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Jurnal Ekonomi Kesehatan Indonesia

jurnal-eki
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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 103 Documents

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Timbang Besarnya Manfaat dari Salah Sasar Penerima Bantuan Iuran Jaminan Kesehatan Prastuti Soewondo
Jurnal Ekonomi Kesehatan Indonesia Vol 2, No 2 (2017)
Publisher : Fakultas Kesehatan Masyarakat

Abstrak Salah satu kebijakan pemerintah dalam percepatan capaian Jaminan Kesehatan Semesta bagi seluruh penduduk adalah memberikan keringanan keuangan dengan membayarkan iuran Jaminan Kesehatan bagi 92.4 juta masyarakat miskin dan rentan kemiskinan yang mewakili sekitar 35% dari total populasi. Kelompok masyarakat ini disebut sebagai Penerima Bantuan Iuran (PBI). Studi ini mengkaji seberapa banyak masyarakat miskin dan rentan yang telah menerima kebijakan pemerintah dalam pemberian subsidi jaminan kesehatan. Data penelitian menggunakan data Survei Sosial Ekonomi Nasional tahun 2016, khususnya data konsumsi rumah tangga dan status kepemilikan berbagai jenis jaminan kesehatan. Hasil menunjukkan bahwa, pada tingkat nasional, bantuan subsidi iuran jaminan kesehatan telah dinikmati oleh mayoritas (51%) rumah tangga miskin dan rentan kemiskinan, terlebih lagi rumah tangga yang tinggal di wilayah Timur Indonesia (58%). Bersama dengan Jamkesda, 59,5% rumah tangga miskin dan rentan kemiskinan (66,4% di wilayah Timur) telah menerima manfaat proteksi jaminan kesehatan. Capaian kebijakan pemerintah ini patutlah dicatat, walaupun level cakupan harus terus ditingkatkan. Janganlah ini ditutupi oleh isu salah sasaran PBI ke sekitar 3% rumah tangga kaya yang dibesar-besarkan untuk menarik perhatian massa. Abstract One of the foremost government policies implemented in achieving Universal Health Coverage for the Indonesian population is the provision of financial assistance through contribution of Social Health Insurance for 92.4 million targeted poor and near poor households. This segment of the population is referred to as Penerima Bantuan Iuran (PBI) and represents about 35% of the total population. This study reveals the government’s progress in protecting the health of this sub-population. The data is derived from the 2016 National Social Economic Survey. The results indicate that, at the national level, the government’s health protection program has reached the majority of poor and near poor household (51%), especially those residing in Eastern part of the country (58%). Together with local government’s support, 59.5% of poor and near poor households (66.4% in Eastern region) have been insured. While improvements in coverage should still be top policy agenda, this achievement of the government deserves more appreciation. We show that misallocation of PBI to wealthy households is only small (3%), yet often broadcasted with much hype to create agitation.

Analisis Faktor-Faktor yang Berhubungan dengan Tingginya Rujukan Kasus Non Spesialistik Pasien Jaminan Kesehatan Nasional pada Puskesmas di Kabupaten Sukabumi Tahun 2015 Masykur Alawi; Purnawan Junadi; Siti Nur Latifah
Jurnal Ekonomi Kesehatan Indonesia Vol 2, No 1 (2017)
Publisher : Fakultas Kesehatan Masyarakat

AbstrakPuskesmas sebagai garda terdepan dalam pelayanan kesehatan dasar diharuskan menuntaskan kasus-kasus non spesialistik. Namun, data laporan BPJS Kesehatan pada tahun 2015 menunjukkaan adanya 11.487 rujukan kasus non spesialistik dari 58 Puskesmas di Kabupaten Sukabumi. Tujuan penelitian ini adalah mengetahui faktor-faktor yang berhubungan dengan tingginya rujukan kasus non spesialistik pasien JKN pada puskesmas di Kabupaten Sukabumi tahun 2015. Penelitian menggunakan desain cross sectional, pada sampel 58 Puskesmas dengan satu orang dokter dari setiap Puskesmas dengan menggunakan whole sampling. Hasil analisis data didapatkan ada hubungan antara wilayah (nilai p=0,000); kecukupan obat (nilai p=0,040);kecukupan alat kesehatan (nilai p=0,024) dan jarak puskesmas (nilai p=0,003) dengan rujukan kasus non spesialistik. Perlu adanya pemenuhan obat-obatan, alat kesehatan sesuai standar Puskesmas dan monitoring dan evaluasi rujukan kasus non spesialistik dari Puskesmas dan BPJS Kesehatan. AbstractPublic Health Center is the frontline in the basic health services that include non-specialist cases to be solved in this primary health care level. However, a report from BPJS Kesehatan in 2015 showed that there were 11.487 referral of non-specialist cases in Primary Health Cares (PHCs) in Sukabumi. This study was to determine factors associated with high referral rate of National Health Insurance’s members with non-specialist cases by PHCs in Sukabumi in 2015. The study employed cross-sectional design in 58 PHCs along with a general practitioner in each centers using a whole sampling. The result showed that there were correlation between characteristics of the region (P=0,000); adequacy of drug (P=0,040); adequacy of medical devices (P=0,024); and distance from the PHCs to the referral health care facilities (P=0,003) with non-specialist cases referral rate. It is recommended for the PHCs to meet the needs of drugs, medical devices according to the standard, monitor and evaluate the non-specialist referral cases, both from health centers and the Social Security Agency for Health of Sukabumi.

Analisis Hasil Koding yang Dihasilkan oleh Coder di Rumah Sakit Pemerintah X di Kota Semarang Tahun 2012 Dewi Indah Yuniati
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 4 (2017)
Publisher : Fakultas Kesehatan Masyarakat

AbstrakCoder mempengaruhi penerimaan rumah sakit karena kemampuannya dalam menetapkan kode menggunakan ICD untuk mengkode diagnosa dan prosedur yang tercatat didalam dokumen rekam medis. Penelitian ini bertujuan untuk mengetahui perbedaan hasil koding coder di Rumah Sakit Pemerintah X Semarang dan potensi kerugian yang mungkin terjadi. Metode yang digunakan adalah kuantitatif, melibatkan 6 orang coder yang dibagi menjadi 2 kelompok yaitu standar dan uji, berdasarkan masa kerja dan pelatihan yang pernah diikuti. Hasil koding dan besaran klaim antar kelompok dibandingkan. Dari penelitian didapatkan kompetensi coder perlu ditingkatkan karena rerata hasil tarif lebih rendah dari kelompok standar yang tinggi 32,6%, berpotensi menurunkan pendapatan rumah sakit rata-rata sebesar 4,2% dari klaim yang seharusnya diterima. AbstractCoders affect hospital revenue due to their ability to determine specificcode using ICD for diagnoses and procedures stated in medical record. This study aimed to determine the competence of coder in X Hospital and potential losses that may occur. Quantitative method was used in this study, involving 6 coders who were divided into 2 groups: standard and test groups, based on years of experience and followed trainings. Coding results and the amount of the claim were compared between groups. The study showed coder‘s competence still needs to be improved. This was characterized by a high average undercoding result that reached 32.6% and potentially loweringhospital revenue by an average of 4.2% of claims that should be obtainedby the hospital.v

Analisis Pembiayaan Kesehatan Daerah Bersumber Publik: Studi Kasus di Dinas Kesehatan Kabupaten Bogor Tahun 2012, 2013 dan 2014 Tuti Handayani; Mardiati Nadjib
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 2 (2016)
Publisher : Fakultas Kesehatan Masyarakat

AbstrakPenelitian ini bertujuan untuk melihat gambaran realisasi belanja kesehatan di Dinas Kesehatan Kabupaten Bogor dengan melihat peruntukannya menurut empat dimensi DHA di tahun 2014 dengan melihat trend 2012 dan 2013. Penelitian ini mengambil data sekunder realisasi belanja kesehatan yang kemudian diolah dan disajikan menurut sumber biaya, pengelola anggaran, penyedia pelayanan, dan program. Studi ini menggunakan desain penelitian deskriptif dengan pendekatan evaluatif, dilakukan di Dinas Kesehatan Kabupaten Bogor. Analisis menunjukkan bahwa total pembiayaan kesehatan di Dinas Kesehatan Kabupaten Bogor bersumber publik tahun 2012 berjumlah Rp289.069.378.168,- tahun 2013 jumlahnya meningkat menjadi Rp 338.469.794.825,- dan di tahun 2014 yang jumlahnya menurun menjadi Rp 337.451.928.421,-. Dilihat dari peruntukkannya, program kegiatan yang belanjanya paling dominan, di tahun 2012, adalah program pembiayaan kesehatan yaitu sebesar 36,29% yang juga masih terlihat masih dominan di tahun 2013 di mana porsinya mencapai 39,48%, namun di tahun 2014, belanja pembiayaan kesehatan porsinya menurun secara signifikan menjadi hanya 23,69%, Adapun belanja terbesar belanja kesehatan tahun 2014 ini adalah untuk program administrasi dan manajemen yaitu sebesar 30,92%.AbstractThis study aimeds to look at the picture of health expenditures in Bogor District Health Office to see the allotment according to the four dimensions of District Health Accounts (DHA) in 2014 to see the trend in 2012 and 2013. This study took data from a secondary data source realization of health spending that was then processed and presented according to the funding source, budget managers, service providers, and programs. The study used a descriptive research design with evaluative approach and conducted in Bogor District Health Office. Analysis showed that the total health financing in Bogor District Health Department public sources in 2012 amounted to Rp 289.069.378.168 , - in 2013 the number increased to Rp 338 469 794 825 , - and in 2014 that number was dropped to Rp337.451.928.421 , - . The funding in 2012 and 2013 came from the state budget, district budget and provincial budget, whereas in 2014 from the state budget , district budget , provincial budget and other public funds . Judging from its designation, The most dominant spending, in 2012 , is health financing programs spent of 36.29 % , in 2013 also still dominant health financing program , its share reached 40.09 % , and in 2014 expenditure on health financing portion significantly decreased to only 23.69 %, with the largest health spending in 2014 was for program administration and management , that was 30.92 %.

Perkembangan Asuransi Kesehatan Swasta di Indonesia 2012 – 2016 Kurnia Sari
Jurnal Ekonomi Kesehatan Indonesia Vol 2, No 2 (2017)
Publisher : Fakultas Kesehatan Masyarakat

Abstrak Total belanja asuransi swasta di tahun 2015 sekitar 3,9% dari pengeluaran kesehatan Indonesia. Walaupun tidak cukup besar, informasi tentang asuransi kesehatan swasta di Indonesia masih terbatas. Kajian ini ditujukan untuk memberikan gambaran perkembangan perusahaan asuransi kesehatan swasta di Indonesia. Jumlah perusahaan asuransi swasta dalam beberapa tahun terakhir tidak banyak tumbuh, sementara jumlah kepesertaannya cenderung fluktuatif dalam 5 tahun terakhir, bahkan turun untuk kelompok asuransi kerugian. Uang pertanggungan cenderung naik sampai tahun 2014, lalu stagnan pada periode berikutnya. Jumlah premi yang diterima perusahaan dan klaim yang harus dibayarkan cenderung naik, dengan rasio klaim yang cukup tinggi pada asuransi kerugian dan dalam batas wajar untuk asuransi jiwa. Tidak dapat dipungkiri bahwa program pemerintah untuk mencapai universal health coverage merupakan sebuah ancaman bagi pihak asuransi swasta.AbstractTotal private insurance spending in 2015 is about 3.9% of Indonesia’s health expenditures. Although it is not considerably high, the information about private health insurance in Indonesia is still limited. This review is aimed to provide an overview of the private health insurance company growths in Indonesia. The number of private insurance company does not grow significantly, while the number of membership tends to fluctuate in the last 5 years, even it is tend to decrease for non life insurance category. Sums assured tend to rise until 2014, then stagnant for the next period. The amount of premium received by the company and claims to be paid (claim ratio) is considerably increase. It could not be denied that government program for achieving the universal health coverage is a threat to private insurance.

Malnutrition in Eastern Indonesia: Does food access matter? arina nur fauziyah
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 2 (2016)
Publisher : Fakultas Kesehatan Masyarakat

AbstrakMeningkatnya prevalensi kekurangan gizi dan kelebihan berat badan di Indonesia Timur menimbulkan dugaan bahwa keterbatasan akses pangan, baik dari sisi akses ke pasar maupun akses secara ekonomi berpengaruh terhadap beban ganda malnutrisi. Studi ini bertujuan untuk menganalisis pengaruh akses pangan terhadap kekurangan gizi pada balita dan kelebihan berat badan individu dewasa serta kemungkinan terjadinya beban ganda malnutrisi dalam satu rumah tangga di Indonesia Timur. Dengan menggunakan data IFLS East tahun 2012 dan metode estimasi probit serta probit with sample selection, hasil studi menemukan bahwa keterbatasan akses pangan secara ekonomi, dari sisi pendapatan dan harga pangan pokok tidak hanya meningkatkan kemungkinan kekurangan gizi pada anak balita, tetapi juga dapat beban ganda malnutrisi dalam satu rumah tangga. Hasil studi ini mengimplikasikan bahwa diperlukan kebijakan yang berbeda antara satu daerah dengan daerah lainnya karena kecenderungan malnutrisi yang dialami juga berbeda. Selain itu, diperlukan pula upaya peningkatan pendapatan masyarakat serta kebijakan stabilisasi harga pangan, terutama pangan pokok untuk mengatasi malnutrisi, termasuk menurunkan kemungkinan beban ganda malnutrisi dalam satu rumah tangga di Indonesia Timur.AbstractThe increasing of underweight and overweight prevalence in Indonesia represented that Indonesia faces double burden of malnutrition. From these fact, we suggest that lack of food access, either geographically or economically leads to adult’s overweight, but in other side child tends to be underweight. This study aimed to analyze the impact of food access to child undernutrition, adult overweight, and possibilities of the occurrence of household double burden of malnutrition in the Eastern of Indonesia. Using IFLS East Data 2012 and estimate with probit and probit with sample selection, this study found that lack of food affordability lead to malnutrition. These result imply that the policies are needed to tackling malnutrition in the Eastern of Indonesia should be different between each province and also needed policy to increase income and stabilizing food price.

Analisis Implementasi Kebijakan Rujuk Balik Diabetes Melitus di Puskesmas X Kota Tangerang Selatan Aries Hamzah; Wahyu Sulistiadi
Jurnal Ekonomi Kesehatan Indonesia Vol 1, No 3 (2017)
Publisher : Fakultas Kesehatan Masyarakat

Abstrak Peningkatan Prevalensi Diabetes Melitus akan berdampak kepada tingginya pembiayaan kesehatan di Era Jaminan Kesehatan Nasional. Peran Puskesmas sebagai ujung tombak pelayananan kesehatan dalam implementasi rujuk balik Diabetes menjadi sangat penting. Tujuan Penelitian ini untuk mengetahui efektifitas implementasi kebijakan rujuk balik Diabetes Melitus di Puskesmas X tahun 2014. Penelitian ini menggunakan pendekatan kualitatif dengan Desain Studi content analysis dan metode triangulasi. Data primer didapatkan dengan waw¬ancara mendalam, diskusi kelompok terarah, dan pengamatan di lapangan. Data sekunder didapatkan dari dokumen kebijakan dan literatur. Hasil penelitian menunjukkan adanya ketidakefektifan implementasi kebijakan rujuk balik Diabetes Melitus di Puskesmas X. Hasil peneli¬tian ini merekomendasikan untuk menyempurnakan kembali regulasi yang ada selama ini agar rujuk balik diabetes mellitus dapat berjalan efektif dan tidak terjadi kesenjangan dalam implementasi kebijakan rujuk balik diabetes di masa mendatang. Abstract The Increasing of Prevalence of Diabetes Mellitus will increase health expenditure in Universal Health Coverage (JKN). The role of health primary care as the front side in health services on back referral for Diabetes disease becomes very important. The purpose of this study was to determine the effectiveness of policy implementation in Diabetes Mellitus back referral behind PHC X 2014. This study used a qualitative approach to the study design content analysis and triangulation methods. Primary data obtained by in-depth interviews, focus groups, and observations in the field. Secondary data were obtained from policy documents and literature. The results showed ineffectiveness of policy implementation in Diabetes Mellitus back referral in X Primary Health Care. This study recommends to revise and make the existing regulations comprehensive in order to the implementation can be effective and further, there is no gap in Diabetes back referral policy implementation.

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

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.

Analisis Praktik Koordinasi Manfaat (Coodination of Benefit) Layanan Rawat Inap di Indonesia Fera Mutiara Dewi; Budi Hidayat
Jurnal Ekonomi Kesehatan Indonesia Vol 2, No 2 (2017)
Publisher : Fakultas Kesehatan Masyarakat

Abstrak Kepemilikan lebih dari satu asuransi (double insured) telah membuka peluang praktik Coordination of Benefit (COB) di Indonesia. Pada era JKN saat ini, setiap orang selain memiliki asuransi yang bersifat wajib mereka pun memiliki asuransi kesehatan tambahan yang kepesertaanya bersifat tidak wajib. Pada praktiknya, beberapa penerapan COB masih ditemukan belum sesuai dengan prinsip universal asuransi. Penelitian ini bertujuan untuk menganalisis praktik COB dan besaran biaya COB yang terjadi di Indonesia. Metode yang digunakan adalah rancangan studi observasional dengan desain cross sectional. Pemodelan dengan ekonometrik (two-part model) dilakukan untuk memisahkan proses antara praktik COB dengan besaran biaya COB. Hasil penelitian menyatakan kovariat Usia, LOS dan penyakit sistem sirkulasi menunjukkan efek yang signifikan dalam pengujian secara statistik. Kurangnya koordinasi antar provider dengan asuradur atau asuradur dengan asuradur yang lain menyebabkan meningkatnya potensi moral hazard yang dilakukan baik oleh peserta maupun provider sehingga peserta berpotensi mendapatkan cakupan ganda. Perlu dibuat organisasi khusus untuk mengelola COB dan dibuatnya regulasi COB.AbstractNowadays, some people may have double insurance. Besides having compulsory insurance that regulated by government, they also have additional health insurance which is not mandatory. This condition has opened up opportunities for Coordination of Benefit (COB) in Indonesia, especially in JKN era. Unfortunately, in practice COB still not executed according to the principle of general rules of insurance. This research seeks to analyze the practice of the COB and COB fee scale in Indonesia. The method used is the observational study with cross sectional design. The modeling uses an econometric approach that is a two-part model which separates the process between the COB practice and the COB funds. The result of the research states that age covariate, LOS, and circulatory system diseases show significant effects in statistical testing. Lack of coordination between providers and assurer or between assurer and assurer, causes increasing potential moral hazard by both participants and providers so that participants may get double coverage. The suggestions of this research are first the need to create an independent organization that manages COB and second the need to made regulation of COB.

Determinan Harapan Peserta Jaminan Kesehatan Nasional Terhadap Layanan Di Klinik Pratama Kota Depok Periode Mei Tahun 2016 Baiq Qurrata Aini; Rita Damayanti
Jurnal Ekonomi Kesehatan Indonesia Vol 2, No 1 (2017)
Publisher : Fakultas Kesehatan Masyarakat

Abstrak Hasil survei kepuasan peserta Jaminan Kesehatan Nasional (JKN) terhadap pelayanan klinik yang dilakukan pada tahun 2014 mencapai sekitar 80% dan melampaui target Road Map Menuju Jaminan Kesehatan Nasional. Namun, masih banyak keluhan yang disampaikan peserta JKN seperti pada laporan YLKI, situs resmi Kemenpan, dan lain-lain. Penelitian ini bertujuan untuk mendapatkan informasi mengenai determinan harapan peserta BPJS Kesehatan terhadap layanan di Klinik Pratama Kota Depok Periode Mei Tahun 2016. Penelitian ini mengkombinasikan antara penelitian kualitatif dengan penelitian kuantitatif. Desain penelitian ini adalah sequential exploratory yang diawali dengan penelitian kualitatif dan dilanjutkan dengan penelitian kuantitatif. Dari hasil analisis data didapatkan bahwa ada hubungan antara pendidikan (nilai p= 0,02), personal needs (nilai p= 0,01), word-of-mouth (nilai p = 0,001), dan past experience (nilai p = 0,001) dengan tingkat harapan peserta BPJS terhadap layanan di klinik pratama Kota Depok periode Mei tahun 2016. Faktor yang paling dominan mempengaruhi tingkat harapan peserta BPJS terhadap layanan di klinik pratama Kota Depok periode Mei tahun 2016 adalah personal needs(r =0,919).Abstract The score of JKN member’s satisfaction in primary clinic in 2014 reached as high as 80%, which means that it achieved the target of Jaminan Kesehatan Nasional’s (JKN) Road Map. However, there were still many complaints coming from the BPJS customer as shown in YLKI report and in Kemenpan official website regarding unfulfillment of their expectations. This study aimed to obtain information about the determinant of member’s expectation to the service of primary clinic in Depok (May 2016). This study combined qualitative and quantitative study by sequential exploratory, which was started by qualitative study to explore the phenomena and then followed by quantitative design. The number of participants in the qualitative and quantitative study were 12 and 203, respectively. The result showed that there were no correlation between gender, age, and occupation with the level of their expectation. On the other hand, there were correlation observed between the level of education, personal need, word-of-mouth, and past experience with the level of their expectation. The most dominant factor that influences the level of respondent’s expectation was personal need, which means that the higher respondent frequency to visit primary clinic to get treatment when sick, the higher the level of respondent expectation.

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