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Jurnal Ekonomi Kesehatan Indonesia
Published by Universitas Indonesia
ISSN : 25278878     EISSN : 25983849     DOI : 10.7454
Core Subject : Health, Education, Social,
Education Environmental Science Health Professions Public Health
Jurnal Ekonomi Kesehatan Indonesia, Jurnal EKI, presents scientific writings on information and updates of health economic in collaboration with Centre for Health Economic and Policy Studies (CHEPS) Universitas Indonesia and INAHEA (indonesian Health Economic Association). Jurnal EKI is published four times (four number) annually (per volume) in two languages (Bahasa Indonesia and English) electronically and printed. It includes research findings, case studies, and conceptual fields, namely: health economic, health insurance, health administration/policy, pharmaco-economic, and Health Technology Assessment (HTA).
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Articles 6 Documents
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Search results for , issue "Vol 1, No 1 (2016)" : 6 Documents clear
People’s Support on Sin Tax to Finance UHC in Indonesia, 2016 Hasbullah Thabrany; Zahrina Laborahima
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (275.547 KB) | DOI: 10.7454/eki.v1i1.1759

Abstract

AbstractIndonesia has the highest prevalence of smokers with 67% of adult males were smokers. Smoking prevalence among all adults increased sharply from 27% in 1995 to 36.3% in 2013. High consumption of cigarettes has been correlated with low price and excise of cigarettes. Experiences from other countries showed that one of the most effective way to reduce cigarette consumption is by increasing cigarette price and excise. Burden of tobacco related diseases has increased. The health burden will increase claims of JKN or Universal Health Coverage which currently has claim ratio of 115% and the quality of care remain low. The difficulties in collecting contribution from non salaried workers are blamed to contribute the deficit. Many countries have earmarked cigarette excise to supplement financing of (UHC) both in tax-funded system or in social health insurance system. The question is do people support? This study explored the possibility the people’s support to increase cigarette prices and excise to meet financial shortage of the JKN.ObjectivesThis polling conducted to explore cigarette consumption and supports of price increase to finance JKN or UHC.MethodsThis study used telephone polling conducted form December 2015 to January 2016. The sample (n=1,000) was randomly selected using systematic random by the interval of 20,000 of mobile phones numbers. Analysis is focused on how various groups support incrasing cigarette prices and excise. The final analysis is logistic regression to assess any difference in supporting the excise increase.Results and DiscussionThe polling (65.9% males and 3.3% females) showed 41.3% respondents consume 1-2 pack cig­arette per day with spending of IDR 450 – 600 thousands per month. In total, 80.3% respondents support increasing cigarette price and exice to supplement health financing of JKN. The proportion of non smokers who supported the earmarking was higher (83.4% ) compared to smokers (75.9%), but the difference is not significance in the final model. The proportion of smokers who know that cigarette is harmful reached 96.8% but the large majority of them had difficulties to quit smoking. There are plenty of room to mobilize money through increasing price and excise of cigrettes since more than 72.3% of smokers said that they would stop smoking if the price of cigarette is above IDR 50,000 per pack; far above current prices. If the prices of cigarettes are double and the excise level reaching maximum allowable levels, there is potential to increase revenue up to IDR 70 Trillion that is almost equivalent to estimate all claim of JKN in 2016. In the logistic model, all groups of respondents unanimously support increasing prices and excise of cigarettes to finance JKN.ConclusionThe prevalence of cigarette smoking is high because of prices of cigarette is relatively cheap and the excise levels have not reduced consumption. This study found that large majority (80%) of non smokers and 76% smokers supported increasing cigarette prices and excise to supplement financing for the JKN. The potential money to supplement JKN is double of the current revenue of JKN.
Terapi Sistemik Defisit JKN: Bahan Refleksi Bagi Semua Pihak Budi Hidayat
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (260.545 KB) | DOI: 10.7454/eki.v1i1.1869

Abstract

Defisit layak disandang sebagai penyakit kronis JKN. Indikasi defisit terungkap dari angka rasioklaim. Pada tahun 2014 dan 2015 angka rasio klaim selalu berada diatas 100%. Angka ini merupakan hasil pembagian biaya klaim (atau biaya kesehatan peserta) dengan pendapatan iuran. Dengan demikian rasio klaim menggambarkan penyerapan dana iuran untuk biaya kesehatan saja. Padahal pendapatan iuran juga harus dialokasikan untuk biaya operasional dan cadangan. Defisit JKN akan terus bergulir jika terapi sistemik nihil. Untuk tahun 2016, hasil estimasi penulis dengan merujuk pada asumsi besaran iuran sesuai Peraturan Presiden No 28/2016 (Sekretariat Kabinet, 2016) dan tarif pelayanan Permenkes 59/2014 (Menteri Hukum dan Hak Asasi Manusia, 2014) menemukan angka rasio klaim 101%. Artinya, pendapatan iuran masih kurang meski hanya untuk mendanai pelayanan kesehatan. Dari mana sumber dana untuk mendanai biaya operasional? Apakah JKN hanya mengandalkan suntikan dana pemerintah? Label penyakit kronis defisit layak disandang oleh JKN. Apa obatnya?
A Comparative Budget Requirements for TB program based on Minimum standard of Services (SPM) and Budget Realization: an Exit Strategy Before Termination of GF ATM Ery Setiawan; Purwa K Sucahya; Hasbullah Thabrany; Kalsum Komaryani
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (273.53 KB) | DOI: 10.7454/eki.v1i1.1761

Abstract

AbstractIt has become a common issue that the Global Fund (GF) as one of the largest international donors to AIDS, Tuberculosis, and Malaria Program will immediately stop the funding. Data shows that in 2009 GF ATM support reached 88,8% while APBN funding just cover 11,2% of the total budget needed. Howev­er, APBN budget for ATM programs was significantly increased in 2012 which covered almost 30% of the total budget. Eventhough the increasing trend of ATM budget seemed at the central government level, how­ever the local governments will hold the key to the sustainability of the post- termination GF ATM FundingObjectivesThis study aimed to get a picture of the local government’s commitment as an implementing insti­tution to respond the financing needs specifically for TB programs.MethodsThis economic evaluation compared the amount of the existing budget of local governments and the amount needed based on the Minimum Standards of Services (MSS) of TB Programs. We sampled two district in west java that were Cirebon and Garut. The cost component calculated in these evaluation were: medicines, medical supplies, case findings, and administrative cost.Results and DiscussionTotal budget needed in Garut according to MSS amounted 2,5 Billion Rupiahs, whereas the total budget which has been alocated approximately 2 Billion Rupiahs. For those budget allocated in Garut, 90% of the total was supported by the Government then the rest of that was supported by GF. A similar trend showed in Cirebon, which was found a budget shortage amounted 700 Million Rupiahs from approximate­ly 1,6 Billion Rupiahs budget needed and 80% of those was sourced by The Government. The particular finding showed that prevention and case detection program in Garut still dominated by GF support which slightly above 65%. Otherwise, budget allocated for those Activity in Cirebon has been dominated by the government approximately 80%.ConclusionIn general, both Garut and Cirebon faced two common challenges in terms of financing the TB program. First, the high shortage between needs and budget alocated of the program becomes an important concern for addressing TB cases reduction in related district. The second is program’s sustainibility after termination of Global Fund, particularly for prevention and case detection programs. Therefore, it might be need a support from NGO or other related institution to advocate the local government and DPRD to allocate more budget for reducing TB cases.  
Application of Decision Analytic Model in Health Economic Evaluation: Smoking Cessation Cases septiara putri
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (593.372 KB) | DOI: 10.7454/eki.v1i1.1762

Abstract

  Health economic evaluation that encompasses decision analytic model is a beneficial approach for assisting decision maker to choose the best health intervention for patients. Decision analytic model has been increasingly applied in health economic evaluation. This mathematical approach is mostly used for conducting cost-effectiveness of healthcare interventions.Decision tree and Markov model has been widely applied in the past 20 years. Decision tree is the simplest form of decision model that drawn by the series of branches and clear pathways. Meanwhile, Markov model is one of the powerful approaches that employ stochastic process in health economic eval­uation. This paper describes the applications of those two models in tobacco cessations, specifically for pharmacological interventions.First, decision tree for cost-effectiveness of smoking cessation program with pharmacist and thera­pies interventions compared to no program or self-aid cessation. Second, the application of Markov model estimates cost-effectiveness of veranicline, in comparison to bupropion. Markov model is constructed with morbidity and mortality states that consists of: well/no morbidities, lung cancer, COPD, stroke, myocar­dial infarction, and dead. This paper provides step by step of populating and constructing the model-with some modification of data. Several sections discuss the understanding of transition probabilities, costs data, cohort simulation, and the role of sensitivity analysis. Other models, despite deterministic approach, prob­abilistic approach are also reviewed.Both of models had both advantages and limitation that analysts should be aware of. Translating the ‘real world’ to mathematical model yields beneficial and insightful information for analysts. In addition, it could fulfill the need of evidence-based policy by decision maker. From simulation, the model may easy to be replicated-with appropriate context to generate evidence related health and costs.
Biaya dan Outcome Hemodialisis di Rumah Sakit Kelas B dan C firda tania; Hasbullah Thabrany
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (345.53 KB) | DOI: 10.7454/eki.v1i1.1763

Abstract

 Gagal Ginjal Kronis (GGK) merupakan kondisi yang semakin meningkat kejadiannya di Indone­sia, menghabiskan banyak dana publik Jaminan Kesehatan Nasional (JKN). Dalam program JKN, hemodi­alisis (HD) untuk penanganan GGK dijamin tetapi perleu keseimbangan antara biaya dan outcome. Sejak 2014, BPJS menanggung hampir seluruh biaya HD di Indonesia dengan besaran tarif Casemix Base Group (CBG) yang berbeda menurut kelas Rumah Sakit (RS). Tujaun dari penelitian ini adalah untuk mengetahui perbedaan biaya Hemodialisis pada Rumah Sakit Kelas B dan Kelas C.Studi evaluasi ekonomi ini dilakukan di dua RS dengan kelas berbeda: kelas B (RS B) dan kelas C (RS C) dengan perbedaan kepemilikan. Kepemilikan RS B adalah pemerintah daerah sedangkan RS C dimiliki oleh yayasan swasta. Outcome HD diukur dengan suatu survey ke pasien HD. Analisis outcome dilakukan dengan penilaian kualitas hidup (instrumen EQ-5D) dengan Indeks EQ, EQ VAS, intermediate outcome berupa rerata Intra Dialytic Weight Loss (IDWL), dan rerata Hb. Perbedaan rerata nilai hasil diuji dengan Student’s t-test. Responden dipilih dari pasien GGK yang menjalani HD di kedua RS selama Feb­ruari-April 2016. Analisis biaya menurut perspektif pasien, meliputi biaya langsung medis, biaya langsung non medis, dan biaya tidak langsung. Biaya sebenarnya yang dikeluarkan oleh RS dikumpulkan dari doku­men RS. Studi kualitatif tambahan dilakukan dengan wawancara mendalam kepada informan kunci di RS yang bertanggung jawab atas unit HD. Pada penelitian ini, total responden sebanyak adalah 100 orang (di RS B 76 orang & di RS C 24 orang). Menurut perspektif pasien, biaya langsung medis HD selama sebulan di RS B Rp 5.215.331 dan di RS C Rp 7.781.744. Besaran tarif CBG untuk RS kelas B adalah Rp 962.800 dan kelas C adalah Rp 893.300. Menurut perspektif RS, tidak terdapat perbedaan biaya operasional HD antar kelas RS. Biaya langsung non medis HD selama sebulan di RS B Rp 566.260 dan di RS C Rp 334.500. Biaya tidak langsung HD selama sebulan di RS B Rp 165.530 dan di RS C Rp 45.830. Rerata total biaya HD selama sebulan di RS B Rp 6.149.285 dan di RS C Rp 8.162.077. Pada intermediate outcome didapatkan bahwa rerata Hb pada RS B sebesar 10,26 g% berbeda secara signifikan dengan RS C (8,21 g%), p= 0,000. Rerata IDWL pada RS B (0,0403) tidak berbeda secara signifikan dengan RS C (0,0438), p= 0.188. Rerata EQ Indeks sebesar 0,7178 dan EQ VAS sebesar 64,74 di RS B tidak berbeda secara signifikan dengan rerata EQ Indeks sebesar 0,7208 dan EQ VAS sebesar 64,79 di RS C, dengan p value secara berurutan p=0,94 dan p= 0,986
Evaluasi Pengadaan Obat Publik Pada JKN Berdasarkan Data e-Catalogue Tahun 2014-2015 Ary Dwiaji; Prih Sarnianto; Hasbullah Thabrany; Muhammad Syarifudin
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 1 (2016)
Publisher : Fakultas Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (205.077 KB) | DOI: 10.7454/eki.v1i1.1933

Abstract

AbstrakSejak dimulainya JKN, pengadaan obat di fasilitas pelayanan kesehatan (faskes) publik dilaku- kan dengan e-Purchasing melalui e-Catalogue. Didasarkan pada RKO dan HPS, penyusunan e-Catalogue dilakukan melalui proses lelang dan negosiasi harga. Rantai proses tersebut akan berdampak pada jenis (molekul) dan jumlah obat yang tayang dalam e-Catalogue maupun jumlah dan volume permintaan oleh faskes publik (e-Order).TujuanPenelitian bertujuan untuk mengevaluasi e-Order menurut kategorisasi obat, yaitu generik (OGB) dan dengan merek dagang (OMD), pada data e-Catalogue 2014-2015.MetodePada penelitian ini dilakukan pula wawancara dengan pegawai LKPP yang berwenang dalam peny- usunan e-Catalogue. Evaluasi dilakukan dengan menganalisis profil penawaran obat JKN (e-Catalogue atau RKO) dan kesenjangannya dengan permintaan oleh fasilitas kesehatan publik, baik pada kelompok OGB maupun OMD.Hasil Penelitian dan PembahasanHasil analisis deskriptif menunjukkan bahwa dalam e-Catalogue, pada 2014 ditawarkan 800 item obat (50,3% OGB; 49,7% OMD) dari 73 perusahaan farmasi dan, pada 2015, sedikit menurun jadi 795 item obat (40,4% OGB; 59,6% OMD) dari 79 perusahaan farmasi. Di sisi lain, e-Order pada 2014 tercatat Rp1.199,01 miliar (71,9% OGB, 28,1% OMD) untuk 1.928,50 juta satuan obat terkecil (98,2% OGB; 1,8% OMD) dan, pada 2015, mengalami peningkatan jadi Rp3.201,44 miliar (48,4% OGB; 51,6% OMD) untuk 3.175,78 juta satuan obat terkecil (96,8% OGB; 3,2% OMD). Rerata harga OMD pada 2014 dan 2015 itu masing-masing Rp9.978,04 dan Rp15.957,70 per satuan obat terkecil, sekitar 20 sampai 30 kali lipat rerata harga satuan OGB yang hanya Rp454,86 dan Rp504,19 per satuan obat terkecil. Hasil analisis juga menunjukkan adanya kesenjangan antara RKO dan e-Order yang, menurut data kualitatif, terutama berakar dari penetapan RKO dan HPS serta penayangan e-Catalogue yang tidak memberikan cukup waktu bagi pemenang lelang untuk mempersiapkan obat dalam jumlah yang sesuai dengan komitmen, pada saat dibutuhkan oleh fasilitas kesehatan.KesimpulanGuna mengatasi masalah mendasar ini, perlu dilakukan penyempurnaan dalam penetapan RKO dan HPS serta dibuat kesepakatan terkait alur dan jadwal penyusunan e-Catalogue.

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