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Jurnal Manajemen Pelayanan Kesehatan
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HAMBATAN DAN HARAPAN SISTEM KREDENSIAL DOKTER: STUDI KUALITATIF DI EMPAT RUMAH SAKIT INDONESIA Herkutanto, Herkutanto
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Background : The accountability of the physicians serving inhealth care is a crucial factor to establish the patient safety.The credentialing system, a process to grant clinical privilege,aims to ensure the accountability. Credentialing processes varyin different Indonesian Institutions, and frequently areinadequately performed. Information about obstacles andexpectations on current credentialing process is needed todesign a strategy to develop credentialing system.Methods: A qualitative study using Focus Group Discussions(FGD) were conducted in four hospitals in Indonesia withdifferent characteristics. Every FGD was attended by 10-20participants, consisted of physicians and hospital management.The results of the FGDs were analyzed with qualitativeapproach.Results: The obstacles of the establishment of ideal credentialsystem rooted in the inappropriate perception that credential isthe same as physicians recruitment as hospital employees.The expectations of the participants are the needs of monitoringprocess, sound relationship between credential team andhospital management, standardization of policy and credentialinstruments, existence of objective credential team, and goodrelationships among colleagues.Conclusions: Indonesia needs a credentialing system that isable to establish the patient safety. The expectations ofparticipants are in line with the recommended credentialsystem, which is based on the concept of professionalism.Keywords: physicians credentialing system, professionalism,patient safety
APAKAH UNDANG-UNDANG SISTEM JAMINAN SOSIAL NASIONAL DAPAT TERUS DILAKSANAKAN? SEBUAH ANALISIS SEJARAH DAN BUDAYA Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Di penghujung tahun 2009 ini, usia Undang –Undang (UU) Jaminan Kesehatan Masyarakat(Jamkesmas) telah lima tahun (UU No. 40/2004).Selama lima tahun, praktis UU Sistem Jaminan SosialNasional (SJSN) tidak berjalan. Salah satupenyebabnya adalah bahwa UU SJSN inimembutuhkan UU lain yaitu UU Badan PengelolaJaminan Sosial (BPJS) yang tidak kunjung selesai.Pernyataan menarik adalah bahwa UU SJSN ini terlihattidak efektif untuk merubah masyarakat dan tentunyapertanyaannya mengapa gagal? Salah satupenjelasan adalah bahwa UU SJSN tidakmemperhatikan sejarah masyarakat yang akan diaturoleh UU. Sebuah UU dapat gagal karena tidak berhasilmerubah tata kehidupan masyarakat. Artinya tatakehidupan yang sudah berlangsung lama sejarahnyatidak bisa diubah. Masyarakat secara sengaja atautidak sengaja menolak pelaksanaan UU.Diskusi mengenai kebijakan dan historymerupakan hal menarik untuk diperdebatkan. Sebuahkebijakan (misal UU) dapat bersifat ahistorik jika tidakmempertimbangkan atau melihat sejarah. Namunperlu dicatat bahwa kebijakan memang dapatbertujuan membalikkan sejarah atau merubah sebuahtradisi. Lee Kuan Yew dengan kebijakan kerasberpuluh tahun mampu merubah perilaku kebersihanpenduduk Singapura. Jadilah sekarang situasiSingapura yang lebih bersih dibanding London(sebagai benchmark Lee Kuan Yew). Situasi iniberbeda dengan kebiasaan hidup tidak bersih dalamsejarah masyarakat perantauan Chinese. KebijakanSingapura bersih tersebut berhasil membalikkanpeninggalan sejarah. Kebijakan Singapura memangsangat keras karena melihat budaya kebersihandalam sejarah Singapura yang tidak baik. Jadi kalausebuah kebijakan tidak memperhatikan sejarah/tradisibudaya, maka kebijakan ini mempunyai risiko tidakberjalan. Hanya di atas kertas.Undang-Undang (UU) SJSN merupakan halsangat berat karena harus mampu merubah berbagaihal termasuk perubahan budaya masyarakat, dokter,tenaga kesehatan lainnya, pimpinan dan stafperusahaan asuransi kesehatan, pejabat dinaskesehatan, sampai ke pejabat. Undang-Undang (UU)SJSN bukan hanya merubah prosedur, tapi budayayang sudah menjadi tradisi, menjadi bagian darisejarah panjang sektor kesehatan Indonesia. Tradisidokter mendapat fee for service tidak hanya 10tahunan. Sudah lama sekali.Sejarah sangat penting untuk menjadipertimbangan kebijakan. Pada tahun 1948,pemerintah Inggris dari Partai Buruh secara kerasmenasionalisasi semua pelayanan kesehatan agarterjadi pemerataan. Hal ini tidak terjadi di AmerikaSerikat. Dengan menasionalisasi RS swasta,pemerintah Inggris dapat melakukan intervensidengan kuat. Patut dicatat bahwa sekitar tahun 1948medico industrial compleks belum sekuat sekarang.Dalam konteks perubahan di Inggris, kebijakanmenasionalisasi menjadi NHS dilakukan oleh PMPartai Buruh saat itu, dalam suasana rekonstruksiInggris pasca Perang Dunia II. Kebijakan inimenasionalisasi pelayanan kesehatan swasta,kemanusiaan (termasuk keagamaan), pemerintahlokal diinisiasi oleh kantor PM Inggris yang cenderunglebih ke kiri (sosialis) yaitu Partai Buruh.Kebijakan ini sangat memperhatikan tradisidalam sejarah, termasuk tradisi pendapatan tinggidokter yang sangat kuat. Para pengambil kebijakanpaham bahwa para dokter pasti menentang. Olehkarena itu, Aneurin Bevan (Menteri Kesehatan Inggrissaat itu) menyatakan: “I stuffed their mouths withgold”. Agar tidak ditentang dokter, kebijakan inisangat memperhatikan pendapatan para doktersehingga mau berubah.Dari gambaran ini, kita dapat melihat betaparapuhnya UU SJSN. Terbukti selama lima tahun tidakberjalan. Kerapuhan timbul dari berbagai sudut.Pertama dari saat disahkannya. Undang-Undang(UU) SJSN disahkan oleh Ibu Megawati di hari-hariakhir periode kepresidenan. Undang-Undang (UU)semacam ini sering disebut sebagai “Midnight Laws”.Dapat dipahami bahwa periode kepresidenenberikutnya tidak merasa memiliki (ownership) UUSJSN. Sangat berbeda dengan NHS di Inggris yangdisiapkan bertahun-tahun sebelumnya sebagaiagenda Partai Buruh. Oleh karena itu, UU SJSN perludiamandemen dengan salah satu tujuan adalahmeningkatkan kepemilikan dan dukungan politis daripemerintah yang berkuasa.Kerapuhan kedua, UU SJSN tidak bicarabanyak mengenai tradisi di sektor kesehatan,termasuk peran para dokter yang sangat powerfull.Masalah apakah para dokter akan kekuranganincome apabila menjalankan UU SJSN tidak dibahas.Kenyataan memang sudah terjadi. Model UU SJSNmemberikan insentif rendah dibanding OOP. Undang-Undang (UU) SJSN tidak bicara banyak mengenaibagaimana meratakan pelayanan kesehatan keberbagai tempat, UU SJSN tidak bicara banyakmengenai tradisi masyarakat Indonesia yang tidakkenal risiko dan lain-lain. Banyak sekali haloperasional tidak dibahas.Kerapuhan ketiga, UU SJSN mencakupkesehatan dan berbagai aspek welfare dalamhubungan pengusaha dengan buruh. Aspek ini sangatpolitis. Berbagai kepentingan dan ideologi yangsaling bertentangan dapat terjadi. Hal ini dapat dilihatdari kecurigaan para industrialis terhadap UU SJSNini yang dianggap mengurangi daya kompetisi produkIndonesia. Undang-Undang (UU) SJSN menjadisangat rapuh pada perdebatan ideologis. Akibatnyamasalah teknis yang banyak terdapat disektorkesehatan menjadi terabaikan. Komponenkesehatan bisa menjadi tidak terurus secara baikdalam UU SJSN.Oleh karena itu, diusulkan agar UU SJSNdiamandemen dan kalau bisa dipisahkan sendiri.Dari titik ini kemudian disusun UU AsuransiKesehatan dan atau UU Jaminan KesehatanNasional. Mengingat beratnya masalah yang sampaimencakup tata kehidupan dan sejarah yang sudahpanjang, diharapkan jangan diletakkan bersamasamadengan jaminan sosial lainnya (LaksonoTrisnantoro, trisnantoro@yahoo.com).
UPAYA MENINGKATAN PENANGGULANGAN GAKI PADA ANAK SEKOLAH DI DAERAH GONDOK ENDEMIK BERAT DI KOTA SURABAYA Oktarina, Oktarina
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Background:  Iodine  deficiency  disorder  is  one  of  fourmalnutrition problems in Indonesia. Initial surveys at PrimarySchool  children  in  East  Java  reveal  the  goiter  prevalence  ishigh, the Total Goiter Rate (TGR) 22,9%. The recent study atSurabaya  City,  has  16,93%  of  severely  iodine-deficiencyvillages,  higher  than  normative  value  (less  than  5%).  SinceSurabaya is regarded as the second largest city after Jakarta,the  iodine-deficiency  disorder  have  been  considered  majorproblem.  This  need  to  be  examined  and  analysed  theimplementing programmed after all.Method:  The  purpose  of  this  study  was  a  descriptive  type,done cross sectionally a carried out from Mei to July 2005. Thestudy was conducted to examine the effect of iodine-deficiencydisorder in 7 district area at 10 villages in Surabaya; TambakOso  Wliangun,  Romokalisari  (Benowo),  Sidotopo  Wetan,Tambak Wedi  (Kenjeran),  Manyar  Sabrangan  (Mulyorejo),Kedung Cowek (Bulak), Perak Utara, Nyamplungan (P.Cantikan),Bubutan, and Bangkingan (Lakarsantri).Result: The result show many faktor, such as social economicfactors from the society, the lack of iodine-deficiencies discrderknowledge, low health staff motivation to run the program etc.The  middle  term  and  short  programme  of  iodine-deficiency,planning, organizing, actuating and coordination at the PrimaryHealth Center (Puskesmas) should be taken soon.Conclusion:  The  recommendation  as  follow  promotive,preventive, curative and rehabilitative strategy, by socialization,advocation  salty  iodine  and  knowledge  of  goiter  disease  torelated  cross  sectoral  department,  as  well  as  health  staffs,Primary  Health  Center  staff,  the  society  in  severely  iodine-deficiency, nutrition and food awareness area. Provide overallhealth  services  for  iodine-deficiency  disorder  problems;  dietcounseling, medical treatment, integrated management planning,organizing and actualization. Coordinating and evaluating theprogramme, improve the quality and professionalism in managingthe  iodine-deficiency  disorder  problem  especially  in  PrimaryHealth Center in Surabaya City.Keywords:  iodine-deficiency  disorder  problem,  society  andhealth staff  factors,  management and control
POLITIK PEMBANGUNAN DAN KEBIJAKAN PRIVATISASI PELAYANAN KESEHATAN Ayuningtyas, Dumilah
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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A wave into democratization and liberalization which influencedthe development of government politic had arisen. This wavealso provided space for public’s participation or any otherprivate sector on development privatization including publicservice. Thus health sector is not an exception in this case.Substantive definition of privatization is action of diminishingthe government’s participation (state control) and increasingprivate’s partaking. Although the inclination for escalation ofprivatization policy on health service seems promising, yet itstill need endeavor to ensure that the implementation ofprivatization in Indonesia does not contradict with government’sobligation and objective in giving broadened and attainablehealth service with good quality.Keywords: government political development, privatization’spolicy on health service
ANALISIS PENETAPAN PASAR SASARAN RUMAH SAKIT STELLA MARIS MAKASSAR TAHUN 2008 Hamzah, Asiah
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Backgrounds: The increasing of quality competition in serviceof hospital health, driving management of Stella Maris Hospitalin Makassar to design business strategy which can be costeffective and improve the earnings. Strategy of target marketingis one of the accurate alternatives because hospital will getsome benefit namely: 1) more efficient resource allocation 2)can chosen the more interesting target, 3) more comprehendingof requirement and market desire 4) progressively narrow thescope market served, and 5) progressively understand thehospital to its market behavior.Objectives: The aim of this research is to find out the hospitalmarket segment based on: the consumer characteristics, theinterest of market segment, and the profile of Stella MarisHospital in Makassar.Methods: The research was carried out in the inpatient unitof Stella Maris Hospital in Makassar. The data were obtainedby survey and questionnaire to 115 patients or patients’ familyin the inpatient unit of Stella Maris Hospital in Makassar fromApril 15 to May 15, 2008.Results: The result shows that based on customers’characteristics, there were three market segments namelysegment I consisting of 30 people (26.09%); segment IIconsisting of 25 people (21.74%); and segment III consistingof 60 people (52.17%). Based on the interest of market segment,segment III is determined as the target market by Stella MarisHospital in Makassar and labeled as health care maximize.Based on the profile of Stella Maris Hospital in Makassar whichis viewed from potential market size, market compartment, thenumber of closest competitors, substitution attendance,geographical accessibility, and relationship between segmentwith partner companies or insurance, segment III is determinedas the target market by Stella Maris Hospital in Makassar, andlabeled as health care maximize.Conclusions: Viewed from the segment interest and theprofile of Stella Maris Hospital in Makassar, segment III whichlabeled as health care maximize is determined as the targetmarket of Stella Maris Hospital in Makassar in 2008.Keywords: target market, segmentation, hospital marketing
EVALUASI KINERJA PELAYANAN ANTENATAL ANTARA PUSKESMAS CAKUPAN TINGGI DENGAN PUSKESMAS CAKUPAN RENDAH MENGGUNAKAN PENDEKATAN BALANCED SCORECARD Ernawati, Ernawati
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Background: Community Health Center (CHC) is hoped togive quality antenatal care. However, maternal and child healthcoverage in Bekasi District has not achieved the targetedstandard yet. First visit of pregnant mothers in 2006 was 87.5%and fourth visit coverage was 77.8%. There were 21 casesof maternal mortality in 2005 and only four out of 34 CHCsachieved the target of maternal and child coverage. Theseshow that maternal and child health care performance is notoptimal; therefore, improvement should be made. One ofperformance measurements is balanced scorecard whichincludes four perspectives, namely finance, costumers’satisfaction, internal business, and learning and growth.Objective: To evaluate antenatal care performance betweenhigh coverage CHC and low coverage CHC using balancedscorecard approach in Bekasi District.Method: This was an observational study with cross sectionalstudy design. Qualitative data were used in this study. Thesubjects were the head of CHCs, the midwives responsiblefor the implementation of antenatal care in maternal and childhealth room, and all pregnant mothers receiving forth visit care.The study was performed in Mekarmukti and Cibarusah CHCs.Study instruments were questionnaire, checklist, and interviewguide. Univariate analysis and bivariate analysis with chi-squaretest and stratification were used.Results: There was an association between providers’education/training and antenatal coverage (χ² = 10.015; p =0.002; PR = 4.026; CI 95% = 1.667-9.724), and patients’satisfaction (χ2 = 4.607; p = 0.032; PR = 2.516; CI 95% = 1.080-6.348), while standardized care was not related to antenatalcare coverage. Stratification analysis showed that antenatalcare coverage in Mekarmukti CHC was better than that inCibarusah CHC (χ2 = 5.662; p = 0.017; PR = 4.407; CI 95% =1.082-18.789), patients’ satisfaction in Mekarmukti CHC wasbetter than that in Cibarusah CHC (χ2 = 6.935; p = 0.008; PR =8; CI 95% = 1.256-84.624). Based on the qualitative data, therewas no difference in finance performance in both CHCs.Conclusions: There is a difference between providers’education/training and the level of patients’ satisfaction inMekarmukti and Cibarusah CHCs. There is no difference inMekarmukti and Cibarusah CHCs operational fund and standardantenatal care.Keywords: balanced scorecard, performance, antenatalcoverage
ANALISIS FAKTOR PENYEBAB MELONJAKNYA ANGGARAN OBAT PEMERINTAH KOTA BATAM SETELAH PEMBEBASAN BIAYA RETRIBUSI PASIEN PUSKESMAS Nurliyasman, Nurliyasman
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Background: Batam municipal government has implementedthe program of patient retribution cost exemption in all healthcenters of Batam Municipality with no exception (includes thehaves and the have not) as long as they can show theirpopulation identity card when they visit health canters.Consequently health budget increases four times higher thanthe previous fiscal year. This is interesting to study further inorder to find out the effectiveness or ineffectiveness of theprogram implementation.Objective: The study aimed to analyze the policy of retributionexemption and increased drug expenditure budget.Method: The study was retrospective observational usingboth quantitative and qualitative data, analytical survey methodand cross sectional design. Quantitative data were obtainedwith cluster sampling from documents of health centers suchas monthly report, number of visits of the patients, prescriptionwithin three years (2005 – 2007) of samples of each yearwere taken three months during peak visits to health centers(June, July and August). Data obtained were tabulated andanalyzed using paired t-test at significance level 95%.Qualitative data were obtained from in-depth interview withrelated stakeholders.Result: Retribution exemption program led to sharp increaseof visits to health centers to twice. There was no difference indisease pattern before and after retribution exemption. Theresult of paired t-test to prescription pattern showed differencebefore and after retribution exemption. The Health Institution ofBatam succeeded to maintain good prescription pattern.Conclusion  : Caused sharp increase of drug budget afterretribution exemption in health centers was over anticipate ofdrug procurement to forecast of visits health centre. The overprocurement can be anticipated by planning of drugprocurement the next years.Keywords: health centers, retribution exemption, drug budget
KINERJA PENERAPAN SISTEM MANAJEMEN KESELAMATAN DAN KESEHATAN KERJA PERUSAHAAN PESERTA PROGRAM JAMINAN KECELAKAAN KERJA PADA PT JAMSOSTEK CABANG MEDAN Silaban, Gerry
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 03 (2009)
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Background: The high number of industrial accident is causedby management dysfunction in term of occupational healthand safety. The implementation of occupational health andmanagement system (OHSMS) established by the Regulationof The Minister of Manpower No. 05/1996, is a governmentpolicy that has to be implemented by the enterprises in theattempt to decrease industrial accident rate. The performanceof OHSMS implementation is assessed by OHSMS audit togather objective evidence from strength and weakness in theimplementation of occupational health and safety in work places.Method: The type of this research is survey research.Research sample was established based on the manpowernumber criteria of at least 100 people in each enterprise. Theperformance of OHSMS implementation based on 12 OHSMSaudit elements was known to be correlated with 5 OHSMSimplementation principles. One factor repeated observationvariance analysis was used to test the performance differenceof 12 OHSMS audit items and 5 OHSMS implementation principles.Result: A number of 53 (96.36%) enterprises fulfilled 0-60%criteria and 2 enterprises (3.64%) fulfilled 60-84% criteria from166 OHSMS audit criteria. The mean criteria fulfillment number(percentage) was highest achieved (scored 4) in 5th element(purchasing) that is 4 out from 7 criteria (57.14%) in 5th element.Mean score of 5th element was reached with the highestpercentage (74.87% from 5th element maximum score). F-testresult showed a significant difference (p < 0.01) in 12 OHSMSaudit elements performance and t-test showed variety betweeneach performance in 12 OHSMS audit elements. Mean criteriafulfillment number (percentage) was highest achieved (scored4) in 3rd principle that is 20 out of 67 criteria (29.85%) of 3rdprinciple. Principle 3 means score was reached with the highestpercentage (55.40% from 3rd principle maximum score). F-testresult showed a significant difference (p < 0.01) in 5 principlesof OHSMS implementation performance and t-test resulted invariety between each principle performance in 5 principles ofOHSMS implementation.Conclusion: Management should have a commitment andinvolve all workers in enhancing OHSMS implementationperformance to reduce industrial accident rate which lead toproductivity and work quality improvement.Keywords: industrial accident, registered enterprises in theemployment accident benefit program, the implementationperformance of occupational health and management system

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