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Journal : Jurnal Manajemen Pelayanan Kesehatan

TINJAUAN TATA LAKSANA PELAYANAN KESEHATANMELALUI SISTEM ASURANSI KESEHATANDI RSUD PROF. DR. WZ. JOHANNES KUPANG TAHUN 2009 Kasim, Felix
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Abstract

Background: In the developed countries, the role of health insurance becomes more important because there is a great demand for health service. Health insurance is a kind of insurance product which is especially medical care for the member of health insurance if they are sick or get an accident. For that reasons, a research about The Analysis of the Management of the Health Service through the Health Insurance System in the Prof. Dr. WZ. Johannes Hospital Kupang 2009. Objective: The purpose of this research is to describe about the analysis of the management of the health service through the health insurance system also the enthusiasm of the participant of ASKES to health insurance services in the Prof.Dr. WZ. Johannes Hospital Kupang 2009.Method: The method used in this research was mixed of qualitative and quantitative methods, with grounded theory for the qualitative method and cross sectional for the quantitative method, descriptive observational design and survey instrument in a questionnaire form with 18 questions and depth interview to some informed. The subject of the research was the participants of ASKES outpatient and inpatient in the Prof. Dr. WZ. Johannes Hospital Kupang. The sampling method used was an accidental sampling made of 60 respondents. Result: The results of the research show that health insurance services system in Prof. Dr. WZ. Johannes Hospital Kupang ASKES administration section, infrastructure means, medic or non medics are good. Conclusion: There should be more research on service system in Prof. Dr. WZ. Johannes Hospital to ASKES members with analytical methods so that more things can be explained and described. Refers to the results of this study, it is necessary to have a Minimum Service Standards (MSS) that patterned tripartite relationship between the members, ASKES administrator and party health service providers who have contracted with health insurance provider with the managed care health insurance with service system by PPK network. On hospital’s principal of autonomy as organizers of activity, so that health status, income and education, consumer factor and PPK ability and acceptance of health service and sickness risk and environment will be develop to comprehensive responsible with overutilization decreasing and high inflation on health service, through the better financial management, more efficient and transparent. The other side of restructuring costs in hospital that global nature need cost unit which is one way for hospital to make efficiency because by that way will be known which service in hospital need to subsidized and which is profitable. By doing restructuring costs in hospital, we can use Strategic Cost Management. This strategy will help hospital to face competition. The implementation with Cost Leadership Strategy(CLS) or Low-Cost Strategy will do all it can to beat competitors by giving cheaper services from another hospital, but with same quality or better. General Hospital is the examples of hospital that may choose this strategy. Tools to reach this strategy are analysis cost hospital services better known as Unit Cost. This consideration will obtain recommendation rates, efficiency strategy and System Account Design overall in hospital.Keywords: health insurance, health service system, high quality health
ROLES OF THE STAKE HOLDER AND PROVIDER OF BATAM CITY IN AN ATTEMPT TO ENHANCE CLINICAL GOVERNANCE OF HEALTH SERVICES IN CONNECTION WITH DOCTOR PRACTICE LAWS Kasim, Felix
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 03 (2010)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Abstract

Background: Deming (1984), Crosby (1979, 1985), and Juran(1988), all found that more than 85% of errors are related to asystem; whereas, only 15% of them constitute human error,or an employee’s. According to NGO coordinator, IskandarSitorus, 2000 victims of malpractice have been recordedthroughout Kepulauan Riau. This malpractice occurs when asystem does not have a proper policy, standard procedure,and equipment needed.Objective: The purpose of this research is to find out themanagement, obstacles, and expectations with regards toclinical governance management from the point of view of thestakeholder and provider of Batam City.Method: The method used in this research was a qualitativemethod with a grounded theory. The primary data are derivedfrom in-depth interview. The respondents involved are thecommission IV chairperson of Batam City local Parliament,Kepulauan Riau, chairperson of Medical Committee of Batu AjiLocal Public Hospital Kepulauan Riau using a purposivesampling with an extreme case sampling approach.Result and conclusion: The research shows that clinicalgovernance by the stakeholder and provider still needs furtherimprovement. There are still obstacles in terms of regulationsand implementation of clinical governance. Based on theMinimum Service Standard, some indicators of Batam City in2008 did not meet the performance target and national standard.Therefore, the clinical governance system has not beenimplemented throughout health services in Batam City.Suggestions: For IV Legislative Commission for People’sWelfare and Human Resources Batam Riau Islands areexpected to lack of regulation and appropriate systems inimproving health services. And then for Hospital MedicalCommittee Batu Aji, Batam Riau Islands is expected to implementClinical Governance.It is expected that the recording and reporting systems as wellas obtaining accurate data in making the next Batam healthprofile based on the quality of evidence-based.Keywords: Clinical Governance, stakeholder, provider