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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 388 Documents
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DETERMINAN KINERJA PELAYANAN KESEHATAN IBU DAN ANAK DI RUMAH SAKIT PEMERINTAH INDONESIA (ANALISIS DATA RIFASKES 2011) Ernawati, Demsa Simbolon Djazuli Chalidyanto
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 04 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Abstract

Background: The hospital has quite an important role inreducing IMR and MMR because hospitals as providers ofplenary personal health services including maternal and childhealth (MCH). However, until now the IMR and MMR Indonesiais still high compared to other ASEAN countries. The maincauses of maternal mortality are obstetric complications ordisease as a complication that arises during pregnancy, childbirthand postpartum. This factor was experienced by approximately20% of all pregnant women, while complication cases thatwere treated well are less than 10%.Objective: The research aims to identify the effect of hospitalcharacteristics, management of MCH services, humanresources for MCH, MCH services, and MCH equipment on theperformance of MCH services in government hospitals inIndonesia.Methods:Research is using secondary data of Health FacilitiesResearch 2011 (RIFASKES) with a cross sectional study.Population and sample is the entire Indonesian governmenthospitals (685 hospitals). The research variables wereidentified from the available variables in the questionnaireRIFASKES. Performance measurement of the compositevariable proportion of maternal deaths due to hemorhage d”1%, d” 10% pre-eclampsia, sepsis d” 0.2%, d” 20% secariasection, the proportion of stillborn d” 4%, and the proportion ofLBW handling 100% based SPM hospital. Multivariate logisticregression was used to obtain a model determinants ofperformance MCH services.Results: The majority (66.3%) government hospitals inIndonesian has less than optimal performance. As thedeterminant is unaccredited status (OR = 2.99: 1.43 to 6.28),the hospital is not a vehicle of education (OR = 1.78; 1.11 to2.85), team PONEK is incomplete (OR = 1.89; 1.27 to 2.82),there is no PONEK-trained doctor in the ER (OR = 1.89; 1.27 to2.82), there is no team ready to perform the operation or taskthough on call (OR = 2.16; 1.32 to 3.53). The most dominantfactor is the unaccredited status.Conclusions: Suboptimal performances of MCH at Indonesiangovernment hospitals are influenced by the low hospital servicecharacteristics and incomplete of human resources. TheMinistry of Health needs to support improvement in all types ofservices to complete an accredited hospitals (16 types ofservices), not just 5 or 12 services. They also need to makethe government hospital as a vehicle of education, increasethe quantity and quality of human resources are trained inPONEK-skill, ensure availability of PONEK-trained doctor inemergency, provide the team that are ready to perform theoperation or task though on call, and increase organizationalcommitment to overall performance improvement.Keywords: Performance, Maternal and Child Health Services,Government Hospital
KEBIJAKAN PEMERINTAH DAERAH DALAM MENINGKATKAN SISTEM RUJUKAN KESEHATAN DAERAH KEPULAUAN DI KABUPATEN LINGGA PROVINSI KEPULAUAN RIAU Lutfan Lazuardi, Ignasius Luti, Mubasysyir Hasanbasri,
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
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Ignasius Luti1, Mubasysyir Hasanbasri2, Lutfan Lazuardi21 Dinas Kesehatan Kabupaten Lingga, Kepulauan Riau2 Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran,Universitas Gadjah Mada, YogyakartaABSRACTBackground: One of the critical issues in the development ofnational health care is the limited accessibility to health services.Such problems also occur in Linga District of KepulauanRiau Province. It is caused by many factors, such as geographicallocation, cost, number of health personnel and conditionof health care facilities, such as health centers and theirnetworks which are not accessible to the public. Several attemptshave been made, for example, by improving the statusof sub-health centers to be health centers, health centers tobe treatment centers, assinging health workers both medicaland paramedical, improving health financing and making budgetpolicies. However, its implementation has not been maximal.In accordance with the above background, it would requirea study on the role of local government policy in improvingthe referral system which is useful to know the problemsin the field, so that in the future a variety of improvement canbe done.Objective: To determine the referral system in the islandsarea of Linga District.Methods: This was a case-study research. The researchsubjects were head of health centers / health center doctors,nurses/midwife assistants, ambulance drivers/sea ambulancedrivers, patient families, community figures, jamkesmas/Jamkesda managers, head of health care section/head ofhealth office, director of local hospital/mobile hospital and emergencyroom nurses. The variables in this study were independentvariable (referral system) and dependent variable (ambulanceservice). The research location was in Linga Districtof Kepualauan Riau Province.Results: The results showed that policy efforts of the LingaGovernment District in improving the referral system had existed.The existing financing policy had encompassed twoaspects both from the demand side (medical expenses) andfrom the supply side (a system that supported health care).The process of referral from primary care to advanced serviceshad been going well although there was still lack as theunavailability and completeness of services. Most of the healthworkers had received training; there were also specialist doctors(in collaboration with the faculty of medicine), but networkingin the referral process was done partially and notintegrated.Conclusion: The health referral system in Linga District hadrun pretty well, but did not fully involve community participationin an integrated service system. The local government in thiscase Linga District Health Office needs to revitalize as well asaccelerate the development of Desa Siaga (alert villages) readinessto increase community participation in the developmentof a referral system.Keywords: policy, referral systems, islands, ambulance service
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)
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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
ANALISIS KEBIJAKAN PEMERINTAH DAERAH DALAM PENGEMBANGAN ‘JAMINAN SOSIAL KESEHATAN SUMATERA SELATAN SEMESTA’ MENYAMBUT UNIVERSAL HEALTH COVERAGE Misnaniarti, Misnaniarti
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 03 (2013)
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Abstract

Background: The ‘Jamsoskes Sumsel Semesta’ is a localprogram that offered free medical treatment for health servicesfor the people of South Sumatra who do not have healthinsurance. Meanwhile, starting in 2014, the national Governmentwill implement the Universal Health Coverage as mandated bythe Social Security Law. As insurance have a principle ofindemnity where there should not be a duplicate social security,there should be no society that is assured by the two programswith the aim of speculating to make a profit. This study aims toexplore the implementation of the expansion plan of ‘JamsoskesSumsel Semesta’ to pave the way to Universal Health Coveragein 2014 in South Sumatera.Methods: This study was a qualitative policy research withexploratory design. The focus are policy content, context,actors, and policy processes. Data were collected by in-depthinterviews and observation. Sources of information obtainedfrom five informants from the institution of Provincial HealthOffice, Planning and Regional Development Agency of SouthSumatra, and Provincial Government who selected bypurposive technique based on considerations of participationin Jamsoskes. The analysis used is the analysis of policy.Results and Discussion: Based on the results of study it isfound that the South Sumatra provincial government willcontinue to provide the Jamsoskes program in 2014 as it is,managed by the Health Office. Some of the considerations arefor efficiency and flexibility and that it does not include all thepeople. Also, in the Presidential Decree No. 12 of 2013, thenational government still provides opportunities for local schemeto grow until 2019. Some development is done in Jamsoskesincluding improving the quality and quantity of health careproviders. Preparations are coordinated with Social SecurityAgency about number of contribution beneficiaries. One ofthe challenges is that the community rather go to the hospitaldirectly so it can interfere with the referral system.Conclusion: There has not been a lot of development effortundertaken by local government onJamsoskes in preparationfor the 2014 to welcome Universal Health Coverage. The SouthSumatra provincial government should develop further theservices under Jamsoskes as adjustments in welcoming theimplementation of the second phase of the National HealthInsurance.Keywords: Policy, Health Insurance, Jamsoskes, Efficiency
MANAJEMEN PERUBAHAN DI LEMBAGA PEMERINTAH: STUDI KASUS IMPLEMENTASI KEBIJAKAN PELAKSANAAN PPK-BLUD DI RUMAH SAKIT JIWA PROVINSI NTB Laksono Trisnantoro, Julastri Rondonuwu
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 04 (2013)
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Background: NTB Mental Hospital as the only major referralcenter for mental health services in NTB was required to servethe community, to develop and be self-sufficient, while at thesame time must be able to compete in providing quality andaffordable services to the community. In order to fulfill thesedemands, since January 29, 2011 NTB Mental Hospital hasreceived full endorsement as a Mental Hospital with FinancialManagement Patterns of Local Public Service Agency (PPKBLUD).Therefore, indepth review of the implementation ofPPK-BLUD policy in NTB Provincial Mental Hospital (RSJP) isrequired.Objectives: To explore the transformation process andimplementation of PPK-BLUD policy in RSJP.Methods: The design of this study is a qualitative researchcase study to describe the dynamics of the change processand implementation of PPK-BLUD policy in RSJP.Results and Discussion: The phase of transformationprocess was not running as expected. The implementation ofPPK-BLUD policy is not optimal because some flexibility as ahospital privileges with BLUD financial pattern have not beenimplemented yet. The f inance manager was hesitant toimplement the flexible financial management and still followingthe local government financial management mechanisms. Forexternal stakeholders, the implementation of PPK-BLUD policyimplementation in RSJP did not harm local fiscal policy becausethe revenue of RSJP was still counted as revenue for localgovernment, as opposed to independent PPK-BLUD. A surveywas conducted, consisting of community satisfaction towardsthe services in RSJP, data of revenue and budgettingmanagement and distribution of fee services to employees inRSJP. The survey result described that the implementation ofPPK-BLUD policy in RSJP gives positive impacts on financial,services and benefits performances to RSJP. The positiveimpacts were an increase in the number of income, increasedof service indicators measurement and increased incentive toall employees.Conclusion: Management changes in the transformationprocess were not running optimal so that the PPK-BLUD policyin RSJP is not fully implemented, although there were someperceived positive results.Keywords: Local Public Service Agency, policy, changemanagement.
ANALISIS KEBIJAKAN DALAM MENGATASI KEKURANGAN BIDAN DESA DI KABUPATEN NATUNA Kristiani, Imam Syafari Dwi Handono Sulistyo
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 01 (2013)
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Background: Geographical condition of Natuna Islands whichis not in accordance with health development affects thequantity and availability of midwives distributed in villages inthe District of Natuna. In fact, the ratio between the number ofvillages and the number of midwives in the district has not metthe standard proposed by the Ministry of Health. Unfortunately,there are still around 13 villages from 51 villages that have nomidwives serving in those villages. The location of 13 villagesare separate Island, and it caused lack of provide access toquality health care services. One of efforts done by the localgovernment is to attract midwives’ interest through a varietyof strategies and policies in several fields such as financing,incentive, regulation, organization, and stakeholders’ behaviors.Method: This was a descriptive study with study-case designby using qualitative method. Study case in this study was asingle holistic study case. The informants were head of healthoffice, head of health empowerment and promotion division,head of general affairs and employment sub division, head ofBKD, head of Local Development Planning Agency, theCommission Two of Local Legislative, heads of communityhealth centers, and village midwives. The study case designaimed to know policies in overcoming the lack of midwives inthe District of Natuna.Results: The local government financing policy allocated thebudget or health less than 15%, which was only 3-4% usedfor improving the health workers’ capacity. The incentive givingfor midwives was relatively small compared to the incentiveregulated by the Ministry of Health. There was no specificregulation from the local government, so that the policy wasconsidered not optimal. In the organizational level, the role ofstakeholders was in accordance with their duty and provision;however, the f inal decision was dependent upon LocalLegislative and the local government’s leader. Lastly, midwives’low interest to work in Natuna was caused by its geographicalcondition.Conclusion: Local government’s policy in the field of financing,incentive, organization, regulation, and behavior in overcomingthe lack of village midwives was considered not optimalbecause of the absence of specific policy from the localgovernment in this matter. In addition, midwives’ low interest towork in Natuna contributed the lack of midwives in this district.Keywords: policy analysis, the lack of village midwives
EDISI PERTAMA JURNAL KEBIJAKAN KESEHATAN INDONESIA Trisnantoro, Laksono
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
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Edisi ini merupakan penerbitan pertama JurnalKebijakan Kesehatan Indonesia yang berdiri tahun2012. Mengapa diperlukan jurnal ini? Pada pertemuannasional II Jaringan Kebijakan Kesehatan Indonesiadi Makassar tahun 2011, telah disepakatipenerbitan Jurnal Kebijakan Kesehatan Indonesia.Jurnal yang mengambil bentuk e-journal dan cetak(dua versi) akan dikelola oleh Jaringan KebijakanKesehatan Indonesia, bekerja sama dengan ProgramStudi Ilmu Kesehatan Masyarakat, Minat Kebijakandan Manajemen Pelayanan Kesehatan UniversitasGadjah Mada. Pertemuan di Makassar memandangperlu adanya sebuah jurnal yang fokus pada pengembangankebijakan kesehatan di Indonesia.Apa materi jurnal ini? Dengan berfokus padakebijakan kesehatan maka materi akan berada padaproses penyusunan kebijakan, mulai dari penyusunanide dan agenda sampai ke evaluasi pelaksanaankebijakan. Terkait dengan penyusunan kebijakan,ada dua kelompok topik yang dapat dicermati. Pertamaadalah kelompok topik yang sudah mempunyaikebijakan publik. Kebijakan publik tersebut dapatberada di level pusat dalam bentuk Undang-Undang,Peraturan Pemerintah, Peraturan Presiden, PeraturanMenteri Kesehatan, dan sebagainya. Di level propinsiadalah Peraturan Daerah, Peraturan Gubernurdan sebagainya. Demikian pula di level kabupaten/kota. Contoh topik kebijakan di kelompok ini adalahUU SJSN di tahun 2004 dan UU BPJS di tahun 2011.Kelompok kedua, adalah berbagai topik kesehatanyang belum mempunyai kebijakan. Sebagai gambaranadalah topik “medical-tourism” yang belummempunyai kebijakan publik sama sekali. Kelompokini juga studi mengenai persiapan penyusunankebijakan publik di level Peraturan Pemerintahsebagai perintah dari sebuah UU.Berbagai kebijakan di level internasional yangperlu dicermati ada kebijakan yang mengikat sepertiTreaty, namun juga ada berbagai kebijakan di levelinternasional yang lebih banyak menghimbau.Kebijakan formal yang dapat dilihat berdasarkan tatahukum nasional dan internasional, dikenal pulaberbagai kebijakan lokal yang informal. Gambarankebijakan informal diberbagai kelompok masyarakatyang menolak vaksinasi merupakan hal menarikuntuk ditulis dalam jurnal ini. Kecocokan, dan ketidakcocokan antara kebijakan kesehatan formal dan informaldi berbagai tempat merupakan isu penelitianyang menarik.Pertanyaan yang sering muncul adalah siapayang akan membaca jurnal ini? Pertanyaanberikutnya adalah: siapa yang akan menulis di jurnalini? Diperkirakan pembaca jurnal ini adalahpengambil kebijakan kesehatan di Indonesia yangberada di Kementerian Kesehatan dan berbagaikementerian terkait kesehatan. Adanya kebijakandesentralisasi, tentunya ada ribuan pengambilkebijakan di propinsi dan kabupaten yang diharapkanmembaca jurnal ini. Dengan mengambil kriteriapembaca adalah level kepala bidang ke atas, makadiperkirakan akan ada 2500 pembaca di daerah dansekitar 300 di pusat. Ada pengajar dan penelitikebijakan kesehatan di berbagai universitas danlembaga penelitian yang akan membaca dansekaligus menulis artikel-artikel penelitian. Edisipertama ini kami menghimbau para calon penulisuntuk mengirimkan naskah ke Jurnal KebijakanKesehatan Indonesia. Topik-topik naskah tersebuttentunya terkait dengan proses kebijakan yang sudahdi bahas di atas. Kami tunggu naskahnya. (LaksonoTrisnantoro, )
SISTEM PEMBIAYAAN DAN KEBIJAKAN PENGENDALIAN BIAYA Dewi, Shita
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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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.
HUBUNGAN ANTARA REALISASI DANA BANTUAN OPERASIONAL KESEHATAN DENGAN INDIKATOR GIZI KIA DI KABUPATEN/KOTA PROVINSI JAWA TENGAH TAHUN 2012 Malik Cahyadin, Ulma Putri Septyantie
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 04 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Abstract

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
EFEKTIFITAS DAN EFISIENSI PEMANFAATAN DANA BANTUAN OPERASIONAL KESEHATAN DENGAN PENERAPAN METODE ANALYTIC HIERARCHY PROCESS Makkasau, Kasman
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Abstract

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

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