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Jurnal Manajemen Pelayanan Kesehatan
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SKENARIO PELAKSANAAN KEBIJAKAN DESENTRALISASI: APAKAH MENUJU DESENTRALISASI SETENGAH HATI DI SEKTOR KESEHATAN? Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Abstract

Bukti empirik di berbagai negara menyatakanbahwa penyusunan dan pelaksanaan kebijakandesentralisasi membutuhkan waktu, proses yangrumit, dan penghalusan-penghalusan. Dapat dipahamibahwa ada pihak yang tidak sabar denganpelaksanaan desentralisasi. Bagi pihak yang kontradengan kebijakan ini maka kata desentralisasi menjadihal yang tidak lagi menarik untuk dipergunakan.Namun harus ditegaskan bahwa Undang- Undang (UU)No. 32/2004 menyatakan bahwa sektor kesehatanmerupakan bidang yang harus didesentralisasikan.Undang – Undang (UU) ini diikuti dengan berbagaiPeraturan Pemerintah (PP) seperti PP No. 38/2007,PP No. 41/2007, PP No. 08/2008 yang memastikanpelaksanaan desentralisasi. Mau atau tidak mau,kebijakan desentralisasi sudah merupakan kebijakannasional dalam tingkat UU, kecuali apabila terjadiamandemen. Pada tahun 2008 ini sudah terjadi situasi“Point of No Return”.Dalam konteks pelaksanaan kebijakandesentralisasi ketidakpastian yang ada adalah: pihakmana yang akan “lebih berpengaruh” dalam strategipembangunan kesehatan di Indonesia: apakah yangpro sentralisasi ataukah yang pro desentralisasi.Bagaimana kita menghadapi ketidakpastian tentangpelaksanaan kebijakan desentralisasi kesehatan diIndonesia?Berbagai teori perencanaan sering gagalmemperkirakan masa depan. Salah satu penyebabkegagalan adalah asumsi bahwa perkembangan kemasa depan adalah sesuatu yang linier. Sementaraitu kenyataan menunjukkan bahwa masa depandapat bervariasi akibat berbagai faktor. Dalam halini dibutuhkan perencanaan yang bersifat skenario.Perencanaan berdasar skenario (scenario planning)bukan merupakan kegiatan untuk memilih alternatif,akan tetapi lebih untuk pemahaman bagaimana tiapkemungkinan akan berjalan. Dengan pemahamanini sebuah lembaga atau negara dapatmempersiapkan diri dalam membuat berbagaikeputusan strategis untuk menghadapi berbagaikemungkinan di masa mendatang. Perencanaanskenario adalah alat bantu untuk melihat ke depanyang penuh ketidak-pastian.Inti perencanaan skenario adalahpengembangan gambaran mengenai kemungkinankemungkinankondisi di masa mendatang danmengidentifikasi perubahan-perubahan, sertaimplikasinya yang muncul sebagai akibat darikondisi tersebut. Referensi lain menyebutkan bahwaperencanaan skenario dilakukan untuk menilaiskenario-skenario yang memungkinkan untuk suatukegiatan: kemungkinan terbaik, kemungkinanterburuk dan berbagai kemungkinan diantaranya.Dalam konteks pelaksanaan kebijakandesentralisasi kesehatan di Indonesia, faktor yangtidak pasti adalah keinginan pemerintah daerah danpemerintah pusat untuk menjalankan desentralisasidengan sepenuh hati. Dengan menggunakan keduakemungkinan tersebut ada 4 skenario yang mungkin:skenario 1, adalah situasi dimana pemerintah pusatbersemangat untuk melaksanakan desentralisasi,berusaha melaraskan struktur organisasinya denganpemerintah daerah, dan pemerintah daerahbersemangat pula untuk melakukannya. Skenario2: terjadi situasi dimana pemerintah pusat(khususnya Departemen Kesehatan) cenderungingin sentralisasi, sementara pemerintah daerahberada dalam sistem yang semakin desentralisasi.Skenario 3: Pemerintah pusat tidak berkeinginanmelakukan desentralisasi di bidang kesehatandemikian pula pemerintah daerah. Akibatnya terjadiperubahan UU (amandemen UU No. 32/2004)sehingga kesehatan kembali menjadi sektor yangsentralisasi; dan skenario 4: pemerintah pusat(Departemen Kesehatan dan DPR) berubah menjadibersemangat untuk desentralisasi, namunpemerintah daerah tidak mau menjalankan.Skenario mana yang paling besarkemungkinannya terjadi? Jika tidak ada usahaapapun, dikhawatirkan skenario ke-2 yang akanterjadi. Skenario ini dapat disebut sebagaidesentralisasi setengah hati. Keadaan ini sudahterjadi saat ini dan juga pernah terjadi di berbagainegara yang melakukan desentralisasi. Sesuaidengan predikatnya yang setengah hati, kebijakandesentralisasi tentu tidak akan memberikan dampakpositif pada pembangunan kesehatan. Oleh karenaitu, perlu berbagai usaha agar mengurangiprobabilitas skenario 2, untuk masuk ke skenario 1.Laksono Trisnantoro (trisnantoro@yahoo.com )
MANAJEMEN PENYAKIT LINGKUNGAN BERBASIS WILAYAH Hasyim, Hamzah
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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Abstract

New Emerging and Re Emerging Infectious Diseases based ofenvironment, were concern of public health, affect the socioeconomic loss, political aspect and others. Existence of tripleburden of disease, environmental pollution, management thehealth which not full support to national development representsome factors causing damage health nation.Through literature review this writing make solution alternativeby management environment disease which ”evidences based”approach collected periodical, systematic and planned tospecific area.Keywords: management of disease, new emerging and reemerging infectious diseases
KOTAK HITAM SISTEM PENETAPAN KEBIJAKAN DAN FAKTOR-FAKTOR YANG MEMPENGARUHINYA Ayuningtyas, Dumilah
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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Abstract

A policy can be manifested in statement, action, regulation,and law as decision result about how to implement something.Policy decision in health sector is a related system of thesurrounding condition such social factors, politic, economy,history, and other factor that influenced. There is a circuit ofcomponent, process, resources allocation, actor, and authoritythat play role in policy-making. Therefore the result policy issuch a product of elite interaction in every detail of that policymakingincluding attraction of interests between the actors,authority interaction, resources allocation, and bargainingposition on involved elites. Policy-making system cannot avoidfrom individual or certain group effort which endeavor toinfluence the decision makers so as to cause a policy morebenefited for their side. There are factors that influencingindividual politic behavior of actor either external (social politicenvironment) or internal (personality, behavior, value, interest).Keywords : health policy, policy making process as a system,black box in policy making process
DETERMINAN KINERJA DOKTER KELUARGA YANG DIBAYAR KAPITASI Hendrartini, Yulita
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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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.
EVALUASI BESARAN PREMI TERHADAP KESESUAIAN PAKET PELAYANAN KESEHATAN PADA JAMINAN PEMELIHARAAN KESEHATAN DAERAH Iwan, Iwan
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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Abstract

Background: The concept of community health care insuranceis presently being adopted by the local government of SinjaiDistrict known as Local Health Care Insurance of Sinjai managedby an operating council. This program provides health servicepackages for inpatient, outpatient and other particulartreatments at health centers and local hospitals of Sinjai. Thepremi presently imposed is used to pay operational cost oflocal health care insurance program and more than 80%-90%of claims from health service providers have to be supportedby local government. If the amount of fund required to payclaims is continuously increasing and not supported by relevantamount of premi, the local government will consequently havegreater burden. Therefore some aspects related to real premi,normative utilization of premi and benefit package have to beevaluated by considering the ability and willingness to pay ofthe community.Objective: The objective of the study was to identify theamount of real premi and normative utilization of standard premi,assess the ability and willingness to pay premi of the participantsand analyze perception of the participants and stakeholdersabout the relevance of benefit package, as well as identify theperception of stakeholders about the existence and solution tofinancial problems of Sinjai Local Health Care Insurance.Method:  This descriptive study used both quantitative andqualitative approaches. Data of claims and administration wereobtained from the operational council of local health careinsurance; ability and willingness to pay of the community andperception about relevance of benefit package of local healthcare insurance were obtained from questionnaires distributedto 96 respondents of participants and in depth interview with7 stakeholders from the government.Result: Real premi in 2006 was Rp2,923.86/capita/month andin 2007 was Rp2,453.59/capita/month; premi of normativeutilization in 2006 was Rp10,101.97/capita/month and in 2007was Rp9,857.13/capita/month; ability to pay (ATP) 1 of eachparticipant was Rp11,246, ATP2 was Rp66,178/capita/monthand willingness to pay was Rp3,104/capita/month; 97.92% ofparticipants perceived benefit package relevant with theirexpectation whereas stakeholders perceived that benefitpackage greatly varied, the existence of local health careinsurance had to be sustained and financial problems could besolved by increasing premi and optimizing premi billing, providingsubsidy for poor communities and generating other financialsources.Conclusion: In order to sustain the existence of local healthcare insurance the real premi should be increased fromRp10,000,00/family/month to Rp12.500,00 – Rp15.000,00 perfamily/month as compensation for relevance of benefit packageof Sinjai Local Health Care Insurance.Keywords: real premi, premi of normative utilization, perceptionof stakeholders, benefit package, cost of claims, ability to pay,willingness to pay
MODELLING THE DEMAND FOR HEALTH CARE GIVEN INSURANCE: NOTES FOR RESEARCHERS Hidayat, Budi
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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Abstract

Understanding on health care demand given insurance givesprecious information to anticipate health care costs in the future,which in turn provides valuable information for policy makers,among other, to estimate claim rate, set up premium, designcost-sharing policy, etc. Unfortunately, estimating the effectsof health insurance on health care demand is not straightforward. This paper identifies crucial factors (e.g., adverseselection and provider behaviour) that need to be consideredin estimating the effects of health insurance on health caredemand. These considerations persuade researchers to usea rigorous econometric model in estimating health care demandgiven insurance with a view to isolate the true effects ofhealth insurance program. Such considerations can be furtherclassified into two-main factors. First is the features of thedependent variables used to measure the demand, and secondis the source of the data (or study design) used in the analysis.Keywords: modelling, health insurance, demand healthcareservices, applied econometrics
ANALISIS FAKTOR KONTRIBUSI RISIKO KLINIS TERJADINYA ADVERSE OUTCOME DI IGD RS ”X”TAHUN 2006 Raharjo, Saptono
Jurnal Manajemen Pelayanan Kesehatan Vol 11, No 02 (2008)
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Abstract

Background: The function of the emergency department is toserve medical emergency patient as high clinical risk areas.The lack identification of care delivery problems in emergencydepartment could be disadvantages to the patient, medicalstaff, and hospital organization.Method: The objectives of the research are to find out thecontribution factors clinical risks which influence adverseoutcome in emergency department. Research phase is basedon report case from emergency department staff and fulfilofficial criteria, interview, document study and observation toarrange chronology.Result: Research result shows that contribution factors thedirectly influence problems is patient condition and the lackskill of individual factor in cardiopulmonary resuscitations. Theother contribution factors are medical staff workload,uncompleted patient observation standard operating procedure,also the medical tools. Contribution factors indirectly influenceis institutional context factor and its most influence for caredelivery problems, another factor is changing behaviour of thepeople and tendency to more critical and high demand.Conclusion: Conform to research result, suggest “X” Hospitalhave to applied formal and structural risk management,increasing the capability of the medical staff by training,complete all unavailable medical tolls to monitoring patient whileobservation.Keywords : clinical risks, adverse outcome, contributionfactors

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