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Jurnal Manajemen Pelayanan Kesehatan
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CITRA RUMAH SAKIT BALIMÉD DENPASAR Rahajeng, Ida Ayu
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Abstract

Background: Hospital industry competition in Indonesia isgetting more intense. Identifying image position and positiveimage building of new hospital become one of importantstrategies in anticipating competitive situation and consumers’characteristics that are getting more critical in the choice ofhealth service. Positive image building of hospitals encouragepatients to pay more for health services they get and helps todecide purchase of the community.Objective: To identify perception of patients and visitors aboutimage of BaliMéd Hospital Denpasar, and to identify effect ofrespondent demography characteristics toward perceptionabout image of BaliMéd Hospital Denpasar.Method: The study used cross sectional survey design withquantitative as well as qualitative method as supplement.Primary data were obtained through questionnaire distributedto 200 patients and visitors as respondents at BaliMéd HospitalDenpasar. Qualitative method was applied through in-depthinterview to 4 patients and 3 visitors of BaliMéd HospitalDenpasar. Data were analyzed descriptively, usingindependent t-test and U Mann – Whitney test followed bymultiple regression analysis to identify the effect ofrespondents’ characteristics to perception about image ofBaliMéd Hospital Denpasar.Result: Average perception of patients (150.12) about theimage of BaliMéd Hospital Denpasar showed positive imagewhereas average perception of visitors (144.68) showedneutral image. The result of independent t-test with p=0.003(p<0.05) showed there was significant difference in perceptionabout the image of BaliMéd Hospital Denpasar between thepatients and the visitors. R=5.5% indicated low contribution ofeffect of variables of education, income, and frequency ofhealth service utilization to perception about the image ofBaliMéd Hospital Denpasar. Only the variable of frequency ofhealth service utilization at regression coefficient 1.658 thathad significant effect p=0.016 (p<0.05) to perception abouthospital image.Conclusion: Perception of patients about the image of BaliMédHospital Denpasar was positive image but visitors had neutralimage. In general, patients and visitors had significantdifference in perception about the image of BaliMéd HospitalDenpasar. Only the frequency of health service utilization thathad positive and significant effect to the image of BaliMédHospital Denpasar. Education, income and frequency of healthservice utilization all together did not have significant effect tothe process of perception building on the image of BaliMédHospital Denpasar.Keywords: image of hospital, perception
PENGEMBANGAN POLA KARIR PERAWAT KLINIK RUMAH SAKIT UMUM DAERAH TARAKAN JAKARTA PUSAT TAHUN 2008 Azwir, Azwir
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Background: The nurse as a majority health worker in thehealth care sector including the hospital has a significant rolein the health care. The value of nursing care that is continuous,constant, coordinative, and advocative so the preparation,usage, distribution, and retention of the nurse, has an importantimplication to obtain the objectives of health care and itscontinuity.Purpose: This study is conducted to explore the clinical nursecareer pattern development in the Tarakan General Hospitaland to design the career pattern development which suitablewith their role and function.Method: The qualitative method had been used in this study.The data collection was done by indepth interview and FGD.Result: Tarakan Hospital have 245 nurses with thecharacteristics as below: 77.96% of total nurses have theage range of 25 - 44 years old, 61.22% of nurses had workingperiod > 3 years, 72.24% of nurses had nursing diplomaeducational background, and 41.22% of nurses aregovernmental officer. The implementation of nurse careerdevelopment is not based on the competency test. The nursecommittee also did not play their role as it should be.Conclusion: The study recommended Tarakan Hospital toconduct advocacy toward the hospital director board todetermine the regulation of nursing career path remunerationsystem based on their career rank in the hospital and tooptimally make the function of nursing committee in formulatingthe competency test instrument related to the nursing careerdevelopment.Keywords: career pattern development, clinical nurse, TarakanHospital
PERANCANGAN SISTEM KERJA YANG ERGONOMIS DI INDUSTRI PEMELIHARAAN LOKOMOTIF “BALAI YASA YOGYAKARTA” Hariyono, Widodo
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Background: Balai Yasa PT Kereta Api (Persero) Yogyakartais the only diesel locomotive maintenance industry operating inJava Island that has a major role in determining thesuccessfulness of whole train transportation mode operated.A ‘new’ locomotive it produces indicates locomotive systemreliability operating. This is a result of a reliable maintainingprocess. Balai Yasa Yogyakarta applies manual process indoing its job. It means that the operator uses his hands to fixthe problems. In the meantime, working process in some unitsare not ergonomics from the point of motion, working position,and operator working hour. Besides, the application ofOccupational Safety and Health Management System is notintegrated with industry management system. This can lead torisks such as accident and illness of work, ineffective and notefficient work, and finally produces unqualified products.Objective: Based on (1) strategic task of Balai YasaYogyakarta, (2) product and work system produced, (3)operator interest on occupational safety and health in productionprocess, and (4) Occupational Safety and Health ManagementSystem interest in locomotive maintenance industry, theresearch conducted in order to discover (a) an ergonomicwork system, on motion and operator working position, (b)time duration in production process of work unit, (c) auditresult of Occupational Safety and Health Management Systemcan be applied as an integrated department with industrymanagement system.Method: This is a non-experimental and observational researchusing modelling style and evaluating in nature.Result: (1) In nine work stations representing complete workprocess characters, the operators show unergonomics motionand working position. It risks work accident and illness, nonoptimum work gain because of improper motion and workingposition. It needs total recovery in operator motion and theirworking position in two standards: standing or sitting must bein straight back. (2) Time duration, work hour for a locomotiveis 143 hours normally. This can be the guideline to arrange astandard in operator motion and their working position basedon time duration. (3) Occupational Safety and HealthManagement System has done the audit and the standardparameter result is 11%. The absence of Occupational Safetyand Health Committee causes occupational safety and healthrun in non standard application. Occupational Safety and HealthManagement System must be integrated in total industrymanagement system.Conclusion: Balai Yasa Yogyakarta has not appliedOccupational Safety and Health Management System andergonomic program, so that it must implement ergonomicprogram and Occupational Safety and Health ManagementSystem.Keywords: ergonomics, occupational safety and healthmanagement system, railway affairs, work system design
UNDANG-UNDANG SJSN PERLU UNTUK DIAMANDEMEN DAN DIIKUTI PENYUSUNAN UNDANG-UNDANG ASURANSI KESEHATAN Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Indonesia diharapkan mengikuti Konvensi ILONo 102/1952 yang mengatur (1) kecelakaan kerjapenyakitjabatan, (2) sakit-persalinan, (3) cacat totaltetap termasuk karena hal lain, (4) pemutusanhubungan kerja bagi yang bekerja, (5) sementarabelum bekerja (fresh graduate), (6) hari tua dan (7)potensi kemiskinan (tunjangan keluarga). Undang-Undang SJSN yang disahkan di tahun 2004 sebagaikebijakan nasional mengenai jaminan sosialdiperlukan untuk mengatur berbagai hal tersebut.Masalah kebijakan yang ada saat ini adalah UUSJSN yang diharapkan banyak pihak akan efektifuntuk mengatur asuransi/jaminan kesehatan diIndonesia ternyata gagal memenuhi harapan ini.Undang-Undang SJSN sudah lebih dari 5 tahun tidakefektif, dan mempunyai prospek yang sulit dijalankansecara teknis. Mengapa hal ini terjadi? Dipandangdari tujuannya, isi UU SJSN bersifat tanggung.Apakah sebagai UU yang bertujuan mengaturberbagai jaminan sosial seperti amanah Konvesi ILOsecara garis besar, ataukah bertujuan mengatursampai ke urusan operasional pelaksanaan.Salahsatu ketidak jelasan UU SJSN sebagaiUU yang bertujuan untuk mengatur Social Securityadalah mengenai fungsi pemerintah. Di dalam UUSJSN juga tidak jelas peran pemerintah propinsi dankabupaten. Hanya disebut sebagai Pemerintah.Konotasi adalah pemerintah pusat (APBN).Sementara itu de-facto saat ini, pemerintah propinsidan kabupaten mempunyai andil besar dalam jaminankesehatan. Ketidak jelasan ini memicu YudicialReview di MK dan sampai sekarang masih menjadikontroversi.Apabila UU SJSN bertujuan mengatur haloperasional untuk asuransi dan jaminan kesehatan,terlihat bahwa hanya sedikit pasal yang mengaturnya(10 Pasal, dari nomor 19 sampai 28). Pasal-pasaltersebut tidak cukup karena asuransi/kesehatan danjaminan kesehatan sangat kompleks. Diperlukanaturan dalam level UU yang mencakup posisijamkesda, perusahaan asuransi swasta, bagaimanamutu pelayanan akan dijamin, apa peran Kemkes,DinKes, RS, hubungan kontraktual, masalahpemerataan pelayanan, dan lain sebagainya.Khusus untuk pemerataan ada pasal dalam UUSJSN yang menyulitkan operasionalnya misalnyapasal 23 ayat 3.Dalam hal di suatu daerah belum tersediafasilitas kesehatan yang memenuhi syarat gunamemenuhi kebutuhan medik sejumlah peserta, BPJaminan Sosial wajib memberikan kompensasi.Pasal ini sungguh sangat sulit dijalankan karenapenyebaran tenaga dan fasilitas kesehatan diIndonesia yang masih sangat timpang. Sebagaigambaran di Propinsi NTT saat ini tidak ada dokteranastesi bekerja penuh. Jika pasal ini dijalankanmaka BP Jaminan Sosial harus memberikankompensasi pada warga NTT yang membutuhkanpelayanan anastesi. Apa bentuk kompensasinya?Apakah harus memberikan dana transportasi keDenpasar bagi pasien dan keluarganya untukberobat? Pasal ini pelaksanaannya sulit didefinisikan.Hal ini yang menyebabkan UU SJSN ini sulit dalampelaksanaan secara teknis.Dalam konteks perbandingan isi, UU SJSN perludibandingkan dengan Amerika Serikat yang besarnyanegara, sistem ekonomi, adanya pemerintah pusatdan daerah, mirip dengan Indonesia. Di AmerikaSerikat, hal-hal dalam Konvensi ILO (tahun 1952)disebut sebagai Social Security Act yang diterbitkanlebih awal di tahun 1935 dengan berbagai amandemensesudahnya. Secara lengkap yang diatur adalah:Federal Old-Age, Survivors, and Disability Insurance,Unemployment benefits, Temporary Assistance forNeedy Families, Health Insurance for Aged andDisabled (Medicare), Grants to States for MedicalAssistance Programs (Medicaid), State Children’sHealth Insurance Program (SCHIP), dan SupplementalSecurity Income (SSI). Selanjutnya untuk hal-hal yanglebih spesifik untuk asuransi kesehatan diatur olehberbagai UU, antara lain: The Health InsurancePortability and Accountability Act of 1996 (HIPAA),the Medicare Prescription Drug, Improvement, andModernization Act, dan tentunya yang terkait denganreformasi kesehatan Obama. Dengan demikian SocialSecurity Act yang disusun tahun 1935 ini tidak satusatunyaUU yang mengatur asuransi/jaminankesehatan di Amerika Serikat.Di Indonesia ada beberapa pendapat yangmenyamakan UU SJSN dengan ReformasiKesehatan. Menurut hemat kami, UU SJSN lebihmirip dengan Social Security Act yang seperti UUpayung di Amerika Serikat. Dengan logika inisebaiknya UU SJSN diamandemen agar menjadisemacam UU payung untuk melaksanakan KonvensiILO. Sementara itu untuk mengatur sistem jaminandan asuransi kesehatan diperlukan UU mengenaiasuransi/jaminan kesehatan. (Laksono Trisnantoro,trisnantoro@yahoo.com).
ANALISIS BIAYA PER KAPITA SEBAGAI UPAYA ADVOKASI PENGENDALIAN BIAYA PROGRAM JAMINAN KESEHATAN JEMBRANA Januraga, Pande Putu
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Introductions: Jembrana Health Insurance (JHI) program isintended to provide health insurance at first level (PPK I) forinhabitants of Jembrana District. Up till now, financing of JHIdepends on subsidy in which it is growing up and has a trendto be out of target. Therefore, it needs to manage cost byimplementing capitation payment system. Aim of this researchwas to analyze cost per capita and to identify perceptions ofJHI stakeholders towards capitation system.Methods: This research was case study through analyzingsecondary data and performing in-depth interview. Data onmember’s utilization and claim cost were collected using forms.Results: Result of cost per capita calculation based on realutilization of PPK I namely Rp5.262,- per month per member is63 % higher than cost per capita based on normal utilization ofPPK I namely Rp1.949,- per month per member. Furthermore,result of in-depth interview shows that both policy makersand providers have a bad perception towards capitationsystem and results of cost per capita calculation.Conclusions: Local government could apply principles ofmanaged care by controlling cost and quality by developingcapitation payment system for PPK I based on normal utilization.Keywords: health insurance, cost per capita, capitation
KEBIJAKAN INFORMED CONSENT DALAM PELAYANAN GIGI DI INDONESIA DENTAL CARE INFORMED CONSENT POLICY IN INDONESIA Oktarina, Oktarina
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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More than 50% out patients in Puskesmas at Surabaya citycame to the dentist for dental permanent extraction. The targetratio between filling and extraction that government statedwere 1:1, but coveraged in Puskesmas at Surabaya City in2003 were 1:5,9. Informed consent was given to patientsbefore the actions, consisted the diagnoses, procedures, themedical purpose, alternative actions, risks, possiblecomplications and prognoses.In Indonesia, there were not the rules yet that regulated theinformed consent before dental extraction. The law ofIndonesian Medical Practices No. 29/2004 has described theresponsibilities to do the informed consent for the actions thatpurposed on preventive, diagnostic, teurapeutic andrehabilitative. So, a dental extraction which is the teurapeuticprosedured needs the informed consent. After all, the informedconsent should be protect both of patient as a subject anddoctor/paramedic from unpredictable conditions.Keywords: informed consent, dental permanent extraction,policy
EVALUASI PENERAPAN SISTEM INFORMASI TRANSAKSI PUSKESMAS DI KABUPATEN BANTAENG PROPINSI SULAWESI SELATAN Sudarianto, Sudarianto
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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Background: Health information system is one of four healthdevelopment major strategies. Health Office of South CelebesProvince has tried to implement an electronic information systemin health centers (Puskesmas) which is named Puskesmas’Transaction Information System (SITRAPUS) in BantaengDistrict since 2006. However, its performance andeffectiveness have not been evaluated yet.Objectives: The research aimed to evaluate the implementationof SITRAPUS in Bantaeng District from aspects of developmentprocess, the output, the barriers and entries during theimplementation.Methods: This was a qualitative study. The data was gatheredby in-depth interview and observation in health centers,Bantaeng District Health Office, and Health Office of SouthCelebes Province.Results: From the development process, the result showedthere was lack of operator participation in the process ofSITRAPUS designing; the use of SITRAPUS was not wellsocialized so that the users were not familiar with the system;there was no a division which managed the information system,less supervisory; and there was no technical support for theSITRAPUS maintenance. The SITRAPUS output were diseasereports but they were not accurate and irrelevant with theorganization needs. Nevertheless, the users felt that the systemcould make their works easier, especially in data searching.The SITRAPUS output were used by the health centers incalculating the retribution, meanwhile data access to the districtwas not up to date and timely.Conclusions: The SITRAPUS implementation in BantaengDistrict was not optimal, because this implementation did notaccordance to the system development life cycle and the outputwas only report.Keywords: evaluation of information system, informationsystem of health center transactions
MEASURING TRANSPARENCY TO IMPROVE GOOD GOVERNANCE OF PHARMACEUTICALS IN INDONESIA Suryawati, Sri
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 01 (2010)
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A national survey has been conducted to assess thetransparency in public pharmaceutical sector in Indonesia. Thesurvey was conducted during 2007, and writer was appointedby the government as independent assessor. The assessmentcovered five functions of government in pharmaceutical sector,i.e., registration, control of promotion, inspection of production,selection of essential medicines, and central procurement ofnational buffer stock. Key informants were selected based onfirst-hand knowledge on each function, representinggovernment, pharmaceutical company, academe/professionals,and NGOs, i.e. 10 informants for each registration, control ofpromotion, inspection of production, selection of essentialmedicines, and 20 informants for central procurement. Datawere collected by means of in-depth interviews, using sets ofquestionnaires provided by the WHO. Findings were analyzedfollowing a scoring system that ranging from zero to ten. Thesmaller the score indicates in-transparency, and thereforeindicates the more vulnerability for corruption.The results showed that the registration process scored 7.2,control of promotion scored 7.6, inspection of production scored8.7, selection of essential medicines scored only 5.5, and thecentral procurement scored 7.0. In general, it is appreciatedthat the functions of registration, control of promotion,inspection, and procurement were well governed, but theselection of essential medicines obtained a low score. Therehas been remarkable lacking of written procedures that publiclyavailable. In regard to the selection function, there is no writtenprocedure in every process of selection, i.e., selection criteriaof the revision committee member, written criteria for application,written criteria for addition, substitution and deletion, and writtenprocedures of decision making. Declaration of interest is tosome extents, lacking from most functions. It wasrecommended that the Government should establish writtenprocedures of each function and make them publicly available,establish mechanism to minimize conflict of interest in eachfunction i.e., by means of declaration of interest, and establishmeasures to fill up regulatory gaps. By the time of publication,corrective actions in all five functions have been made and atthe time being the Government is ready for re-assessment.Key words: transparency, pharmaceuticals, good governance,public sector, vulnerability for corruption

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