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Jurnal Manajemen Pelayanan Kesehatan
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PERAN PENYELENGGARA PELAYANAN KESEHATAN PRIMER SWASTA DALAM JAMINAN KESEHATAN DI KABUPATEN BANDUNG Gondodiputro, Sharon
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Background: Apart from funding, the role of health careproviders on the health insurance scheme should be takeninto account, because they are one of the components ofhealth insurance scheme and could play as gate keepers.They include private and public health providers. 92.14% ofthe total primary health providers in Bandung District are privatehealth providers, consisted of 561 doctors, 392 midwives and154 private clinics. The objective of the study was to assessthe involvement, mechanism of payment and willingness toparticipate of the private health providers in the health insuranceschemeMethod: A survey with a simple random sampling wasconducted using questionnaire for 207 respondents (153doctors and 54 clinics).Result: Only 23% doctors and 21% clinics that already hadcontracts with 14-20 third payers. The mechanisms of paymentfrom the third payer to the providers were capitation (43%doctors, 50% clinics) and claims (39% doctors, 43% clinics).Among private providers who had not yet contracts with thirdpayer, only 55% doctors and 56% clinics wanted to havecontract. Factors contributed to the refusal were humanresource and facilities, finance, administration and health caredeliveryConclusion: Private health providers should be involved, aspart of the health insurance scheme in Bandung District withdeveloping efforts to gain trust between the providers andthird payers and considering a proper benefit for all.Keywords: Private Health Providers (PPK I), gate keeper,health insurance
PENGOBATAN TRADISIONAL, UPAYA MEMINIMALKAN BIAYA KESEHATAN MASYARAKAT DESA DI JAWA Triratnawati, Atik
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Background: Traditional medicine is frequently perceived asnegative and even though many people still practice. It the useof traditional medicine is mainly due cause to tradition. Thevillager tends to use traditional medicine as primary healing.This article tried to identify frequent diseases among Javaneseand economic capability to afford health cost.Methods: Ethnography study using observation and in-depthinterviewamong 48 informants and 6 key informant of peasantcommunity in Sleman, DIY and fisherman in Rembang, CentralJava, during 2007-2008. Phenomenology approach used duringdata collection and analysis.Result: Masuk angin (wind illness) is a disease whichfrequently occur among the villager. Traditional medicine wasapplied because it is inexpensive, easy, effective and suitablewith the cognitive related to the harmony (equilibrium). Theprinciple of coining was binary opposition such as: hot x cold;loose x tight; angin masuk x angin keluar; better x awful andthe equilibrium is the basic rational of traditional medicine.Recommendation: Traditional medicine must be recognizedby the government and should be in equal position to modernmedicine in order to reduce negative opinion, so the rational ofit is recognized by others.Keywords: holistic, traditional, masuk angin, effective, cheap
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)
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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
IMPLEMENTASI KEBIJAKAN JAMINAN SOSIAL KESEHATAN SUMATERA SELATAN SEMESTA DI PUSKESMAS SE-KOTA PALEMBANG TAHUN 2009 Ainy, Asmaripa
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Background and objective: Universal Social Health Insuranceof South Sumatera (Jamsoskes) is an effort undertaken by theGovernment of South Sumatera to improve the accessibility ofhealth services for the people in South Sumatera, held since22 January 2009. The aim of this study was to analyze theimplementation of Jamsoskes policy in the community healthcenters in Palembang during the year 2009.Methods: This was a policy analysis research with qualitativeand quantitative approaches. Data were obtained in HealthOffice of South Sumatera Province, Health Office of PalembangCity, 38 community health centers in Palembang and users ofJamsoskes. Qualitative data were collected through: in-depthinterviews and FGDs, then quantitative data were collectedthrough review of documents related to Jamsoskes. Contentanalysis was used to analyze qualitative data and quantitativedata were analyzed by univariate statistics.Results: Results showed that: 1) Implementation of Jamsoskeshas been according to district regulation of South SumateraProvince Number 2/2009 and Governor Regulation Number 23/2009; 2) Source of funds were contribution from budget ofSouth Sumatera Province and Palembang City; 3) Organizingconsist of the provincial coordination team, the city coordinationteam, the service managers team, and verification officers. 4)The utilization of Jamsoskes in 38 community health centerswas 408.830 people and the total of referral 9.089 people. 5)Several problems in implementation of Jamsoskes i.e. on aspectof membership administration, services administration, andfinancial administration. There were incomplete identities inmembership administration, in services administration aspect,medical diagnosis’ or treatments sometimes were not appropriate,whereas in the financial administration, the claims cost werenot in accordance with district regulation. During the year 2009the difference between billing and approval of claims in 38community health centers at total of Rp21.037.000,00Conclusion: Health financing policy in Palembang City throughJamsoskes program was not optimal, as seen from severalproblems: membership, services, and financial administration.Recommendation for Health Office of South Sumatera Provinceto build membership database and not use Jamkesmasverificator for Jamsoskes verificator in order to reduce workoverload. Health Office of Palembang City need to disseminateroutinely of data verification to community health centers andalso to verificators. Community health centers need to intensifyprovisia of information to society about prerequirements to getJamsoskes service.Keywords: healthcare financing, social health insurance,community health centers
PENGARUH PENGEMBANGAN JAMINAN KESEHATAN BALI MANDARA TERHADAP KEBERADAAN JAMINAN KESEHATAN TINGKAT KABUPATEN DI BALI DAN UPAYA PENCAPAIAN UNIVERSAL COVERAGE Januraga, Pande Putu
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Background: To conduct an analysis of the influence of theBali Mandara Health Insurance (JKBM) policy concerning theexistence of district level health insurance and its impact onachieving universal coverage.Method: Literature review to produce an analysis of JKBMpolicy and to produce appropriate policy alternatives forfinancing and health care issues which emerged from theimplementation of JKBM.Results: The aim of Bali Mandara Health Insurance is to providehealth services which are fully subsidized by the Provincialand Districts Government in Bali. JKBM is intended for peopleswho do not protected by health insurance programs. Theimplementation of JKBM has forced Tabanan to stop the AskesMandiri program while Jembrana District decided not to takepart in JKBM. Unlike JKJ and Askes Mandiri, JKBM is still managedby a coordination team under Bali Health Office Supervision.Furthermore another fundamental difference is regarding onhow they finance the program. JKBM is fully financed fromsharing subsidies while JKJ and Askes Mandiri are financedfrom member premium. Nevertheless JKBM policy is potentialto expand the efforts of achieving universal coverage, improveequity in health financing and fulfil a non-profit principle ofsocial health insurance. Along with the positives impact, thisprogram also has several weaknesses. One of theweaknesses is lack of consideration to the principles of socialsolidarity and mutual cooperation. Communities’ participation inhealth financing program which has been developed by JKJand Askes Mandiri is abandoned. In addition to theseweaknesses JKBM also less able to adopt the district healthinsurance who have first evolved. JKJ case shows of JKBMfailure to apply the principle of portability and benef itscoordination of the services thereby potentially harming thepeople of Bali.Conclusion: Bali provincial government should immediatelydevelop Implementing Agency (Badan Pelaksana) of JKBM toorganize and develop the program. In addition to this, memberparticipation throughout premium payment could be establishedgradually to ensure the sustainability of the program. JKJ andJKBM should operate in harmony by considering role distributionbetween member, Provincial Government of Bali, andGovernment of Jembrana.Keywords: health insurance and universal coverage
BAGAIMANA PERAN PERGURUAN TINGGI DALAM PENGEMBANGAN UNIVERSAL COVERAGE? Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Jurnal Manajemen Pelayanan Kesehatan (JMPK) bulan Juni 2010 ini merupakan edisi khusus yang membahas mengenai kebijakan untuk Universal Coverage. Mengapa dilakukan edisi khusus? Diharapkan edisi ini dapat merangsang para peneliti untuk menuliskan penelitian mengenai Universal Coverage, sekaligus mencoba menghadirkan JMPK ke para pengambil keputusan. Diharapkan JMPK menjadi salahsatu jembatan untuk menghubungkan antara dunia akademik dengan pengambilan keputusan yang selama ini kurang efektif. Pengalaman subyektif Pusat Manajemen Pelayanan Kesehatan-Fakultas Kedokteran Universitas Gadjah Mada (PMPK-FK UGM) sebagai lembaga peneliti dan kebijakan menyiratkan penelitian memang belum dipergunakan secara penuh dalam sejarah program jaminan kesehatan di Indonesia. Dalam pengalaman tersebut dapat dilihat bahwa perguruan tinggi berada dalam posisi yang tidak mantap. Dalam hubungan segitiga tersebut, ada pengalaman empirik bahwa pendapat dari perguruan tinggi diabaikan dan hubungan kerja yang berbasis pada kontrak jangka pendek tidak dilanjutkan. Dalam pengalaman program JPKM di Klaten (awal dekade 90-an) pada saat fase identifikasi masalah dan isu untuk kebijakan terjadi perbedaan pendapat antara perguruan tinggi dan penyandang dana mengenai berbagai hal prinsipil. Dalam perbedaan pendapat ini maka dalam proses kebijakan selanjutnya (perumusan kebijakan, pelaksanaan kebijakan, dan evaluasi kebijakan) terlihat bahwa pihak perguruan tinggi dan lembaga penelitian kurang mendapat peran. Akibatnya tidak ada ruang untuk melakukan evaluasi independen terhadap efektivitas kebijakan model JPKM. Sebagai bangsa, Indonesia membuang kesempatan dalam masa pembelajaran besar antara tahun 1990-an ke tahun 2004. Pengalaman lain, pada awal tahun 2005 ketika kebijakan askeskin dilakukan, usulan untuk mengembangkan suatu sistem jaminan kesehatan yang detil ditulis berdasarkan good governance yang perlu dicoba secara empirik dengan melibatkan berbagai stakeholder. Usulan PMPK- FK UGM ditulis dalam bentuk dokumen saran untuk penyusunan kebijakan kesehatan yang didanai GTZ. Intinya usulan ini menyatakan bahwa kebijakan pembiayaan kesehatan bukan hanya menyangkut kebijakan, namun menyangkut berbagai hal lain yang kompleks, antara lain: rujukan kesehatan, ideologi, budaya para dokter, sampai ke masalah kompensasi. Namun usulan ini ternyata tidak diperhatikan. Akibatnya dana kegiatan askeskin melalui PT Askes Indonesia berjalan tanpa ada persiapan mengenai sistem pembiayaan dan pelayanan kesehatan, dan tidak disertai dengan evaluasi kebijakan secara ilmiah. Perubahan di tahun 2008 ke Jamkesmas, adalah kebijakan yang berada di luar jangkauan manfaat ilmu pengetahuan karena kebijakan ditetapkan secara situasional. Kebijakan ini merupakan hasil negosiasi pragmatis terhadap situasi yang mendesak. Secara keseluruhan, dalam masa 20 tahun terakhir ini, terlihat bahwa Perguruan Tinggi atau Lembaga Penelitian tidak ada yang menjadi mitra atau think-tank khusus untuk asuransi kesehatan. Hal ini berbeda dengan Reformasi Kesehatan oleh Presiden Obama yang didasari oleh sekelompok peneliti dari Harvard University, atau skema di Thailand yang merupakan sebuah kelompok yang terdiri dari beberapa perguruan tinggi dan lembaga penelitian. Kegiatan yang terjadi lebih banyak pada hubungan antara pengambil kebijakan dan individuindividu di perguruan tinggi saja. Dalam konteks kekuatan tawar, tentunya hubungan ini menjadi lebih lemah dibanding dengan kalau ada hubungan organisasi antara pengambil kebijakan dan lembaga. Keahlian perorangan sebagai konsultan atau narasumber sangat rentan untuk tidak diteruskan. Dengan demikian secara jelas terlihat bahwa peran perguruan tinggi masih lemah. Apakah hal ini terkait dengan ketidakstabilan proses kebijakan, mulai dari perencanaan, penyusunan, sampai implementasi dan monitoring kebijakan jaminan kesehatan. Sebagai catatan: pembiayaan kesehatan adalah sebuah sistem yang riil yang dapat diukur keberhasilannya. Saat ini terlihat bahwa keberhasilan sistem jaminan kesehatan belum baik. Bagaimana dengan jaminan kesehatan yang ada di daerah. Dimana peran perguruan tinggi di daerah? Logikanya peran perguruan tinggi di kebijakan jaminan kesehatan di daerah akan lebih mudah karena skalanya yang lebih kecil dan akses ke pengambil kebijakan lebih muda. Akan tetapi data menunjukkan bahwa beberapa pemerintah daerah tidak menggunakan para dosen atau peneliti di daerah masing-masing. Sebagai penutup: dalam konteks sejarah di Indonesia, secara keseluruhan, peran Perguruan Tinggi belum berada dalam posisi yang baik. Dapat dikatakan bahwa perguruan tinggi atau lembaga penelitian belum pernah secara utuh berada dalam posisi sebagai pemberi masukan kebijakan dalam tahap penyusunan kebijakan, pelaksanaan kebijakan, sampai monitoring dan evaluasi kebijakan, terutama di level nasional. Dipandang dari Evidence Based Policy situasi saat ini untuk sistem jaminan kesehatan adalah situasi dimana kurang ada bukti ilmiah kuat yang dipergunakan sebagai dasar pengambilan keputusan. (Laksono Trisnantoro, trisnantoro@yahoo.com).
ANALISA PENGARUH KEPEMILIKAN POLIS ASURANSI KESEHATAN TERHADAP KEMAUAN MEMBAYAR PRODUK PELAYANAN LABORATORIUM KABUPATEN BANYUWANGI Maharani, Asri
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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Background: The willingness to pay of society for theproducts of laboratory services need to be improved.Objective: The purpose of this study is to determine the effectof health insurance police ownership on willingness to pay forlaboratory services.Methods: A cross sectional study design using 100respondents taken proportionally from eight selected districtsin Banyuwangi. Variables that were examined include thewillingness to pay as measured by the method of contingentvaluation and ownership of health insurance police. The datacollection tool is a questionnaire. Data were analyzed usinglogistic regression.Results: The results showed that the level of willingness topay of respondents for all types of laboratory examinations isstill low. Most respondents (76%) did not have health insurance.Only about 50% of respondents who do not have healthinsurance are willing to pay for laboratory examination.Respondents who have health insurance tend to want to payfor laboratory services. From 24 respondents who have healthinsurance, more than 50% of respondents (15 respondents)were willing to pay for laboratory services. The ownership ofhealth insurance of respondents did not significantly affectthe willingness to pay for laboratory examination product (sig.= 0.287, B =- 0.511). This may be due to the fact that BanyuwangiDistrict society community so familiar with health insuranceand only few has it, so most are out-of-pocket payments.Conclusion: The ownership of health insurance do notsignificantly affect the willingness to pay for laboratoryexamination.Keywords: willingness to pay, laboratory services, ownershipof health insurance
ANALISIS TRADE-OFF DALAM REFORMASI SISTEM PELAYANAN KESEHATAN DI INDONESIA Siswanto, Siswanto
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 02 (2010)
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The impact of regional autonomy Act has resulted in healthservices system reform in Indonesia by central, province aswell as district/municipalities. The article is to analyze the “tradeof f” of Indonesian health services reform after theimplementation of regional autonomy Act by the use of normativegoals of health system, i.e equity, quality, and efficiency, asassessment parameters. The analysis revealed that: (i) theimplication of regional autonomy Act has resulted in Indonesianhealth services system reform which is partial and scattered,(ii) part of health services system reformation has moved tosocialism, another part of the reformation has moved toliberalism, with the implication of trade-off between equity,quality and efficiency, (iii) the whole Indonesian health servicessystem remains in the position of liberalism (market system),(iv) the choice toward socialism or liberalism is inherent withthe trade-off of advantages and disadvantages, so theintervention of its negative impacts are important. The articlerecommended that it is of importance to set in advance the endgoal of Indonesian health services system by all stakeholders,whether choosing liberal (market) system or social system,then setting up a clear road map completed with feasibleincremental programs to achieve the predetermined end goal.Keywords: regional autonomy, liberalism, socialism, trade-off

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