Yulita Hendrartini
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DETERMINAN KINERJA DOKTER KELUARGA YANG DIBAYAR KAPITASI Hendrartini, Yulita
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Background: In the last two decades, the payment system inhealth insurance scheme in Indonesia for GPs (family doctors)has been changed from fee for service to capitation. Thecapitation payment used by managed care organizations toinfluence the practice of primary care physician is stillcontroversial. The purpose of this study was to describe theestimation of a causal model of GP’s performance on capitationpayment.Methods: This study used cross sectional survey design.Total subjects were 290 GPs who had contract with managedcare organization’s at least 6 months and 580 patients whowere member of managed care organization which chooseby simple random sampling. The data were collected by usingquestionnaires to asses knowledge, satisfaction, attitude andpatient’s satisfaction. The dependent laten variable was GP’sperformance with observed variable were utilization’s rate,refferal’s rate and patient’s satisfaction. The data wasanalyzed with Structural Equation Model with AMOS 6 toestimate the statistical model of capitation and associationsbetween variables on capitation, doctor’s satisfaction, attitudeand GP’s performance.Result: The results of this study confirmed that the importantvariables in the prediction of GP’s performance wereknowledge, attitude and length of contract. Income ratio ofcapitation and GP’s satisfaction had indirect effect on GP’sperformance, but influence GP’s attitudes as mediating variablestoward GP’s performance to control the cost. Almost half ofthe GPs (45,2%) had ratio income of capitation lower than10% from the total income, therefore it couldn’t be expectedas main income. This situation caused that GPs still fee forservices oriented.Conclusion: The capitation payment is not effective to changethe GP’s performance, because the income ratio is still low.The implication of these findings is important to improve thecontract of payment capitation and it needs a strategy to maintaingood relationship between managed-care organization andprovider in addition to improve GP’s performance.Keywords: capitation, contract, GP’s satisfaction, GP’s attitude,GP’s performance.
DAMPAK KEBIJAKAN KEPESERTAAN MANDIRI JAMINAN KESEHATAN NASIONAL (JKN) DI YOGYAKARTA Endartiwi, Sri Sularsih; Trisnantoro, Laksono; Hendrartini, Yulita
Jurnal Kesehatan Masyarakat Vol 10, No 1 (2017): Jurnal Kesehatan Masyarakat Volume 10/ Nomor 01
Publisher : STIKES Wira Husada Yogyakarta

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ABSTRACT Background: The implementation of National Health Insurance (JKN) had been started since 1 January 2014. In the first semester, several problems are found in the admission department. First, it is found that there about 10% or 4,400 participants are they who are suffering for disease or have used the health insurance. Second, there are participants who are already undergoing treatment at the hospital and turning out a large cost then they are newly registered as JKN participants. Objective: To monitoring the implementation of independent participants policy of the National Health Insurance (JKN) in Yogyakarta. Methods: This research is a case study with qualitative and quantitative approaches. Research will be conducted in the BPJS Yogyakarta, Academic Hospital of the Gadjah Mada University, the Office of the Provincial Council Commission D Yogyakarta, Yogyakarta Provincial Health Office in April 2015. The study was conducted by in-depth interviews as well as filling the form of independent patient data. Results: The viewpoint of the national health insurance participant is positive. Independent participants consider it is important to enforce the national health insurance program. Participants also consider it is reasonable for them to pay the monthly dues. Their motivation to register as an independent participant is already going to take advantage of health services, a precaution and to protect themselves against the risk of illness. Compliance participants who pay dues are in arrears to pay dues by 27%. The impact of independent participants is people who are already sick or have health services and will utilize it for about 123% claims ratio. It is better for the hospital to do socialization, add more facilities and infrastructure, improve the hospital services, leadership and bureaucracy. Conclusion: Independent participants policy is to motivate people who are already sick to register as a participants and 27% of participants who had recovered in arrears to pay.The fundamental improvement in the independentparticipants policy is an improvement on Presidential Decree No. 12 of 2013, especially chapters 4 and 5, Presidential Decree No. 111 of 2013 chapter 16F, and The Health Minister regulations No. 71 of 2013 article 21 paragraph 1 and 22 paragraph 1 Keywords: impact, independent participant,National Health Insurance (JKN)
Kesadaran Pekerja Sektor Informal terhadap Program Jaminan Kesehatan Nasional di Provinsi Daerah Istimewa Yogyakarta Siswoyo, Budi Eko; Prabandari, Yayi Suryo; Hendrartini, Yulita
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 4 (2015)
Publisher : Center for Health Policy and Management

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (253.332 KB) | DOI: 10.22146/jkki.v4i4.36116

Abstract

Background: The subsidized members (PBI) dominate the membership of the National Health Insurance Scheme (JKN) in Indonesia, including in Yogyakarta. The low number of nonwage earners (PBPU) and the decrease in the number of new non-PBI members, doesn’t indicate optimal socialization, but also the lack of a awareness of informal sector workers towards JKN. Public awareness determines the ability and community involvement in support JKN. Objective: To analyze the informal sector workers’ awareness of the JKN programs in Yogyakarta. Method: This study was observational analytic with the cross-sectional design. The subjects are informal workers in Yogyakarta who have not joined JKN, set with quota sampling (200 respondents) and they were selected purposively. The data was collected by questionnaire and analyzed using quantitative and qualitative approaches as univariate, bivariate, and multivariate. Result: Linear regression test showed that the affect of independent variables towards consciousness, namely: the main types of jobs [B = 2,5452 dan (p) = 0,00 < ±]; education [B= 1,6609 dan (p) = 0,00 < ±]; knowledge [B = 1,3944 dan (p) = 0,00 < ±]; age [B = 1,0736 dan (p) = 0,00 < ±]; employment status [B = 1,0451 dan (p) = 0,01 < ±]; and income [B = 0,0001 dan (p) = 0,02 < ±]. Conclusion: Generally, the level of awareness of the informal sector workers towards JKN is considered in the high category. However, most informal sector workers tend to delay membership. Latar belakang: Peserta penerima bantuan iuran (PBI) mendominasi kepesertaan Program Jaminan Kesehatan Nasional (JKN) di Indonesia, termasuk di Provinsi D.I. Yogyakarta. Rendahnya jumlah peserta bukan penerima upah (PBPU) dan turunnya jumlah peserta baru yang non PBI, bukan hanya menjadi indikasi belum optimalnya sosialisasi, tetapi juga belum terbentuknya kesadaran pekerja sektor informal terhadap program JKN. Kesadaran menentukan kesanggupan dan keterlibatan masyarakat dalam mendukung penyelenggaraan program JKN. Tujuan: Menganalisis kesadaran pekerja sektor informal terhadap program JKN di Provinsi D.I. Yogyakarta. Metode Penelitian: Penelitian ini adalah observasional analitik dengan rancangan cross sectional. Subjeknya adalah pekerja informal di Provinsi D.I. Yogyakarta yang belum menjadi peserta JKN yang ditetapkan dengan quota sampling (200 responden) dan dipilih secara purposive. Data dikumpulkan dengan instrumen berupa kuesioner dan dianalisis menggunakan pendekatan kuantitatif dan kualitatif, baik secara univariabel, bivariabel, dan multivariabel. Hasil: Uji regresi linear menunjukkan bahwa pengaruh variabel bebas terhadap kesadaran, yaitu : jenis pekerjaan utama [B = 2,5452 dan (p) = 0,00 < ±]; pendidikan [B = 1,6609 dan (p) = 0,00 < ±]; pengetahuan [B = 1,3944 dan (p) = 0,00 < ±]; umur [B = 1,0736 dan (p) = 0,00 < ±]; status pekerjaan [B = 1,0451 dan (p) = 0,01 < ±]; dan pendapatan [B = 0,0001 dan (p) = 0,02 < ±]. Kesimpulan: Pada umumnya tingkat kesadaran pekerja sektor informal terhadap JKN termasuk kategori tinggi. Sebagian besar pekerja sektor informal cenderung menunda kepesertaan.
PERSEPSI DOKTER DALAM MERUJUK PENYAKIT NONSPESIALISTIK DI LAYANAN KESEHATAN PRIMER DALAM JAMINAN KESEHATAN NASIONAL (Studi di Daerah Istimewa Yogyakarta) Utami, Aras; Hendrartini, Yulita; Claramita, Mora
Media Medika Muda Vol 2, No 1 (2017)
Publisher : Faculty of Medicine Diponegoro University

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Latar Belakang:Dokter layanan primer berperan sebagai gatekeeper untuk mengurangi biaya dengan membatasi rujukan ke pelayanan spesialis yang tidak sesuai. Pembatasan penggunaan pelayanan spesialis yang tidak perlu bisa meningkatkan kualitas pelayanan.Pembatasan rujukan dalam jaminan kesehatan nasional (JKN) antara lain dengan diberlakukannya 144 diagnosis penyakit level kompetensi 4 yang harus dilayani di fasilitas kesehatan tingkat pertama (FKTP).Ada 13 kasus terbanyak dari 144 diagnosis penyakit nonspesialistik yang dirujuk ke pelayanan kesehatan tingkat lanjut (FKTL) berdasarkan hasil monitoring BPJS Kesehatan Jawa Tengah-DIY tahun 2014.Meningkatnya kasus penyakit yang dirujuk ke FKTL meningkatkan biaya pelayanan kesehatan.Tujuan penelitian ini adalah mengetahui faktor-faktor yang mempengaruhi dokter merujuk 13 penyakit nonspesialistik berdasarkan persepsi dokter.Metode:Penelitian ini merupakan studi kualitatif dengan pendekatan “grounded theory”. Penelitian dilakukan pada bulan Juli-Agustus 2015 di DIY.Sampel dipilih secara purposive.Jumlah sampel 20 FKTP.Responden adalah dokter.Pengumpulan data dengan wawancara mendalam.Triangulasi dilakukan kepada sumber yang berbeda dan observasi.Hasil:Faktor yang mempengaruhi dokter dalam merujuk penyakit meliputi faktor eksternal dan internal. Faktor eksternal merupakan faktor yang menurut dokter dirasa cukup dominan meliputi kurangnya ketersediaan obat seperti obat-obat yang masuk dalam program rujuk balik (PRB); kurangnya ketersediaan alat medis seperti alat fisioterapi, alat pemeriksaan mata, alat penyedot serumen, permintaan pasien; kebijakan BPJS tentang penjaminan resep kacamata hanya bisa di dokter spesialis mata di FKTL; dan perilaku dokter spesialis rumah sakit yang tidak mengembalikan pasien PRB ke FKTP. Faktor internal antara lain faktor penyulit penyakit seperti tidak respon dengan pengobatan, multidrug resistan tuberculosis (MDR-Tb); dan kompetensi dokter yang kurang pada penyakit Bell’s palsy dan presbiopia.Kesimpulan: Faktor-faktor yang mempengaruhi dokter merujuk penyakit adalah kurangnya alat medis, kurangnya ketersediaan obat, permintaan pasien, kebijakan BPJS Kesehatan, perilaku dokter spesialis, dan faktor penyulit penyakit, serta kompetensi dokter yang kurang. Kata kunci: dokter layanan primer, rujukan, pelayanan kesehatan primer, jaminan kesehatan nasional
Gaya hidup terkait hipertensi dan partisipasi dalam program layanan penyakit kronis di kabupaten Batang Bahrun, Mutmainah; Prabandari, Yayi Suryo; Hendrartini, Yulita
Berita Kedokteran Masyarakat (BKM) Vol 32, No 4 (2016)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.445 KB) | DOI: 10.22146/bkm.8501

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Hypertension-related lifestyle and participation in chronic disease service programs in Batang districtPurposeThe purpose of this paper was to explore the behavior of hypertension patients who participated in the universal health coverage that forms a lifestyle in the prevention of complications due to hypertension.MethodsA qualitative-case study was conducted involving observations and depth interviews to 13 hypertension patients who participated in universal health coverage, including 2 wives and 1 husband of patients with hypertension, and also 3 doctors who were BPJS partners in Batang.ResultsThe study found that first, hypertension patients in Batang knew that they were potentially affected by complications due to hypertension. Second, there was a difference in experience and behavior among hypertension patients of prolanis (chronic disease service programs) members and non-prolanis members. The behavior of hypertension patients of prolanis members tended to be better than non-prolanis. Third, consumption of antihypertensive drugs was preferred in the prevention of complications due to hypertension rather than improving or modifying the behavior of hypertension patients.ConclusionThe positive experience of hypertension patients while being a JKN participant of prolanis and non-prolanis members formed a different lifestyle, and also had different prevention efforts. Innovative, adaptive and accessible information delivery needs to be considered in an effort to improve the lifestyle behavior of hypertension patients.
PEMANFAATAN PELAYANAN KESEHATAN BERDASARKAN STATUS WILAYAH DAN KEPEMILIKAN JAMINAN KESEHATAN NASIONAL (KAJIAN SUSENAS TAHUN 2015) Ruhukail, Prisilya Prety; Hendrartini, Yulita; Wahyuni, Heni
2-TRIK: TUNAS-TUNAS RISET KESEHATAN Vol 9, No 1 (2019): FEBRUARI 2019
Publisher : WAHANA RISET KESEHATAN

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Background: Changes in funding towards Universal Health Coverage (UHC) also have side risks such as inequitable availability of health facilities and health workers, as well as a lack of socialization on JKN policies. Indonesia's Health Profile in 2014 shows that there is still an imbalance in the utilization ratio of health services by region. This is due to the relatively small population, but has a large working area. The same thing is found in the aspects of health insurance membership. Injustice in accessing health services is a challenge faced to achieve equity in health services, where equity will occur if health services are distributed according to geography, socio-economy and community needs. Objective: To analyze the utilization of health services based on regional status and JKN ownership. Method: This research is a quantitative study that examines secondary data, namely Susenas in 2015, using a cross-sectional design. The unit of analysis in this study is the individual. This research uses descriptive, bivariate and multivariate analysis. The multivariate test uses a logistic regression test to determine the effect of regional status and ownership of health insurance on the utilization of health services. Results: Utilization of health services is mostly done by individuals in non-DTPK areas. A p value (0,000) indicates a relationship between the status of the area and the utilization of health services. Individuals in non-DTPK areas are more likely to utilize health services. Individuals who have private health insurance use more health services than those who JKN. There is a relationship between JKN ownership and health service utilization (p-value = 0,000). Individuals who have private health insurance, and who are more than one, are more likely to utilize health services. The control variables which include age, sex, education and occupation have a significant relationship with the utilization of health services. Conclusion: JKN ownership and territorial status are significantly related to the utilization of health services in Indonesia. Keywords: utilization; health services; JKN; Susenas 2015 ABSTRAK Latar Belakang: Perubahan pembiayaan menuju Universal Health Coverage (UHC) juga memiliki resiko sampingan seperti ketidakmerataan ketersediaan fasilitas kesehatan dan tenaga kesehatan, serta kurangnya sosialisasi kebijakan JKN. Profil Kesehatan Indonesia tahun 2014 menunjukkan masih adanya ketimpangan rasio pemanfaatan pelayanan kesehatan berdasarkan wilayah. Ini disebabkan oleh jumlah penduduk yang relatif sedikit, namun memiliki wilayah kerja yang luas. Hal yang sama ditemukan dalam aspek kepesertaan jaminan kesehatan. Ketidakadilan dalam akses pelayanan kesehatan merupakan tantangan yang dihadapi untuk mencapai ekuitas dalam pelayanan kesehatan, dimana ekuitas akan terjadi jika pelayanan kesehatan terdistribusi menurut geografi, sosial ekonomi dan kebutuhan masyarakat. Tujuan: Menganalisis pemanfaatan pelayanan kesehatan berdasarkan status wilayah dan kepemilikan JKN. Metode: Penelitian ini merupakan penelitian kuantitatif yang mengkaji data sekunder yaitu Susenas tahun 2015, menggunakan rancangan cross-sectional. Unit analisis dalam penelitian ini adalah individu. Penelitian ini menggunakan analisis deskriptif, bivariat dan multivariat. Uji multivariat menggunakan uji regresi logistik untuk mengetahui pengaruh status wilayah dan kepemilikan jaminan kesehatan terhadap pemanfaatan pelayanan kesehatan. Hasil: Pemanfaatan pelayanan kesehatan lebih banyak dilakukan oleh individu yang berada di wilayah non-DTPK. Nilai p (0,000) menunjukkan adanya hubungan antara status wilayah dan pemanfaatan pelayanan kesehatan. Adapun individu pada wilayah non-DTPK lebih berpeluang untuk memanfaatkan pelayanan kesehatan. Individu yang memiliki jaminan kesehatan swasta lebih banyak memanfaatkan pelayanan kesehatan dibandingkan dengan yang JKN. Ada hubungan antara kepemilikan JKN dan pemanfaatan pelayanan kesehatan (p-value=0,000). Individu yang memiliki jaminan kesehatan swasta, dan yang lebih dari satu, lebih berpeluang untuk memanfaatkan pelayanan kesehatan. Adapun variabel kontrol yang meliputi umur, jenis kelamin, pendidikan dan pekerjaan memiliki hubungan yang signifikan dengan pemanfaatan pelayanan kesehatan. Kesimpulan: Kepemilikan JKN dan status wilayah berhubungan secara signifikan dengan pemanfaatan pelayanan kesehatan di Indonesia. Kata kunci: pemanfaatan; pelayanan kesehatan; JKN; Susenas 2015