performance in the sub national level. At the central level, an in-depth and systematic evaluation is required for the allocation of BOK funds. At the local level, it requires significant improvement on the input side and on the process of planning and oversight mechanisms for community health centers and health authorities – which is integrated in nature - so that the BOK’s policy implementation could pose significant impacts on the improvement of the local health system performance. Latar belakang: Saat ini, pembangunan kesehatan terfokus pada upaya pencapaian target MDGs melalui beberapa pro- gram prioritas seperti perluasan jaminan kesehatan; pemerataan akses terhadap pelayanan kesehatan di Daerah Terpencil, Perbatasan, dan Kepulauan (DTPK); peningkatan upaya promotif-preventif; dan penanggulangan penyakit. Salah satu langkah strategis yang dilakukan pemerintah untuk mencapai tujuan itu dilakukan dengan mengeluarkan Kebijakan Bantuan Operasional Kesehatan. Dalam beberapa tahun terakhir, terjadi kenaikan anggaran kesehatan di tingkat pemerintah pusat. Kenaikan tersebut di satu sisi secara proporsi belum mencapai ukuran 5% dari APBN namun di sisi lain penyerapan anggaran yang sedikit tersebut ternyata tidak mencapai 100%. Sebagian besar anggaran tersebut lebih banyak diserap pada kuartal terakhir. Hal ini mengindikasikan bahwa ada problem serius dalam pelaksanaan sistem kesehatan yakni inefisiensi. Fenomena ini juga terjadi dalam implementasi kebijakan BOK. Proporsi dana BOK dalam beberapa tahun terakhir makin meningkat namun jumlah yang diserap tidak mencapai 100%. Hal ini tentunya secara kumulatif akan sangat mempengaruhi pencapaian kinerja sistem kesehatan. Tujuan: Penelitian ini bertujuan untuk mengeksplorasi pelaksanaan kebijakan BOK di tingkat puskesmas terkait faktor- faktor yang berkontribusi terhadap inefisiensi pelaksanaan kebijakan BOK sekaligus menilai efektivitas dari kebijakan BOK dalam pencapaian target SPM bidang kesehatan. Metode: Penelitian ini adalah penelitian deskriptif dengan menggunakan strategi penelitian studi kasus. Lokasinya di Kabupaten Sabu Raijua, Provinsi Nusa Tenggara Timur dengan waktu penelitian selama ± 3 bulan yakni dari Bulan Juni sampai Bulan Agustus tahun 2013. Hasil dan Bahasan: Dana BOK adalah satu-satunya sumber dana yang membiayai pelaksanaan program promotif dan preventif di tingkat puskesmas. Alokasi dari dana APBD tidak ada karena dana yang tersedia dalam APBD sangat terbatas jumlahnya. Dengan adanya dana BOK, maka dana daerah yang terbatas tersebut dipakai untuk membiayai sektor lain. Penelitian ini menemukan beberapa faktor yang berkontribusi terhadap inefisiensi penggunaan dana BOK di daerah DTPK antara lain keterbatasan jumlah dan kualitas sumber daya manusia untuk menjalankan program-program puskesmas sehingga terjadi rangkap tugas yang berimplikasi pada tingginya beban kerja (pelayanan dan administrasi); keterlambatan Juknis BOK dan sosialisasinya dari pemerintah pusat dan kabupaten kepada puskesmas terkait pemanfaatan dana BOK; lemahnya kapasitas manajemen dinas kesehatan dalam mengelola manajemen pe- laksanaan dana BOK karena adanya variasi pemahaman seca- ra internal tentang peruntukan dana BOK; kurangnya penggu- naan data atau evidence dalam penyusunan rencana kegiatan; dan keterlambatan pencairan dana yakni sering menumpuk pada kuartal ke-4 (akhir tahun). Temuan lainnya juga menunjuk- kan bahwa tidak ada perubahan yang cukup berarti dalam hal cakupan pelayanan dan program di tingkat puskesmas jika dibandingkan dengan target SPM secara nasional. Kesimpulan: Pelaksanaan kebijakan BOK di Daerah DTPK belum menghasilkan dampak yang signifikan bagi peningkatan kinerja sistem kesehatan di daerah. Di tingkat pusat, diperlukan adanya evaluasi secara mendalam dan sistematis terkait mekanisme pengalokasian dana BOK ke daerah. Di tingkat daerah, diperlukan perbaikan yang signifikan pada sisi input, proses perencanaan dan mekanisme pengawasan untuk puskesmas dan dinas kesehatan - yang sifatnya integratif - sehingga implementasi kebijakan BOK ini nantinya dapat memberi dampak berarti bagi peningkatan kinerja sistem kesehatan daerah.

Survei Pendahuluan Biaya Tambahan Peserta BPJS Kesehatan pada Rumah Sakit Faskes BPJS Kesehatan di Jabodetabek Novianti Br Gultom; Citra Jaya; Atmiroseva Atmiroseva
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 1 (2015)
Publisher : Center for Health Policy and Management

Background: In many countries, universal health coverage rarely runs well in its first year of implementation. In this case, Indonesia is not an exception. The Jaminan Kesehatan Nasional (JKN/National Health Security) program in its first year of implementation found numerous operational obstacles. This survey investigated the presence an additional costs* paid by patient of BPJS to Health Service Provider in Jabodetabek during JKN implementation. Methodology: We conduct a face-to-face interview to 200 JKN patients in 20 hospitals in Jakarta, Bogor, Depok, Tangerang, and Bekasi (Jabodetabek) who have just received health care treatment. Results: From 200 patients, thirty seven (18.5%) paid additional cost for their health care. Ironically, additional costs are also found in public hospitals where JKN patients must pay for drugs. Twenty five JKN patients in private hospitals also pay additional costs for drugs, laboratory, medical equipment, radiology, procedures, and other services. All types of membership experienced additional cost including Premium Subsidy Recipient (PBI/the poor). In total, additional costs for inpatient care exceeds those of outpatient care. Conclusions: from 5 JKN patients, at least one must pay additional cost for their health treatment. Patients felt these additional costs as problems. In response to JKN proposal to implement cost sharing for certain health service, 87% JKN patients expressed their support. From those who supported, 65% prefer fixed-price cost sharing.Recommendation: We recommend a national scale in-depth study to obtain comprehensive inputs on cost sharing arrangements. Latar belakang: Tidak ada Universal Health Coverage yang pertama kali berjalan langsung sempurna. Program Jaminan Kesehatan Nasional (JKN) yang belum genap berusia satu tahun ternyata juga mengalami ketidaksesuaian implementasi di lapangan.Survei ini menyelidiki kesesuaian implementasi JKN dari sisi ada/tidaknya biaya tambahan yang dibayarkan oleh Peserta BPJS Kesehatan di RS wilayah Jabodetabek. Metodologi: Wawancara tatap muka mengenai pengalaman dan usulan menggunakan kuesioner kepada 200 responden yang baru saja mendapatkan pelayanan kesehatan di 20 Rumah Sakit Faskes BPJS Kesehatan di Jabodetabek. Hasil: Sebanyak 37 responden dari total 200 responden (18,5%) ditemukan membayar biaya tambahan.Ironinya, biaya tambahan ini juga terjadi di Rumah Sakit milik Pemerintah.Semua biaya tambahan di RS Pemerintah merupakan biaya tambahan obat. Sedangkan biaya tambahan di RS Swasta dialami oleh 25 responden, meliputi biaya tambahan obat, laboratorium, alat kesehatan, radiologi, tindakan, dan biaya di poli. Biaya tambahan ini dialami oleh semua jenis kepesertaan, termasuk peserta PBI, sebanyak 4peserta PBI membayar biaya tambahan di RS milik Pemerintah, 3 peserta PBI membayar di RS Swasta. Biaya tambahan pada rawat inap lebih besar daripada biaya tambahan pada rawat jalan.Peruntukan terbesar biaya tambahan adalah biaya tambahan obat.Kesimpulan: Satu dari lima peserta JKN membayar biaya tambahan di RS Faskes wilayah Jabodetabek. Biaya tambahan tersebut memberatkan dan masalah bagi mayoritas responden. Namun dari sisi usulan apabila nantinya JKN ingin menerapkan biaya tambahan pada jenis pelayanan tertentu, maka 87% dari total responden menunjukkan respons positif, yang terbanyak memilih bentuk urun biaya nominal tetap (64,5%). Rekomendasi: Survei ini merekomendasikan dilakukannya indepth study dengan skala nasional untuk mendapatkan masukan yang lebih komprehensif mengenai urun biaya pada jenis pelayanan apa saja dalam JKN.

Kebijakan Pembakaran Limbah Medis Padat dengan Insenerator di RSUD Dr. H. Moch. Ansari Saleh Banjarmasin Rusdiana HM; Hari Kusnanto; Retna Siwi Padmawati
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 1 (2014)
Publisher : Center for Health Policy and Management

Background: Hospital activities produce waste that can be the medium of transmission of diseases and environmental pollution. The waste should be destroyed. RSUD Dr. H. Moch. Saleh Ansari Banjarmasin have solid medical waste destruction policy use incinerator. Many things qualify for solid medical waste management is good and does not cause adverse effects to workers, patients, the public and environment. Objective: To determine how the use of an incinerator, waste management procedures, the efforts made to minimize the risk arising from operational incinerator at RSUD Dr. H. Moch. Saleh Ansari Banjarmasin. Methods: This study is a qualitative using case study design. Result: RSUD Dr. H. Moch. Saleh Ansari Banjarmasin established the policy implementation as refers to the government regulations. Although the separation of medical and non-medical wastes has been done, but building an incinerator close to several building. This can cause negative effects, especially for staff working close to incinerator building. Ash disposal using open dumping system. Separation of medical and non medical waste has been done. Transportation using special trolley. Transporting and burning activities are recorded and reported. Utilization of solid medical waste is carried out by former utilization infusion bottles. Officer of the incinerator only one person, sometimes not fuel available, the capacity of the incinerator and sometimes less damage. Disturbance of operational incinerator fumes and odors, especially in the mental ward. Conclusion: Some things should be included in the planning of the hospital incinerator repositioning away from the room, routine monitoring and inspection of the quality of incinerator ash and gas, manufacturing waste incinerator ash landfills are safe and supervision is supported by the decisive and obvious regulations. Latar Belakang: Kegiatan rumah sakit menghasilkan berbagai limbah yang dapat menjadi media penularan penyakit dan sumber pencemaran lingkungan. Limbah tersebut harus dimusnahkan, salah satu caranya adalah dengan insenerator. RSUD. Dr. H. Moch. Ansari Saleh Banjarmasin menetapkan kebijakan pemusnahan limbah medis padat melalui pembakaran dengan insenerator. Banyak hal dipersyaratakan untuk pengelolaan limbah medis padat yang baik sehingga tidak menimbulkan dampak buruk bagi petugas, pasien, masyarakat dan lingkungan. Tujuan: Mengetahui bagaimana pemanfaatan insenerator, prosedur pengelolaan limbah, dampak serta upaya yang dilakukan untuk memperkecil resiko yang ditimbulkan dari operasional insenerator di RSUD. Dr. H. Moch. Ansari Saleh Banjarmasin. Metode: Merupakan penelitian kualitatif dengan rancangan studi kasus. Hasil: RSUD Dr. H. Moch. Saleh Ansari Banjarmasin menetapkan kebijakan pelaksanaan pengelolaan limbah yang mengacu kepa- da peraturan pemerintah. Walaupun pemisahan limbah medis dan non medis telah dilakukan, tetapi bangunan insenerator berdekatan dengan beberapa ruangan. Hal ini dapat menimbul- kan dampak buruk terutama bagi petugas yang bekerja dekat dengan bangunan insenerator apalagi pembuangan abu hasil pembakaran menggunakan sistem open dumping. Pengang- kutan menggunakan troli khusus, kegiatan pengangkutan dan pembakaran dicatat dan dilaporkan. Pemanfaatan limbah medis padat yang dilakukan adalah dengan memanfaatkan bekas botol infus. Kendala dalam pengelolaan limbah adalah jumlah operator insenerator hanya satu orang, bahan bakar kadang tidak tersedia serta kondisi insenerator yang mempunyai kapa- sitas pembakaran kurang dan kadang mengalami kerusakan. Gangguan yang ditimbulkan dari operasional insenerator berupa asap dan bau terutama di ruang perawatan jiwa Kesimpulan : Beberapa hal sebaiknya dimasukkan dalam perencanaan rumah sakit yaitu penempatkan insenerator yang jauh dari ruangan, pemantauan dan pemeriksaan rutin kualitas abu dan gas buangan insenerator, pembuatan tempat pembuangan abu yang aman serta pengawasan yang di dukung dengan peraturan pengelolaan limbah medis padat yang tegas dan jelas.

Evaluasi Implementasi Program Jaminan Kesehatan Nasional terhadap Pasien Stroke di RSUP Dr. Sardjito Muhammad Dahlan; Ismail Setyopranoto; Laksono Trisnantoro
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 2 (2017)
Publisher : Center for Health Policy and Management

ABSTRACTBackground: Since 2014, Indonesia has implemented universal health coverage. In Indonesia, it was named as Jaminan Kesehatan Nasional or JKN. “Quality control and cost control” is the tagline of these program. Health provider such as doctors, nurses and the others health provider must control the quality and the cost of the patient’s treatment. Stroke, as one of the disease which needed such a complex treatment, must be treated as effective as possible.Aim: The aim of this study is evaluating the implementation of the JKN in stroke care especially in Central hospital. Measuring the quality of the care in stroke unit is compulsory in implementation research. Knowing acceptability and fidelity of the rules from JKN by the doctors must be described.Method: This study is mixed method with sequential explanatory design. The qualitative research was a cross sectional research which began in June 15th-July 31st. Interview from three doctors in stroke unit Sardjito General Hospital were performed to know the acceptability of the program.Result: The quality of care in Unit Stroke RSUP Dr. Sardjito from the doctors are good. Rationalization of the drugs and safety of the patients were prioritized. From that conditions the unit got a debt condition. The financial performance from one patient could get debt up to eleven million rupiahs. From the qualitative research, the acceptability of the national formulation slightly didn’t accept by the doctors. Neuro protector and another kind of drugs isn’t on the list. rtPA which can be found in the list is too expensive. Reimbursement from the BPJS was too low. Homecare as one the rehabilitation isn’t covered by BPJS. Back referral system to general practitioner isn’t accepted by the neurologist because of the lack of the facility in puskesmas or PPK I. Research and education in academic hospital didn’t do well because of the lack of patients.Conclusion: National formularies are needed to revised based on the patients need. Reimbursement from BPJS should be higher than before. Homecare patients should be guaranteed by BPJS. Keywords: Universal health coverage, stroke, quality care, implementation research ABSTRAKLatar Belakang: Era baru program asuransi kesehatan nasional mulai 1 Januari 2014 yang diselenggarakan oleh BPJS Kesehatan yang mempunyai target bahwa seluruh masyarakat telah menjadi peserta BPJS pada tahun 2019. Apresiasi diberikan kepada pemerintah atas usahanya melaksanakan JKN. Dalam pelaksanaannya, evaluasi perlu dilakukan terhadap program ini. Stroke sebagai salah satu penyakit mematikan dan perlu manajemen yang menyeluruh patut untuk dievaluasi. Penerimaan penyedia pelayanan kesehatan dalam hal ini dokter perlu diidentifikasi.Tujuan: 1) Mengukur kinerja pelayanan; 2) Mengukur kinerja keuangan; 3) mengetahui penerimaan dan ketaatan pemberi pelayanan terhadap aturanMetode: mixed method dengan desain sekuensial ekplanasi. Penelitian kualitatif merupakan cross sectional dimulai 15 Juni–31 Juli. Interview dengan tiga dokter di Unit Stroke Rumah Sakit Umum Pusat Sardjito dilakukan untuk menggambarkan penerimaan.Hasil: Mutu pelayanan penyakit stroke sudah sesuai dengan mutu standar. Rasionalisasi obat, maupun pemulangan pasien tetap sesuai standar. Performa keuangan dari Unit Stroke mengalami kerugian. Penerimaan dari para dokteer terkait beberapa aturan seperti sistem rujukan dan standar tarif belum diterima sepenuhnyaKesimpulan: Permasalahan program Jaminan Kesehatan Nasional masih terjadi. Perbedaan persepsi antara pembuat aturan dengan pemberi pelayanan masih menonjol. Performa keuangan dari unit stroke mengalami kerugian walaupun mutu pelayanan sudah dilakukan secara optimal. Sistem rujukan terutama rujuk balik belum dapat dirasa layak oleh para dokter karena keterbatasan di PPK I. Pelayanan home care yang biasa digunakan tidak dapat optimal karena peserta asuransi belum mendapatkan jaminan untuk memperoleh pelayanan home care. Kata Kunci: jaminan kesehatan nasional, stroke, quality care, implementation research

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

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