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INDONESIA
Jurnal Kebijakan Kesehatan Indonesia
Published by Universitas Gadjah Mada
ISSN : 2089 2624     EISSN : 2620 4703     DOI : -
Core Subject : Health,
Public Health
Arjuna Subject : -
Articles 7 Documents
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Search results for , issue " Vol 2, No 02 (2013)" : 7 Documents clear
EVALUASI KEBIJAKAN BEROBAT GRATIS DI KABUPATEN TANJUNG JABUNG TIMUR PROPINSI JAMBI Juanita, Hendriyanto Julita Hendrartini
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Abstract

Background: In the decentralized era, local government haswider authority to decide policies relevant with local needs.For this reason the Regent of Tanjung Jabung Timur District in2005 issued a decree on free medication at the health centerand secondary health center. However there are problemswith the sources and allocation of budget to support the decree.Besides, there is also a problem with target of the programfunded by the government. Therefore there should be anevaluation to find out facts for future improvement.Objective: The study aimed to identify mechanisms of funding,relevance of target and efficiency of the policy.Method: This was an explanatory case study which usedquantitative and qualitative approaches. Analysis units of thestudy were local government, health center and secondaryhealth center; and the subject were members of localparliament, head of health office, head of local planning council,head of health centers, staff of health centers/secondary healthcenters and the community. The size of samples to measuretarget relevance was determined using stratified sampling;qualitative method was determined using purposive sampling.Data were obtained through questionnaire, in-depth interviewand document checklist. Data were analyzed qualitatively andquantitatively in proportion.Result: Local government of Tanjung Jabung Timur allocatedbudget in the form of operational fund of health centers, drugallocation and incentives. The realization of budget was delayedso that health centers used alternative financial resources,i.e. budget of health insurance for poor community. Operationalfund did not give much support for free medication when therewas no clear cut distinction between users of health insurancefor poor communities and free medication. This caused overlapin budgeting which might end in inefficiency. The authority didnot do monitoring and supervision appropriately. Users of freemedication were mostly non poor communities. Poorcommunities utilized free medication at secondary healthcenters more frequently than at health centers.Conclusion: The local government of Tanjung Jabung TimurDistrict had not implemented good health insurance principlesin health financing to support free medication policies. Therewas misallocation of funding because more non – poorcommunities used the service. This increased the potential ofinefficiency in government budget utilization.Keywords: free medication policy, health financing, budgetefficiency
ANALISIS UNTUK PENERAPAN KEBIJAKAN: ANALISIS STAKEHOLDER DALAM KEBIJAKAN PROGRAM KESEHATAN IBU DAN ANAK DI KABUPATEN KEPAHIANG Lutfan Lazuardi, Iswarno Mubasysyir Hasanbasri2
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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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
SISTEM PEMBIAYAAN DAN KEBIJAKAN PENGENDALIAN BIAYA Dewi, Shita
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Abstract

Dalam edisi kali ini beberapa artikel menyajikanpenelitian mengenai kebijakan berobat gratis dan implikasinya.Disebutkan bahwa dampak positifnya berupapeningkatan utilisasi pelayanan, namun didugamengakibatkan moral hazard dan penurunan motivasidi sisi para penyedia layanan. Masalah utamautama yang ditemui biasanya adalah sustainabilitydari sistem berobat gratis karena kurang diperhitungkannyakebutuhan anggaran dan lemahnya mekanismepengendalian biaya. Apakah kebijakan berobatgratis hanya suatu kebijakan yang bersifat politisuntuk memenuhi ‘janji pemilu’ yang justru merugikansistem kesehatan, ataukah merupakan kebijakanyang aplikatif? Bila itu merupakan kebijakan yangaplikatif, sistem seperti apa yang harus ada untukmendukungnya?Jelas bahwa menyediakan perlindungan kesehatanbagi masyarakat harus mempertimbangkanbanyak hal dari sisi demand mau pun dari sisi supply.Terlebih lagi, mekanisme pembiayaan dan pengendalianbiaya harus diperhitungkan secara serius.Pada kesempatan ini kita akan melihat bagaimanasistem pembiayaan kesehatan dan sistem pengendalianbiaya dilakukan di Perancis. Seperti telahdisinggung pada edisi lalu, sistem kesehatan diPerancis adalah salah satu yang terbaik di NegaranegaraOECD. Sistem sécurité sociale berlaku diPerancis, khusus untuk kesehatan sistem disebutCouverture Maladie Universelle (CMU). Sistem inime-reimburse sebagian besar biaya perawatan, sisanyabiasanya di-reimburse oleh asuransi pribadi (privateinsurance atau mutuelles) yang kita miliki yaituassurance complémentaire santé atau top-up voluntaryinsurance.Selain itu sistem CMU ini juga mengharuskankita menunjuk seorang dokter keluarga untuk menjadimédecin traitant kita. Caranya adalah dengan pergike dokter tersebut dan meminta beliau mengisi formuliruntuk didaftarkan sebagai médecin traitantyang kita pilih. Sistem CMU ini dikelola oleh Caissed’Assurance Maladie lokal dimana kita terdaftarsebagai penduduk. Kita harus menyerahkan buktibahwa kita merupakan penduduk setempat (cartede séjour), bukti pendapatan tahunan (taxable income)dan nomor rekening bank, dan dokumenpendukung lain. Kita harus pula menyerahkan formuliryang telah ditandatangani médecin traitant kitakepada Caisse d’Assurance Maladie. Caisse d’AssuranceMaladie kemudian akan menerbitkan Carte Vitale(kartu sehat) bagi kita, dilengkapi foto kita danchip berisi data registrasi kita di dalam sistem CMU.Kartu ini harus selalu dibawa apabila kita pergi kedokter atau membeli obat, apabila kita ingin mendapatkanreimbursement dari CMU. Dengan menggunakancarte vitale, kita akan menerima reimbursementlangsung di rekening bank kita dalam waktukurang lebih seminggu sejak transaksi dilakukan.Biaya yang di-reimburse oleh sistem sécuritésociale melalui CMU adalah tariff pelayanan resmi.Tariff pelayanan resmi ini ditetapkan berdasarkanDRG dan merupakan hasil negosiasi antara asosiasiprofesi kesehatan dengan pemerintah/CMU. Besarnyareimbursement CMU adalah 70% dari tariff pelayananresmi, 65% dari obat yang diresepkan (hanyaobat generik yang di-reimbursed), dan 80% - 95%untuk pelayanan di rumahsakit. Reimbursement100% akan diberikan untuk layanan X-rays atauscans, laboratory tests tertentu, persalinan, sterilisasidan biaya rawat inap di atas 31 hari. Agar dapatdi-reimburse, semua tindakan/perawatan ini harusdilakukan di daerah setempat dimana Caisse d’AssuranceMaladie kita berada. Otoritas kesehatan setempatbertanggungjawab dalam melakukan healthtechnology assessment dan juga melakukan investmentplanning misalnya dalam hal jumlah tempattidur serta jumlah dan jenis alat kesehatan (termasukMRI, CT-scan, dll) yang harus tersedia di daerahnya,untuk menghindari overcrowding atau sebaliknyaunder-utilized.Para provider yang mengikuti tariff resmi disebutsectuer 1. Saat ini sekitar 85% dokter keluarga dan65% dokter spesialis berada dalam secteur 1. Selisihantara tariff yang dikenakan dengan tariff pelayananresmi disebut dépassements, biasanya berkisar antara€5-€30 lebih mahal dari tariff pelayanan resmi.Para dokter yang memiliki tariff di atas tariff pelayananresmi berada dalam secteur 2. Di luar kantordokter selalu tertulis apakah dokter ini termasukdalam secteur 1 atau secteur 2, begitu pula terterasecara jelas tariff untuk setiap jenis pelayanan yang  diberikan. Tidak semua top-up voluntary insuranceakan me-reimburse secara penuh dépassements ini.Reimbursement tidak akan diberikan sama sekalioleh top-up voluntary insurance bila kita langsungpergi ke dokter spesialis (atau ke rumah sakit) tanpaadanya rujukan dari médecin traitant. Sementarasistem sécurité sociale hanya akan me-reimburse40% dari tariff pelayanan resmi bila kita langsungpergi ke dokter spesialis atau ke rumah sakit tanpaadanya rujukan dari médecin traitant. Dengandemikian, ada disinsentif ganda bagi kita/pasien jikamem-bypass sistem rujukan.CMU sebenarnya adalah sistem asuransi wajibberbasis kontribusi. Artinya, seseorang harus berkontribusisebesar 8% dari net income tahunannyadengan memperhitungkan threshold CMU. Batas/threshold CMU ini adalah sebesar €9,356 per tahun.Jadi, seandainya pendapatan tahunan kita adalah€20,000 maka kita boleh mengurangkan dengan ketentuanthreshold sebesar €9,356. Dengan demikiandidapat angka €10,644 sebagai dasar penghitungan8% kontribusi untuk CMU, atau iur premi sebesar€851 per tahun. Selain itu kontribusi juga harus dilakukanoleh perusahaan tempat kita bekerja. Pembayaranpremi dilakukan per kuartal dan dibayarkanke URSSAF. Kita dapat mengakses www.urssaf.fruntuk memahami lebih lanjut bagaimana kontribusiini diperhitungkan dan di-submit, bergantung darijenis pekerjaan kita. Untuk pekerja sector informal(misalnya pertanian) dan mandiri/self-employed,sebagian kontribusi ditanggung oleh pemerintah.Adakah pelayanan yang 100% gratis di Perancis?Tentu ada, dengan beberapa kondisi tertentu.Pihak-pihak yang berhak atas pelayanan 100% gratisadalah (a) mereka yang memiliki penyakit kronis(affection de longue durée misalnya penderitakanker), (b) ibu hamil dan bayi baru lahir hingga usia30 hari, (c) mereka yang berada di dalam sistemsebagai penerima invalidity benefits (karena memilikidisability tertentu), dan (d) mereka yang berada didalam sistem CMU-Complémentaire. Terhadap kelompok-kelompok ini, penyedia layanan hanya diperbolehkanuntuk mengenakan tariff layanan resmi(secteur 1).CMU-Complémentaire (CMU-C) adalah sistemdimana orang dengan pendapatan di bawah pendapatanminimum, atau mereka yang tidak memilikipekerjaan sama sekali, berhak atas sistem CMUtanpa membayar kontribusi. Besarnya pendapatanminimum tahunan dihitung dari jumlah anggota keluarga,mulai dari €7,934 (untuk 1 orang) sampai€19,835 (untuk 5 orang). CMU-C adalah sistem yangdibiayai berbasis pajak, jadi berbeda sama sekalidengan sistem CMU. Berbeda dengan sistem CMUyang merupakan sistem reimbursement, sistemCMU-C merupakan sistem free of charge at the pointof service. Dengan demikian, penyedia layanan kesehatanyang bertanggungjawab untuk memprosesreimbursement dari pemerintah bagi mereka/institusimereka sendiri. Apabila kita dikenai biaya tambahanapa pun, kita harus melaporkan hal ini kepada CMUC,dan pihak yang mengenakan biaya tambahan tersebutakan dikenai sanksi denda mau pun administrativeoleh pemerintah. CMU-C dikelola oleh institusiyang berbeda yaitu Caisse Primaire d’AssuranceMaladie, namun memiliki ketentuan yang samadalam hal kita harus mendaftarkan diri di CaissePrimaire d’Assurance Maladie lokal dimana kita tercatatsebagai penduduk, dan memiliki bukti pendapatandibawah pendapatan minimum serta buktibank. Besarnya pendapatan minimum ini di-reviewsetahun sekali. Implikasinya, kita harus selalu meregistrasiulang setiap tahun untuk dinilai eligibilitasnya.Dengan sekilas membaca bagaimana sistempembiayaan dan sistem pengendalian biaya dilakukandi Perancis, semoga pembaca dapat mencatathal-hal bermanfaat yang bisa dicontoh.
EVALUASI KEBIJAKAN PEMBANGUNAN PUSKESMAS PEMBANTU DI PROPINSI KALIMANTAN TENGAH Deni Kurniadi Sunjaya, Kus Winarno Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: The objective of health development is improvingcommunity health status through increasing public access tohealth services. One of strategy is by supporting facilities forhealth service by developing auxiliary health center for allremote district at Central Kalimantan Province. CentralKalimantan Province with 1,9 million of population, consistedof 14 district, 1348 villages, 805 auxiliary health center. It meansthat only 59% village have facilities for health service such asauxiliary health center.Objectives: This research aimed to know how formulationprocess and implementation of policy of developing auxiliaryhealth center by using provincial funds.Method: It was descriptive case study using mainly methodqualitative designed by semi structured in-depth interview anddocument study. Research subject is stakeholder at levelprovince and chosen district. This research executed inProvince Public Health Service of Central Kalimantan and onechosen district.Result: Development of secondary health center in CentralKalimantan Province is the realization of Central KalimantanProvince local decree number 12 and 13 year 2005 fulfilmenton RPJPD and RPJMD. Initially, the budgeting concept wasplanned by Tugas Pembantuan mechanism, but this mechanismwas not agreed. This scheme was a top down program fromprovince government. Problems occurred in the implementationare 1). Bad monitoring, 2). Lack of reporting by developer, 3).Remote location of, 4). Varieties in cost of production, 5).Shortage health care workforce, 6). Equipments unmatchedthe need of health care provider. Evaluation is executed, butonly concerning physical progress problem. In the meantime,there was increased allocation of DAK fund in each district.Conclusion: Development of auxiliary health center in CentralKalimantan Province which funded by province fund, is notrequired by district. There was no agenda surroundingdevelopment of auxiliary health center. The role of stakeholderin compilation of agenda setting for this policy was only anormative role.Keyword. Auxiliary health center policy, evaluation,decentralization, central Kalimantan
PELAKSANAAN KEBIJAKAN OBAT GENERIK DI APOTEK KABUPATEN PELALAWAN PROVINSI RIAU Nunung Priyatni, Aini Suryani Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: Medicine is an integral part of community healthservice. Therefore it must be available in sufficient quantity,types and adeqaute quality, properly distributed and accessiblefor community when its needed. In order to meet thecommunity’s need for medicine and to guarantee medicineaccessibility, the government released generic medicine policy.Although the price of the generic medicine has already beenset up and fixed by government, there are variety of the pricestill can be found on implementation of the generic medicinesold in the pharmacy store or in the market, and can causeprice uncertainty for community in finding medicine they need.That is why a research needs to be conduct towardimplementation of the generic medicine price policy on thedistribution channel especially at the pharmacy store.onPelalawan District in Riau Province.Method: This research is non experimental/observationalresearch with qualitative and quantitative method using crosssectional design, data analyzed descriptively.Result: Research result indicates that access to genericmedicine at pharmacy store for available medicine are 99,3%,for un available medicine are 0,7% and for replaced medicineare 0,5%. Average availability of the medicine at the pharmacystore are 4-7,3 months. Highest availability rate for medicine isHidrocortison cream 2,5% for 7,3 months and the lowest isPirazinamid tablet 500 mg for 4 months. Pharmacy store thathave an expired medicine are PR (0,7%) and KH (2%). Everypharmacy store have no damaged medicine, 0% percentage.Almost all pharmacy store experiencing out of supply formedicine between 4 to 90 days. Price of the medicine soldaveragely increasing from its pharmacy store Highest RetailPrice (HRP). But there are several medicine that sold under theHRP The highest price medicine that are sold higher than itsHRP is Clorfeniramin Maleat (CTM) tablet by 515,4% increaseand Dexametason tablet is the lowest price sold under HRP by65,2%. Even so they are Alopurinol, Digoksin, and Ranitidin.From in depth interviews with patients, can be learn that theyhave a purchase ability for generic medicine.Conclusion: Implementation of generic drug price on Pelalawandistrict is good. It can be seen from generic medicine accessby community that are high after the release of regulation fromHealth Department of Republic Indonesia, the level of availabilityof generic medicine on pharmacy store at Pelalawan Districtare low but there are no expired or damaged medicine. Theprice of generic medicine at Pelalawan District are variable butthe community still can afford to buy them.Keyword: Generic medicine, availability and affordability.
DAMPAK KEBIJAKAN PELAYANAN KESEHATAN GRATIS TERHADAP KEPUASAN PASIEN DALAM MENERIMA PELAYANAN KESEHATAN PUSKESMAS DI KOTA AMBON Lutfan Lazuardi, Lintje Sintje Corputty Hari Kusnanto
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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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.
EVALUASI IMPLEMENTASI KEBIJAKAN PERSALINAN BAGI MASYARAKAT MISKIN OLEH BIDAN PRAKTEK SWASTA DI KOTA TANJUNGPINANG Mubasysyir Hasanbasri, Elfrida Tambun
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: Economy factor is one of the factors that couldhampered community’s access in the utilization of health service.To guarantee effort of poor community access towardhealth service, the government was conducted managed program.The limitation of working hours in primary health carewas causing limited service hours. Therefore, in order to solvethe problem, the government stated that private midwife practiceas one of the health services could be utilized by poorcommunity with budget that was covered by government. Thegovernment’s policy has not yet able to improve the coverageof delivery attendant by health care provider. Hence, an evaluationto find out the phenomenon occurred in the community isnecessary to solve this problem in order to improve the healthservice in the future.Objective : This research was aimed to find out the descriptionof delivery care for poor community by private midwife inTanjungpinang Municipality.Method: This was a descriptive research that used qualitativeapproach with case study design. The research subjectwas civil servant midwife who had midwifery private practice,head of primary health care, head of health office, headof family health division, and mothers who delivered and hadaskeskin (health insurance for poor community) card. Theselection for midwife and mothers who delivered was usingpurposive sampling technique. Furthermore, the data wascollected by using primary data that was obtained from indepthinterview result that used interview guidance, while the secondarydata was obtained from document observation, andthe data will be analysed qualitatively.Result: The policy of delivery for poor community inTanjungpinang Municipality has not yet obtained optimalsupport.The limited bugdet availability affected in a way thatnot all of the midwives were willing to assist askeskin patientwith cost claim to primary health care. Private practice midwifeasked for fee from askeskin patient. There was no differencethe treatment given between askeskin patient and private/paying patient. However, askeskin patient was satisfiedwith the service given by private practice midwife.Conclusion: The implementation of delivery policy for poorcommunity by private practice midwife has not yet optimal asthere was a lack of support from municipality government,administratively or financially.Keyword: Evaluation, policy implementation, private midwifepractice and poor community

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