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Ruly Wahyuni; Pembimbing: Atik Nurwahyuni; Penguji: Budi Hidayat, Pujiyanto, Upik Rukmini, Agus Marzuki Prihantoro
Abstrak:
Pemanfaatan pelayanan kesehatan mempunyai pengaruh dalammeningkatkan status kesehatan lanjut usia. Jumlah lanjut usia di Indonesia tahun2012 merupakan nomor lima terbesar di dunia dan jika dibandingkan dengantahun 1990 jumlah tersebut diprediksikan akan meningkat 414% pada tahun 2025namun tingkat pemanfaatan pelayanan kesehatan lansia di Indonesia paling rendahdi antara tetangga di Asia Tenggara, sedangkan angka kesakitan lansia tahun 200529,98% dan tahun 2007 meningkat menjadi 31,11%..Penelitian ini merupakan analisis data sekunder Susenas tahun 2012 yangmerupakan penelitian kuantitatif dengan rancangan cross sectional danmenggunakan uji chi square. Penelitian ini bertujuan untuk melihat determinanyang berhubungan dengan pemanfaatan pelayanan kesehatan di rawat jalan(RJTP/RJTL) dan rawat inap pada lanjut usia di Indonesia. Unit analisis adalahlanjut usia berumur ≥ 60 tahun yang mengalami keluhan kesehatan.Hasil analisis menunjukkan bahwa pemanfaatan yankes pada lansiamemang sangat rendah dengan masih banyaknya lansia dengan keluhan kesehatannamun tidak memanfaatkan yankes (unmet need), faktor yang berhubungandengan pemanfaatan pelayanan kesehatan rawat jalan tingkat pertama (RJTP):pendidikan, kepemilikan jamkes, status ekonomi, variabel urban/rural, gangguanaktivitas; sedangkan di rawat jalan tingkat lanjut(RJTL) yaitu: status kawin,pendidikan, pekerjaan, kepemilikan jamkes, status ekonomi, urban/rural sertagangguan aktivitas; Serta di rawat inap(ranap): pendidikan, kepemilikan jamkes,status ekonomi, gangguan aktivitas.Saran dari studi ini adalah Untuk meningkatkan utilisasi/pemanfaatanpelayanan kesehatan di Puskesmas maka diharapkan adanya sosialisasi yangberkesinambungan kepada masyarakat tentang pentingnya pemeliharaankesehatan lansia, meningkatkan akses informasi pelayanan kesehatan bagi lansia,mendorong Pemerintah Pusat dan Daerah untuk memberi dukungan anggarandalam menyediakan fasilitas pelayanan kesehatan yang sesuai dengan kondisilansia, diantaranya Home Care bagi lansia, menambah dan memperkuat sertapemerataan tenaga kesehatan yang terlatih dalam menangani lansia, memperluascakupan jaminan kesehatan yang menjamin seluruh biaya pengobatan para lansiatermasuk lansia dengan kasus multipatologis, mendorong Pemerintah Pusatmaupun Daerah untuk mensosialisasikan ke para dokter di pelayanan kesehatantingkat Pertama seperti Puskesmas, Dokter praktek Umum supaya lebihmemahami konsep dan penerapan SJSN.Kata Kunci:Pemanfaatan pelayanan kesehatan, unmet need, Susenas Panel 2012.
Utilization of health services have an influence in improving the healthstatus of the elderly. The number of elderly people in Indonesia in 2012 is the fifthlargest in the world and when compared with 1990 that number is projected to beincreased 414% by the year 2025, but the level of utilization of health services inthe Indonesian elderly is the lowest among Southeast Asian countries, while themorbidity of elderly in 2005 is 29.98% and increased in 2007 which reached31.11%.This study is a secondary data analysis of Susenas Panel in 2012 which isa quantitative study with cross-sectional design and the use of chi square test. Thisstudy aims to look at the determinant related to the utilization of health services inoutpatient (RJTP / RJTL) and hospitalization in the sick elderly in Indonesia. Theunit of analysis is the elderly aged ≥ 60 years who had health complaintsThe analysis showed that the utilization of health services is very low inthe sick elderly because still many elderly with health complaints but does notutilize health services (unmet need), factors related to the utilization of outpatienthealth services first level (RJTP): education, ownership health insurance,economic status, variable urban / rural, impaired activity; while in outpatientsettings (RJTL) ie: marital status, education, occupation, ownership healthinsurance, economic status, urban / rural and impaired activity; in the facility ofhospitalization (ranap): education, ownership health insurance, economic status,impaired activity.Suggestions of this study is to increase the utilization of health services atthe health center, it is expected that continuous socialization to the communityabout the importance of elderly health maintenance, improving access to healthcare information for the elderly, encourage the Central and Local Government toprovide budget support in providing health care facilities in accordance with theconditions of the elderly such as home care service, add and strengthend theequity of health personnel trained in handling elderly, expanding health insurancecoverage that ensures the entire cost of treatment of the elderly including elderlywith multipatologis case, encourage central and regional government to socializethe doctors at first level health services such as health centers, physician practices,so that the health personel at the first level better understand the concept andapplication of the Social Security System.Key words :Utilization of health services, unmet need, Susenas Panel 2012
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Utilization of health services have an influence in improving the healthstatus of the elderly. The number of elderly people in Indonesia in 2012 is the fifthlargest in the world and when compared with 1990 that number is projected to beincreased 414% by the year 2025, but the level of utilization of health services inthe Indonesian elderly is the lowest among Southeast Asian countries, while themorbidity of elderly in 2005 is 29.98% and increased in 2007 which reached31.11%.This study is a secondary data analysis of Susenas Panel in 2012 which isa quantitative study with cross-sectional design and the use of chi square test. Thisstudy aims to look at the determinant related to the utilization of health services inoutpatient (RJTP / RJTL) and hospitalization in the sick elderly in Indonesia. Theunit of analysis is the elderly aged ≥ 60 years who had health complaintsThe analysis showed that the utilization of health services is very low inthe sick elderly because still many elderly with health complaints but does notutilize health services (unmet need), factors related to the utilization of outpatienthealth services first level (RJTP): education, ownership health insurance,economic status, variable urban / rural, impaired activity; while in outpatientsettings (RJTL) ie: marital status, education, occupation, ownership healthinsurance, economic status, urban / rural and impaired activity; in the facility ofhospitalization (ranap): education, ownership health insurance, economic status,impaired activity.Suggestions of this study is to increase the utilization of health services atthe health center, it is expected that continuous socialization to the communityabout the importance of elderly health maintenance, improving access to healthcare information for the elderly, encourage the Central and Local Government toprovide budget support in providing health care facilities in accordance with theconditions of the elderly such as home care service, add and strengthend theequity of health personnel trained in handling elderly, expanding health insurancecoverage that ensures the entire cost of treatment of the elderly including elderlywith multipatologis case, encourage central and regional government to socializethe doctors at first level health services such as health centers, physician practices,so that the health personel at the first level better understand the concept andapplication of the Social Security System.Key words :Utilization of health services, unmet need, Susenas Panel 2012
T-4097
Depok : FKM-UI, 2014
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Lamhot Tambunan; Pembimbing: Pujiyanto; Penguji: Armasytra Bahar, Rocky Gunung Hasudungan
Abstrak:
Rendahnya utilisasi pelayanan kesehatan gigi di Indonesia menjadipermasalahan yang selama ini menjadi suatu kendala dalam meningkatkan derajadkesehatan di Indonesia karena menurut Undang-Undang nomor 36 tahun 2009bahwa pelayanan kesehatan gigi dan mulut dilakukan untuk memelihara danmeningkatakan derajad kesehatan masyarakat. Dari data penelitian menunjukkanrendahnya utilisasi pelayanan kesehatan gigi padahal prevalensi karies gigi diIndonesia cukup tinggi. Peneliti ingin melihat determinan utilisasi pelayanankesehatan gigi di Indonesia.Penelitian ini merupakan analisis data sekunder Susenas 2012 yangmerupakan penelitian kuantitatif dengan rancangan cross sectional. Penelitian inimelihat determinan utilisasi pelayanan kesehatan gigi diindonesia.Hasil analisis menunjukkan bahwa faktor usia, jenis kelamin, statuspernikahan, status pendidikan, status pekerjaan dan status tempat tinggal tidakmenunjukan hubungan yang sangat kuat dalam memanfaatkan pelayanankesehatan gigi di Indonesia, Sementara faktor kepemilikan asuransi, statusekonomi,wilayah domisili, dan adanya gangguan aktivitas menunjukan hubunganyang sangat kuat terhadap utilisasi pelayanan kesehatan gigi di Indonesia.Saran dari studi ini adalah karena adanya hubungan yang sangat kuatantara kepemilikan asuransi dengan utilisasi pelayanan kesehatan gigi hendaknyacakupan asuransi diperluas terutama untuk masyarakat miskin agar supayautilisasi pelayanan kesehatan gigi juga bisa meningkat, dan distribusi dokter gigijuga harus lebih terdistribusi dengan baik.Kata Kunci:Determinan, unmet need, utilisasi, Susenas 2012.
Lack of dental health services utilization in Indonesia became a problem aslong as it becomes a constraint in increasing degree movies health in Indonesiabecause according to Undang-undang no 36 tahun 2009 that oral health servicesdone to nurture and increases public health degree movies. Data from the sudyshowed poor dental health service utilization whereas the prevalence of dentalcaries in Indonesia is quite high. Researchers would like to see the dental healthservice utilization determinants in Indonesia.This research is analysis of data secondary susenas 2012 that is researchquantitative to a draft cross sectional. This research see determina the utilizationof health services of health services teeth in Indonesia.The result analysis shows that a factor of age, gender, the status ofmarriage, the status of education, the status of the job and the satatus of thedwelling place of not show a very strong in the harness of health services inIndonesia, the teeth insurance, while a factor of possession economic status, theregion of domicile, and any disturbance activity showed a very strong against theutilization of health services teeth in Indonesia.Advice from this study is due to the powerful relationship betweeninsurance with the utilization of health service should tooth-reinsurance coveragesexpanded especially for the poor health services so that the utilization rise, canalso distribution dentist must be distributed properly.Key words :Determinant, Unmet Need, Utilization, Susenas 2012.
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Lack of dental health services utilization in Indonesia became a problem aslong as it becomes a constraint in increasing degree movies health in Indonesiabecause according to Undang-undang no 36 tahun 2009 that oral health servicesdone to nurture and increases public health degree movies. Data from the sudyshowed poor dental health service utilization whereas the prevalence of dentalcaries in Indonesia is quite high. Researchers would like to see the dental healthservice utilization determinants in Indonesia.This research is analysis of data secondary susenas 2012 that is researchquantitative to a draft cross sectional. This research see determina the utilizationof health services of health services teeth in Indonesia.The result analysis shows that a factor of age, gender, the status ofmarriage, the status of education, the status of the job and the satatus of thedwelling place of not show a very strong in the harness of health services inIndonesia, the teeth insurance, while a factor of possession economic status, theregion of domicile, and any disturbance activity showed a very strong against theutilization of health services teeth in Indonesia.Advice from this study is due to the powerful relationship betweeninsurance with the utilization of health service should tooth-reinsurance coveragesexpanded especially for the poor health services so that the utilization rise, canalso distribution dentist must be distributed properly.Key words :Determinant, Unmet Need, Utilization, Susenas 2012.
T-4044
Depok : FKM-UI, 2014
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Azzahrazade; Pembimbing: Budi Hidayat; Penguji: Pujiyanto, Atik Nurwahyuni, Ismiwanto Cahyono, Su`udi
Abstrak:
Demand terhadap pelayanan kesehatan tenaga profesional di Indonesia masihterhitung rendah, walaupun peningkatan pembiayan kesehatan dan implementasiasuransi kesehatan yang menjamin lebih dari separuh populasi Indonesia melaluiJaminan Kesehatan Nasional (JKN) telah dilakukan. Berbagai penelitiansebelumnya menunjukkan bahwa fenomena Supplier Induced Demand merupakansalah satu alasan mengapa ekspenditur kesehatan terus meningkat, sehinggamenyebabkan beban finansial tanpa memberikan keuntungan bagi kesehatanmasyarakat.Menggunakan data Susenas tahun 2012 dan Podes tahun 2011, peneliti melakukanpendekatan mikroekonometri menggunakan metode estimasi two part model danmenganalisis densitas dokter pada level kabupaten dan frekuensi kunjungan kepelayanan rawat jalan pada level individual untuk menemukan indikasi adanyafenomena Supplier Induced Demand pada kunjungan rawat jalan ke dokter praktikperorangan/poliklinik di Indonesia.Penelitian ini merupakan penelitian inisial yang pernah dilakukan di Indonesia.Kesimpulan yang didapatkan adalah densitas dokter merupakan variabel eksogen,dan memberikan korelasi positif pada frekuensi kunjungan responden sakit,sehingga memberikan bukti yang mengindikasikan adanya fenomena SupplierInduced Demand di Indonesia pada tahun 2012. Namun demikian, status sakittetap menjadi faktor utama yang membuat pasien mengakses pelayanankesehatan.Keywords: supplier induced demand, permintaan pelayan kesehatan, asuransikesehatan, rawat jalan
Demand for healthcare remain low, even though Indonesian government continueto increase healthcare funding, and implemented the social health insurance thatcovers more than a half of whole population through Jaminan KesehatanNasional (JKN). Numerous studies mentioned that the Supplier induced Demand(SID) is one of many reason why healthcare expenditure is increasing, causingmore financial pressures, increasing the share of national resources spent onhealthcare, which all of these can occur with few benefits for the health of thepopulation.Using data from Indonesian Household Survey (Susenas 2012) and Potensi Desa(Podes 2011), this study provides an empirical evidence of the phenomenon usingmicroeconometrics approach under the two-part modeling, analyzing district levelphysician density on the individual numbers of doctor visit to find evidenceindicating the existence of SID phenomenon in Indonesia.This is the initial study of the phenomenon in Indonesia, and it concludes thatphysician density is proven exogenous and has positive effect on the frequency ofdoctor visit, thus giving evidence indicating Supplier Induced Demandphenomenon occurred in Indonesia. Nevertheles, poor health status of patients isstill the main reason of the healthcare utilization.Keywords: supplier induced demand, demand for healthcare, health insurance,outpatient care
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Demand for healthcare remain low, even though Indonesian government continueto increase healthcare funding, and implemented the social health insurance thatcovers more than a half of whole population through Jaminan KesehatanNasional (JKN). Numerous studies mentioned that the Supplier induced Demand(SID) is one of many reason why healthcare expenditure is increasing, causingmore financial pressures, increasing the share of national resources spent onhealthcare, which all of these can occur with few benefits for the health of thepopulation.Using data from Indonesian Household Survey (Susenas 2012) and Potensi Desa(Podes 2011), this study provides an empirical evidence of the phenomenon usingmicroeconometrics approach under the two-part modeling, analyzing district levelphysician density on the individual numbers of doctor visit to find evidenceindicating the existence of SID phenomenon in Indonesia.This is the initial study of the phenomenon in Indonesia, and it concludes thatphysician density is proven exogenous and has positive effect on the frequency ofdoctor visit, thus giving evidence indicating Supplier Induced Demandphenomenon occurred in Indonesia. Nevertheles, poor health status of patients isstill the main reason of the healthcare utilization.Keywords: supplier induced demand, demand for healthcare, health insurance,outpatient care
T-4687
Depok : FKM UI, 2016
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Andre Yunianto; Pembimbing: Atik Nurwahyuni; Penguji: Dumilah Ayuningtyas, Felly Philipus Senewe, Mazda Novi Mukhlisa
Abstrak:
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Penelitian ini bertujuan mengetahui peran jaminan kesehatan dan determinan yang mempengaruhi pemanfaatan pelayanan kesehatan oleh penyandang disabilitas di Indonesia pada tahun 2021 menggunakan data Susenas Maret 2021. Variabel terikat penelitian ini adalah pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap di FKTP dan FKRTL. Data dianalisis secara bivariat dan multivariat dengan metode Binary Regression menggunakan model logit. Diketahui variabel kepemilikan jaminan kesehatan, pemanfaatan JKN, jenis disabilitas, tingkat keparahan disabilitas, jenis kelamin, pendidikan, status pekerjaan, status kawin, jumlah anggota rumah tangga, dan karakteristik tempat tinggal serta status ekonomi berpengaruh signifikan pada pemanfaatan layanan rawat jalan dan rawat inap (p-value 0,000 <0,005). Kepemilikan jaminan kesehatan non JKN atau kepemilikan jaminan kesehatan ganda (JKN dan non JKN) meningkatkan peluang pemanfaatan layanan baik rawat inap maupun rawat jalan. Terjadi penurunan kepemilikan jaminan kesehatan terhadap peningkatan status ekonomi penyandang disabilitas (propoor). Sebaliknya terjadi tren peningkatan pemanfaatan jaminan kesehatan terhadap peningkatan status ekonomi keluarga penyandang disabilitas (prorich).
This research aims to determine the role of health insurance and the determinants that influence the use of health services by people with disabilities in Indonesia in 2021 using Susenas data for March 2021. The dependent variable of this research is the use of outpatient and inpatient health services at FKTP and FKRTL. Data were analyzed bivariately and multivariately using the Binary Regression method using the logit model. It is known that the variables of ownership of health insurance, utilization of JKN, type of disability, severity of disability, gender, education, employment status, marital status, number of household members, and characteristics of residence and economic status have a significant effect on the utilization of outpatient and inpatient services ( p-value 0.000 <0.005). Ownership of non-JKN health insurance or ownership of dual health insurance (JKN and non-JKN) increases the chances of utilizing both inpatient and outpatient services. There has been a decrease in ownership of health insurance due to an increase in the economic status of people with disabilities (propoor). On the contrary, there is a trend of increasing use of health insurance towards increasing the economic status of families of people with disabilities (prorich).
T-7080
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Intan Corina Indra; Pembimnbing: Budi Hidayat; Penguji: Prastuti Soewondo, Pujiyanto, Donni Hendrawan, Ratih Dwi Lestari
Abstrak:
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Implementasi program Jaminan Kesehatan Nasional (JKN) sejak tahun 2014 menghadapi tantangan dalam pengelolaan layanan hemodialisis sebagai terapi utama gagal ginjal kronik. Penelitian bertujuan menganalisis pola pemanfaatan layanan hemodialisis dalam konteks Rawat Jalan Tingkat Lanjut (RJTL) oleh peserta JKN. Penelitian cross sectional ini menggunakan data klaim BPJS Kesehatan tahun 2023 dengan sampel 81.816 peserta. Analisis data meliputi univariat, bivariat, dan multivariat menggunakan regresi binomial negatif. Hasil menunjukkan rata-rata kunjungan hemodialisis nasional mencapai 51,46 kali per tahun. Peserta Non-PBI memiliki tingkat pemanfaatan 13,6% lebih tinggi dibanding PBI (IRR=1,136; p<0,000). DI Yogyakarta mencatatkan rata-rata kunjungan tertinggi (61,78 kali/tahun), sementara Papua terendah (18,06 kali/tahun). Fasilitas TNI AU menunjukkan rata-rata kunjungan tertinggi (72,79 kali/tahun). Kesimpulan menunjukkan adanya kesenjangan signifikan dalam pemanfaatan layanan hemodialisis berdasarkan karakteristik demografis, geografis, dan kepemilikan fasilitas kesehatan. Diperlukan pengembangan kebijakan komprehensif untuk meningkatkan akses dan pemerataan layanan hemodialisis bagi seluruh peserta JKN.
The implementation of the National Health Insurance (JKN) program since 2014 has faced various challenges in managing hemodialysis services as the primary modality for chronic kidney disease therapy. This study aims to analyze the utilization patterns of hemodialysis services in the context of Advanced Outpatient Care (RJTL) by JKN participants and identify factors influencing service utilization. This study with a cross-sectional design used secondary data from BPJS Kesehatan claims in 2023. The study population comprised all JKN participants undergoing hemodialysis, with a sample size of 81,816 participants. Data analysis was conducted comprehensively, including univariate, bivariate, and multivariate analyses using negative binomial regression models. The analysis results showed that the national average of hemodialysis visits reached 51.46 times per year. There were significant variations in service utilization based on membership segmentation, where Non-PBI participants showed 13.6% higher utilization rates compared to PBI participants (IRR=1.136; p<0.000). Regional analysis revealed that DI Yogyakarta recorded the highest average visits at 61.78 times per year, while Papua recorded the lowest average with 18.06 visits. In terms of healthcare facility ownership, Air Force facilities showed the highest average visits at 72.79 times per year. Research findings indicate significant disparities in hemodialysis service utilization based on demographic, geographic, and healthcare facility ownership characteristics. These results emphasize the importance of developing comprehensive policies to improve access and equitable distribution of hemodialysis services for all JKN participants.
T-7194
Depok : FKM UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Erfan Chandra Nugraha; Pembimbing: Pujiyanto; Penguji: Ede Surya Darmawan, Vetty Yulianty Permanasari, Esti Widiastuti Mangunadikusumo, Donni Hendrawan
Abstrak:
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Diabetes melitus (DM) merupakan penyakit katastropik yang membebani pembiayaan program Jaminan Kesehatan Nasional (JKN) serta penderitanya terus meningkat. Akses peserta JKN dengan DM dalam memanfaatkan layanan kesehatan di Fasilitas Kesehatan Rujukan Tingkat Lanjutan (FKRTL) masih dipandang banyak dimanfaatkan oleh segmen kepesertaan tertentu. Selain itu terdapat berbagai faktor yang mempengaruhi akses layanan kesehatan di FKRTL. Tujuan penelitian ini adalah melakukan analisis pemanfaatan layanan berdasarkan jenis kepesertaan serta mengkaji faktor-faktor yang mempengaruhi pemanfaatan pelayanan rawat jalan dan rawat inap tingkat lanjutan oleh peserta JKN penderita DM. Penelitian ini menggunakan data sekunder data sampel BPJS Kesehatan kontekstual DM tahun 2022. Data dianalisis secara univariat, bivariat dan multivariat dengan model regresi Zero Inflated Negative Binomial. Hasil uji statistik menunjukan pada rawat jalan, umur, jenis peserta, jenis kelamin, kelas rawat dan provinsi peserta signifikan berbeda dalam pemanfaatan layanan kesehatan sedangkan pada rawat inap, umur, kelas rawat dan provinsi peserta signifikan berbeda dalam pemanfaatan layanan kesehatan. Pengaruh jenis kepesertaan dalam program JKN berpengaruh signifikan terhadap pemanfaatan layanan di rawat jalan namun tidak berpengaruh signifikan pada rawat inap. Pemanfaatan peserta Non PBI lebih besar 1,16 kali dibandingkan peserta PBI pada rawat jalan.
Diabetes mellitus (DM) is a catastrophic disease that burdens the National Social Health Insurance Program (JKN) and sufferers continue to increase. Access for JKN participants with DM to utilize health services at Advanced Level Referral Health Facilities (FKRTL) is still widely seen as being used by certain participant segments. Apart from that, there are various factors that influence access to health services at FKRTL. The aim of this research is to analyze service utilization based on the type of membership and examine the factors that influence the utilization of advanced outpatient and inpatient services by JKN participants with DM. This research uses secondary data from the 2022 DM contextual BPJS Kesehatan sample data. The data was analyzed univariately, bivariately, and multivariately with the Zero Inflated Negative Binomial regression model. The statistical test results showed that in outpatient care, age, type of participant, gender, treatment class, and participant province were significantly different in terms of health service utilization, while in inpatient care, age, treatment class, and participant province were significantly different in terms of health service utilization. The influence of the type of maintenance in the JKN program has a significant effect on the utilization of services in outpatient care but does not have a significant effect on inpatient care. The utilization of non-PBI participants was 1.16 times greater than that of PBI participants in outpatient care.
T-6925
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Jenal Mutakin Sambas; Pembimbing: Pujiyanto; Penguji: Atik Nurwahyuni, Erfan Chandra Nugraha, Elisa Adam
Abstrak:
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Penyakit Jantung Koroner (PJK) merupakan penyebab utama kematian dan penyerap biaya katastropik terbesar dalam Program Jaminan Kesehatan Nasional (JKN), dengan total kunjungan rawat inap dan biaya yang terus meningkat setiap tahunnya. Penelitian ini bertujuan menganalisis pola pemanfaatan, biaya pelayanan, serta determinan utilisasi dan biaya rawat inap tingkat lanjutan (RITL) pada peserta JKN penderita PJK di Provinsi Jawa Barat tahun 2024. Penelitian menggunakan desain cross-sectional dengan data sekunder klaim BPJS Kesehatan (SSBI) yang mencakup 22.986 episode pelayanan rawat inap. Analisis dilakukan secara univariat, bivariat, dan multivariat menggunakan regresi Quasi-Poisson. Hasil penelitian menunjukkan bahwa sebagian besar pasien hanya menjalani satu kali episode rawat inap (98,55%), dengan utilisasi terkonsentrasi di Kota Bandung (25,92%). Total biaya pelayanan mencapai Rp320,01 miliar dengan rata-rata Rp13.922.137 per episode. Berdasarkan analisis multivariat, determinan yang berhubungan signifikan dengan utilisasi RITL adalah komorbid (IRR = 1,006; p = 0,009) dan tingkat keparahan level III (IRR = 1,011; p = 0,003). Sementara itu, determinan biaya RITL yang bermakna meliputi jenis case group INA-CBGs (koefisien +Rp22,68 juta; p < 0,001), tingkat keparahan, komorbid, hak kelas rawat, dan tipe FKRTL. Segmen peserta dan status kepemilikan FKRTL tidak terbukti berpengaruh secara independen terhadap utilisasi maupun biaya. Temuan ini mengindikasikan bahwa faktor klinis mendominasi utilisasi pelayanan, sedangkan kompleksitas tata laksana medis menjadi penentu utama biaya. Prinsip ekuitas JKN terbukti berjalan dengan baik pada pelayanan rawat inap PJK di Jawa Barat.
Coronary Heart Disease (CHD) is the leading cause of mortality and the largest driver of catastrophic healthcare expenditure within Indonesia's National Health Insurance (JKN) program, with inpatient visits and costs rising steadily each year. This study aimed to analyze utilization patterns, service costs, and the determinants of advanced inpatient care (RITL) utilization and expenditure among JKN participants with CHD in West Java Province in 2024. A cross-sectional design was applied using secondary data from BPJS Kesehatan claims (SSBI), covering 22,986 inpatient episodes. Data were analyzed through univariate, bivariate, and multivariate approaches using Quasi-Poisson regression. Results showed that the majority of patients underwent only a single inpatient episode (98.55%), with utilization concentrated in Bandung City (25.92%). Total service expenditure reached IDR 320.01 billion, with a mean cost of IDR 13,922,137 per episode. Multivariate analysis identified comorbidity (IRR = 1.006; p = 0.009) and severity level III (IRR = 1.011; p = 0.003) as significant independent determinants of inpatient utilization. Significant determinants of inpatient cost included INA-CBGs case group (coefficient +IDR 22.68 million; p < 0.001), severity level, comorbidity, ward class entitlement, and hospital type. Membership segment and hospital ownership status were not independently associated with either utilization or cost. These findings indicate that clinical need factors dominate inpatient utilization, while the complexity of medical management is the primary driver of costs. The equity principle of JKN is shown to be functioning effectively in CHD inpatient care in West Java.
T-7571
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Afaf Jauhar; Pembimbing: Mardiati Nadjib; Penguji: Pujiyanto, Amila Megaraini, Mazda Novi Mukhlisa
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Seiring dengan pertumbuhan populasi lansia di Khyber Pakhtunkhwa dan meningkatnya beban biaya pelayanan kesehatan, pemerintah provinsi memperkenalkan program asuransi kesehatan Sehat Insaf Card (SIC) yang bertujuan untuk memperluas akses terhadap perawatan rumah sakit. Penelitian ini mengkaji faktor-faktor yang memengaruhi pemanfaatan rumah sakit oleh lansia di Khyber Pakhtunkhwa sebelum dan sesudah implementasi SIC, dengan fokus pada perubahan pola pemanfaatan serta ketimpangan berdasarkan jenis kelamin, tingkat pendapatan, dan wilayah tempat tinggal, disertai dengan perspektif para pemangku kepentingan. Temuan kuantitatif menunjukkan bahwa secara keseluruhan pemanfaatan rumah sakit meningkat setelah pelaksanaan SIC, dan kesenjangan gender yang sebelumnya ada mengecil, dengan tidak ditemukannya perbedaan yang signifikan antara laki-laki dan perempuan pada tahun 2020. Namun demikian, ketimpangan tetap ada: lansia yang tinggal di wilayah pedesaan masih lebih kecil kemungkinannya untuk mengakses layanan rumah sakit dibandingkan dengan mereka yang tinggal di wilayah perkotaan. Meskipun terjadi peningkatan penggunaan layanan di kalangan lansia berpendapatan rendah akibat pengurangan hambatan finansial, ketimpangan berdasarkan tingkat pendapatan tetap bertahan. Wawancara dengan pemangku kepentingan mengungkapkan berbagai tantangan yang masih berlangsung, termasuk rendahnya tingkat kesadaran lansia terhadap manfaat SIC, serta kesulitan di wilayah terpencil akibat keterbatasan transportasi, fasilitas kesehatan, tenaga medis, dan infrastruktur. Sebagai kesimpulan, meskipun SIC telah berhasil memperluas cakupan dan meningkatkan pemanfaatan rumah sakit di kalangan lansia, hambatan akses yang mengakar tetap ada, sehingga diperlukan upaya pelengkap dalam sosialisasi dan penguatan sistem kesehatan agar seluruh lansia dapat memperoleh manfaat secara adil dari program ini.
As the elderly population in Khyber Pakhtunkhwa continues to grow and faces significant healthcare cost burdens, the provincial government introduced the Sehat Insaf Card (SIC), a health insurance program aimed at expanding access to hospital care. This study examines the factors influencing hospital utilization among the elderly in Khyber Pakhtunkhwa before and after the implementation of the SIC, with a particular focus on changes in utilization patterns and disparities by gender, income, and region, as well as stakeholder perspectives. Quantitative findings indicate that overall hospital use increased following SIC implementation, and the previous gender gap narrowed, with no statistically significant male–female differences observed by 2020. However, disparities persisted: elderly individuals in rural areas remained less likely than their urban counterparts to access hospital services, and although hospital use among low-income seniors improved due to reduced financial barriers, income-based inequalities remained. Stakeholder interviews revealed persistent challenges, including limited awareness of SIC benefits among the elderly and continued difficulties in remote areas due to transportation constraints and shortages in healthcare facilities, staff, and infrastructure etc. In conclusion, while the SIC has successfully expanded coverage and improved hospital utilization among the elderly, entrenched access barriers remain, highlighting the need for complementary efforts in outreach and health system strengthening to ensure that all elderly individuals can benefit equitably from the program.
As the elderly population in Khyber Pakhtunkhwa continues to grow and faces significant healthcare cost burdens, the provincial government introduced the Sehat Insaf Card (SIC), a health insurance program aimed at expanding access to hospital care. This study examines the factors influencing hospital utilization among the elderly in Khyber Pakhtunkhwa before and after the implementation of the SIC, with a particular focus on changes in utilization patterns and disparities by gender, income, and region, as well as stakeholder perspectives. Quantitative findings indicate that overall hospital use increased following SIC implementation, and the previous gender gap narrowed, with no statistically significant male–female differences observed by 2020. However, disparities persisted: elderly individuals in rural areas remained less likely than their urban counterparts to access hospital services, and although hospital use among low-income seniors improved due to reduced financial barriers, income-based inequalities remained. Stakeholder interviews revealed persistent challenges, including limited awareness of SIC benefits among the elderly and continued difficulties in remote areas due to transportation constraints and shortages in healthcare facilities, staff, and infrastructure etc. In conclusion, while the SIC has successfully expanded coverage and improved hospital utilization among the elderly, entrenched access barriers remain, highlighting the need for complementary efforts in outreach and health system strengthening to ensure that all elderly individuals can benefit equitably from the program.
T-7380
Depok : FKM-UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Fredrik Lumbantobing; Pembimbing: Atik Nurwahyuni; Penguji: Budi Hidayat, Kurnia Sari, Doni Hendrawan, Ismiwanto
T-4311
Depok : FKM-UI, 2015
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Helmawati Perangin-angin; Pembimbing: Puput Oktamianti; Penguji: Atik Nurwahyuni, H. A. Y. G. Wibisono,
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ABSTRAK Penelitian ini bertujuan untuk mengetahui gambaran pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap pasien multiguna di RSU Kabupaten Tangerang, mengetahui factor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan, dan untuk mengetahui estimasi nilai rata-rata pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap di RSU Kabupaten Tangerang bagi pasien peserta multiguna. Dan akan dihasilkan suatu nilai estimasi yang menjadi standard acuan untuk melakukan utilisasi review. Dilakukan dengan rancangan cross sectional dan pendekatan kuantitatif. Populasi penelitian adalah seluruh pasien peserta multiguna yang memanfaatkan pelayanan kesehatan rawat jalan dan rawat inap di RSU Kabupaten Tangerang. Dari hasil penelitian dapat terlihat bahwa visite rate rawat jalan pasien peserta multiguna di RSU Kabupaten Tangerang adalah 1,3 kali yang mana hampir sama dengan visite rate pasien peserta Jamkesda di Kota/Kabupaten lain. Visite rate rawat inap pasien peserta multiguna di RSU Kabupaten Tangerang hanya 0,03 kali, dan ini masih rendah dibandingkan dengan visite rate rawat inap peserta Jamkesda Kota/Kabupaten lainnya. Rata-rata biaya rawat jalan dan ALOS pasien peserta multiguna hampir sama dengan tariff rawat jalan dan ALOS INADRG RS Tipe B, Kelas 3 dan Poli Biasa. Pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap pasien peserta multiguna di RSU Kabupaten Tangerang di pengaruhi oleh umur, jenis kelamin, status perkawinan dan diagnose penyakit pasien. Peneliti menyarankan agar di dalam menyusun anggaran untuk peserta kartu multiguna bidang kesehatan ini hendaknya diperhatikan factor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan tersebut. Kata Kunci : pemanfaatan pelayanan kesehatan, utilisassi review, standard acuan, visite rate, alos.
ABSTRACT The goal of this research is to describe of utilization of health service outpatient and inpatient by Multiguna’s patient in The General Hospital of Tangerang, knowing the factors associated with utilization of health services, and to determine an average value of health care utilization of outpatient and inpatient in The General Hospital of Tangerang for Multiguna’s patient that will be estimate the gold standard to conduct the utilization review. Performed with a cross-sectional design using quantitative approach. Population was all Multiguna’s patients who utilize health care outpatient and inpatient at The Genaral Hospital of Tangerang. The result of research showed visite rate of outpatient is 1,3 times which is almost the same visite rate outpatient of Jamkesda participants in the other city. Visite rate of hospitalization only 0,03 times, still low compared with visite rate of hospitalization Jamkesda participants in the other city. The average cost of outpatient care and ALOS multiguna’s patient almost equal with rates of outpatient and ALOS of INA-DRG Type B Hospital, Class 3 and ordinary clinic. The results showed that the utilization of outpatient health services and inpatient care by the multiguna’s patient in the general hospital of Tangerang influenced by age, sex, marital status and diagnosis of patient illness. From this study obtained a standard of reference for utilization review. The research suggested that in preparing the budget for health sector of Multiguna are to be considered factors related to the utilization of health services. Key words: utilization of health services, utilization review, reference standard, visite rate, average length of stay.
T-3369
Depok : FKM-UI, 2011
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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