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Slamet Budiarto; Promotor: Anhari Achadi; Kopromotor: Sutanto Priyo Hastono, Pujiyanto; Penguji: Purnawan Junadi, Andi Arus Vector, Syafiq A. Mughni, Mahlil Ruby, Hasbullah Thabrany
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Stunting anak 0-23 bulan di Indonesia merupakan masalah kesehatan masyarakat yang disebabkan oleh berbagai faktor langsung dan tidak langsung. Penelitian menggunakan data Riset Kesehatan Dasar, Survey Sosial Ekonomi Nasional dan Produk Domestik Regional Bruto per kapita tahun 2018 dengan pendekatan potong lintang bertujuan mengetahui model jalur hubungan langsung dan tidak langsung berbagai faktor risiko stunting dengan prevalensi stunting tingkat kabupaten/kota. Pengolahan data sekunder dilakukan pada Januari-April 2022. Sampel adalah 106 kabupaten/kota prevalensi stunting <20% dan 403 kabupaten/kota prevalensi stunting ≥20% (20%-<30%, 30%-40% dan >40%) yang diagregratkan pada tingkat kabupaten/kota dari 32.095 data individu anak usia 0-23 bulan yang diukur panjang badannya. Pemodelan menggunakan analisis jalur. Model jalur pencegahan risiko stunting memperlihatkan akses terhadap makanan (r=-0,31) dan pemeriksaan kehamilan (r=-0,29) berhubungan langsung dengan prevalensi stunting tingkat kabupaten/kota di kabupaten/kota prevalensi stunting <20%. Keluarga Berencana (r=-0,15), pemeriksaan kehamilan (r=-0,13) dan cuci tangan pakai sabun (r=-0,11) berhubungan langsung dengan prevalensi stunting tingkat kabupaten/kota di kabupaten/kota prevalensi stunting ≥20%. Tablet tambah darah ibu hamil (r=-0,02) dan inisiasi menyusu dini (r=-0,03) berhubungan tidak langsung melalui ASI eksklusif dengan prevalensi stunting tingkat kabupaten/kota di kabupaten/kota prevalensi stunting 20%-<30%. ASI eksklusif (r=-0,15) berhubungan langsung dengan prevalensi stunting tingkat kabupaten/kota di kabupaten/kota prevalensi stunting 20%-<30%. Cuci tangan pakai sabun berhubungan signifikan langsung dengan prevalensi stunting tingkat kabupaten/kota di kabupaten/kota prevalensi stunting 30%-40% (r=-0,22) dan >40% (r=-0,45). Model jalur menyimpulkan bahwa kabupaten/kota dapat memainkan peran penting dalam upaya pencegahan risiko stunting dengan memodifikasi sejumlah faktor risiko terutama pada keluarga anak 0-23 bulan.
Stunting in children 0-23 months in Indonesia is a public health problem caused by various direct and indirect factors. This study uses data from Basic Health Research, National Socio-Economic Survey and Gross Regional Domestic Product per capita in 2018 with a cross-sectional approach. Secondary data processing was carried out in January-April 2022. The samples were 106 districts/cities with stunting prevalence <20% and 403 districts/cities with stunting prevalence 20% (20%-<30%, 30%-40% and >40%) Aggregated at the district/city level from 32,095 individual data for children aged 0-23 months, whose body length was measured. The modeling uses path analysis. The stunting risk prevention pathway model shows that access to food (r=-0.31) and prenatal care (r=-0.29) is directly related to the prevalence of stunting at the district/city level in districts/cities with stunting prevalence <20%. Family planning (r=-0.15), pregnancy check-ups (r=-0.13) and hand washing with soap (r=-0.11) were directly related to the prevalence of stunting at the district/city level in districts/cities stunting prevalence 20 %. Blood supplement tablets for pregnant women (r=-0.02) and early initiation of breastfeeding (r=-0.03) were indirectly related through exclusive breastfeeding with the prevalence of stunting at the district/city level in districts/cities stunting prevalence of 20%-<30% . Exclusive breastfeeding (r=-0.15) was directly related to the prevalence of stunting at the district/city level in the district/city stunting prevalence of 20%-<30%. Hand washing with soap is directly related to stunting prevalence at district/city level in districts/cities, stunting prevalence is 30%-40% (r=-0.22) and >40% (r=-0.45). The pathway model concludes that districts/cities can play an important role in preventing stunting risk by modifying a number of risk factors, especially in families of children 0-23 months.
D-474
Depok : FKM UI, 2023
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Andy Prabowo; Promotor: Ascobat Gani; Kopromotor: Mardiati Nadjib; Penguji: Amal Chalik Sjaaf, Meiwita Paulina Budiharsana, Erna Kristin, Mahlil Ruby, Mursyid Bustami
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Stroke adalah penyakit peringkat ketiga dengan biaya terbanyak dalam program Jaminan Kesehatan Nasional (JKN). Pelayanan medisnya dilaksanakan sesuai dengan alur klinis (clinical pathway), yang merupakan turunan dari Pedoman Nasional Pelayanan Kedokteran (PNPK). Tarif pelayanan penyakit stroke iskemik dalam skema Indonesia Case-Based Group (INA-CBG) ditetapkan sebelum pemberlakuan PNPK. Akibatnya, penyusunan tarif stroke iskemik belum sepenuhnya mempertimbangkan standar pelayanan nasional. Penelitian ini bertujuan untuk menunjukkan bahwa rumah sakit perlu mengelola biaya perawatan dan kualitas layanan agar tarif INA-CBG dapat mencukupi biaya satuan rawat inap stroke iskemik pada pasien JKN di Rumah Sakit Pusat Otak Nasional (RS PON) Prof. Dr. dr. Mahar Mardjono Jakarta. Desain penelitian yang digunakan adalah noneksperimental dengan data retrospektif Oktober—Desember 2019. Unit analisisnya adalah 96 pasien stroke iskemik yang dirawat di RS PON. Penelitian menunjukkan bahwa rata-rata biaya satuan untuk stroke iskemik di RS PON adalah sebesar Rp11.598.286 ± Rp5.799.088. Uji regresi multipel memperlihatkan bahwa lama hari rawat inap, sistolik dan skor National Institutes of Health Stroke Scale (NIHSS) saat admisi ke rumah sakit merupakan determinan signifikan terhadap rata-rata biaya satuan rawat inap stroke iskemik pasien JKN di RS PON. Perbedaan tidak signifikan terlihat antara tarif INA-CBG tahun 2016 regional 1 RS kelas A dan rata-rata biaya satuan rawat inap stroke iskemik pada pasien JKN di RS PON. Namun, temuan ini juga menjelaskan penerapan tarif INA-CBG tahun 2016 regional 1 RS kelas A bagi RS PON mengakibatkan defisit rata-rata sebesar -Rp214.049 ± Rp4.647.223 per kasus. Perbedaan biaya satuan dan tarif INA-CBG ini diperkirakan menyebabkan defisit sebesar -Rp1.262.304.927 bagi RS PON pada tahun 2019. Selain itu, diperkirakan defisit yang ditanggung oleh seluruh rumah sakit peserta JKN mencapai -Rp61.108.299.113, dengan asumsi prevalensi stroke iskemik adalah 1,1‰. Meskipun secara rata-rata biaya satuan lebih tinggi dari tarif, rumah sakit dapat melakukan pengelolaan keuangan yang baik agar operasional tidak terganggu. Hal ini tercermin dari rasio kas dan rasio lancar RS PON yang masing-masing sebesar 240,47% dan 1.695,31%. Dengan demikian, kewajiban jangka pendek dapat dipenuhi oleh RS PON, namun banyak aset lancar yang mengendap dan seharusnya bisa menjadi potensi pendapatan tambahan rumah sakit, atau banyak piutang yang belum terbayarkan. BPJS Kesehatan juga perlu mengelola keuangan dengan baik untuk menjaga keberlangsungan program JKN, yang ditunjukkan dengan rasio kas dan rasio lancar sebesar 152,91% dan 914,6%.
Stroke ranks as the third most costly disease in the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program. Medical services are carried out in accordance with the clinical pathway, which is derived from the national guidelines for medical services (PNPK). The tariff for treating ischemic stroke in the Indonesia Case-Based Group (INA-CBG) was set before establishing of the PNPK, resulting in the tariff for ischemic stroke treatment being issued before calculating the real actual costs of delivering the national service standards of care. This research is necessary to demonstrate that hospitals need to manage care costs and service quality so that the INA-CBG rates can cover the unit costs of inpatient ischemic stroke care for JKN patients at the National Brain Center Hospital (RS PON) Prof. Dr. dr. Mahar Mardjono Jakarta. A retrospective nonexperimental research design was used, analyzing data from ischemic stroke patients hospitalized at RS PON between October—December 2019. The results showed that the average unit cost of inpatient ischemic stroke at RS PON was IDR11,598,286 ± IDR5,799,088, based on the 2019 data. Multiple regression tests indicated that the length of stay, sistolic and the national institutes of health stroke scale (NIHSS) scores upon admission were significant determinants of the variation of the average unit cost. Non-significant difference was found between the INA-CBG 2016 tariff for type A hospitals (region 1) and the average unit cost of inpatient ischemic stroke among JKN patients at RS PON. In conclusion, implementing the INA-CBG 2016 tariff for type A hospitals such as RS PON creates an average deficit of -IDR214,049 ± IDR4,647,223 per case. The discrepancy between unit costs and INA-CBG tariffs is estimated to have resulted in a deficit of -IDR1,262,304,927 for RS PON in 2019. Furthermore, assuming an ischemic stroke prevalence of 1.1‰, the deficit borne by all JKN-participating hospitals is estimated to have reached -IDR 61,108,299,113. Although the average unit cost is higher than the tariff, the hospital can manage its finances well to ensure that operations are not disrupted. This is reflected in RS PON's cash ratio and current ratio, which are 240.47% and 1,695.31%, respectively. Thus, RS PON can meet its short-term obligations, but many current assets are idle and should be potential additional hospital revenue or m any outstanding receivables. BPJS Kesehatan also needs to manage its finances well to maintain the continuity of the JKN program, as indicated by its cash ratio and current ratio of 152.91% and 914.6%.
D-590
Depok : FKM-UI, 2025
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Zulkarnain Abubakar; Promotor: Amal Chalik Sjaaf; Kopromotor: Purnawan Junadi, Tjahjono Darminto Gondhowiardjo; Penguji: Mardiati Nadjib, Budu, Asnawi Abdullah, Mahlil Ruby
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Penelitian ini menggunakan pendekatan Value-Based Healthcare (VBHC) untuk menganalisis value (capaian luaran kesehatan dan biaya yang dikeluarkan) pelayanan katarak dengan prosedur fakoemulsifikasi pada pasien JKN, sekaligus mengidentifikasi penerapan Integrated Care Pathway (ICP) dan faktor risiko pasien terhadap capaian value, kemudian merumuskan paket pembayaran berbasis value untuk pelayanan katarak. Penelitian dilakukan dengan desain cohort retrospective di 2 rumah sakit mata dengan total sampel 184 pasien. ICP dikembangkan di masing-masing rumah sakit berdasarkan clinical pathway yang berlaku, hasil interview dan observasi. Data kesesuaian penerapan ICP, faktor risiko dan luaran klinis diperoleh dari rekam medis, sedangkan kualitas hidup diukur dengan kuesioner NEI VFQ-25. Biaya dihitung menggunakan Time-Driven Activity-Based Costing. Analisis dilakukan menggunakan uji Spearman, Chi-square, Mann-Whitney, dan regresi logistik. Hasil menunjukkan peningkatan capaian value pasca operasi katarak di kedua rumah sakit dengan Postoperative PVA ≥6/18 sebesar 93,5% dan skor kualitas hidup 89,3 dengan biaya rata-rata Rp7.194.147 ±338.316 di RS C, dan di RS B sebesar 96,7% dengan skor kualitas hidup 91,2 dan biaya rata-rata Rp8.008.136 ±Rp400.800. Capaian ini memenuhi standar WHO dan lebih tinggi dari rata-rata nasional. Pada kedua rumah sakit ditemukan korelasi antara luaran klinis yang baik dengan biaya yang lebih rendah dan sebaliknya. Hal ini juga menunjukkan kejadian komplikasi berhubungan dengan biaya yang lebih tinggi dan mempengaruhi capaian luaran secara keseluruhan. Studi menunjukkan penerapan ICP sebagai tools dalam penerapan VBHC di mana kesesuaiannya berhubungan dengan capaian visual outcome yang baik, komplikasi pasca operasi yang rendah dan biaya perawatan yang lebih efisien. Selain itu didapatkan riwayat komorbid okuler dan faktor teknis sebagai faktor risiko pasien yang berhubungan dengan capaian value dalam pelayanan katarak, sehingga perlunya dilakukan risk-adjusted dalam penerapan VBHC pada pasien dengan kedua faktor risiko tersebut. Lebih lanjut studi ini merekomendasikan pengembangan model pembayaran paket pelayanan katarak berbasis value dalam skema JKN sebagai bagian dari upaya penigkatan value pelayanan katarak dan strategi dalam penerapan VBHC di Indonesia.
This study applied a Value-Based Healthcare (VBHC) approach to evaluate the value of cataract care using the phacoemulsification procedure for National Health Insurance (JKN) patients. The objectives were to assess patient outcomes relative to the cost of care, examine the implementation of the Integrated Care Pathway (ICP), identify patient risk factors associated with value achievement, and develop a value-based bundled payment model for cataract care. A retrospective cohort study was conducted at two eye hospitals in Indonesia, involving 184 patients. The ICPs were initially developed at each hospital based on existing clinical pathways, and informed by data from interviews and observations. Data on ICP adherence, patient risk factors, and clinical outcomes were obtained from medical records, while quality of life was assessed using the NEI VFQ-25 questionnaire. Costs of care were calculated using the Time-Driven Activity-Based Costing method. Statistical analyses included Spearman correlation, Chi-square, Mann-Whitney, and logistic regression. The findings demonstrate improved value outcomes following cataract surgery in both hospitals. Hospital C achieved a Postoperative PVA ≥6/18 in 93.5% of patients, a quality-of-life score of 89.3, and an average cost of Rp7,194,147 ±338,316; Hospital B achieved 96.7%, a score of 91.2, and an average cost of Rp8,008,136 ±400,800. These results meet WHO standards and exceed national averages. A significant correlation was observed between favorable clinical outcomes and lower costs, whereas complications were associated with higher costs and poorer overall outcomes. Application of ICP was shown to support VBHC implementation, contributing to better visual outcomes, reduced postoperative complications, and more efficient care delivery. Ocular comorbidities and technical factors emerged as significant patient risk factors affecting value, underscoring the need for risk adjustment in applying VBHC to such patient groups. This study recommends the development of a value-based bundled payment model for cataract care within the JKN scheme to enhance value creation and as strategy for implementing VBHC in Indonesia.
D-611
Depok : FKM-UI, 2026
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Wahyu Pudji Nugraheni; Promotor: Hasbullah Thabrany; Ko-Promotor: Budi Hidayat, Mardiati Nadjib; Penguji: Indang Trihandini, Soewarta Kosen, Fahmi Idris, Pujiyanto, Eko Setyo Pambudi
D-374
Depok : FKM-UI, 2017
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Trisna Budy Widjayanti; Peromotor: Amal Chalik Sjaaf, Anhari Achadi, Budi Hidayat; Penguji: Meiwita Budiharsana, Mardiati Nadjib, Purnawan Junadi, Trihono, Harimat Hendrawan
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Penelitian ini bertujuan melihat hubungan antara faktor sosial ekonomi dan klinis dengan pemanfaatan Clinical Pathway (CP) Sectio Caesaria serta outcome klinis serta pembayaran klaim pada pelayanan Ibu melahirkan Sectio Caesaria (SC). Studi desain Cross Sectional pada unit analisis 1155 data rekam medis ibu melahirkan SC periode 1 Januari 31 Desember 2018 di 3 RS. Hasil penelitian menunjukan pemanfaatan Clinical Pathway Ibu melahirkan Sectio Caesaria peserta Jaminan Kesehatan Nasional dari ke 3 RS studi penelitian proporsinya sebesar 43.1% dengan skor dibawah nilai mean 10. RS Pemda memiliki Proporsi tertinggi skor pemanfaatan Clinical Pathway Sectio Caesaria dibawah nilai mean 10 (76.8%), kemudian diikuti RSP (36.8%). RSNP menunjukkan proporsi (98.1%) skor pemanfaatan Clinical Pathway Sectio Caesaria diatas dan sama dengan (≥) nilai mean 10. Faktor sosial ekonomi dan klinis ibu melahirkan SC peserta JKN antara lain jenis RS (p=0.000), Kelas rawat (p=0.014) dan Rujukan (p=0.008), jenis SC (p=0.005), Usia Ibu (p=0.053), Paritas (p=0.016), Riwayat ANC (p=0.000), Kondisi Panggul p=0.000), kondisi plasenta (p=0.001), penyakit penyerta (p=0.000) dan riwayat SC (p=0.000) menunjukkan berhubungan secara signifikan dengan pemanfaatan Clinical Pathway Sectio Caesaria (p<0.05). Pemanfaatan Clinical Pathway ibu melahirkan Sectio Caesaria peserta JKN menunjukan adanya hubungan yang signifikan dengan Outcome klinis (p=0.002) dan pembayaran klaim (p=0.000). Pemanfaatan Clinical Pathway ibu melahirkan Sectio Caesaria di RS menunjukkan ketidakseragaman dalam dimensi ICPAT dan tidak melibatkan kondisi pasien dalam penyusunannya. Pemerintah harus membuat payung hukum Pedoman Nasional Pelayanan Kedokteran (PNPK) yang menjadi standar prosedur operasional untuk menyelaraskam penyelenggaraan program jaminan kesehatan
D-417
Depok : FKM-UI, 2020
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Fery Rahman; Promotor: Amal Chalik Sjaaf; Kopromotor: Purnawan Junadi, Budi Wiweko; Penguji: Anhari Achadi, Ahmad Syafiq, Sutanto, Trihono, Zulfikar As'ad
Abstrak:
Current world developments have entered industrial revolution 4.0, which is a phenomenon where collaboration occurs between cyber technology and automation technology. This opens up opportunities for medical practitioners and the public to carry out health consultations, medical practice diagnoses in virtual space, without reducing the essence of health services commonly known as Telemedicine. Some of the benefits of Telemedicine in services are effectiveness and efficiency in health services without geographical distance restrictions, patients can also save time and travel costs, as well as increase access to health services. Telemedicine is also used by fellow health practitioners to get advice or further treatment plans for a patient. The most obvious use during the COVID-19 pandemic is being able to provide health services remotely because it reduces exposure to the SARS-CoV-2 virus. With obvious benefits especially in terms of accessibility and convenience, telemedicine also raises problems related to implementation, data security and patient satisfaction. Many countries have not developed a comprehensive regulatory framework, which also hinders the adoption of telemedicine in the health care system. In Indonesia, Minister of Health regulation no. 20/2019 is still considered general, but does not address comprehensive issues such as legal risks, unclear financing schemes, other policies for the continuation of effective, widespread and ethical telemedicine. The aim of this research is to analyze the telemedicine service model at the Nahdlatul Ulama network of hospitals. The research design used is descriptive qualitative with a descriptive interpretive approach. This qualitative research used in-depth interview methods with 14 leaders of NU network hospitals, implementing doctors, leaders of the Association which oversees all members of NU Hospitals and the Head of the Health Service. The information obtained is used for comprehensive analysis to obtain determinant factors that influence the implementation of telemedicine services in hospitals. The telemedicine service model at NU network hospitals is telemedicine in the form of teleconsultation and teleradiology with the basis used being WhatsApp / hospital hotline, personal cell phone and additional applications such as zoom meetings and google-meeting. Factors that influence this service include the creation of SOPs by hospital leaders, adequate internet infrastructure (> 200 Mbps), the existence of an Electronic Medical Record (EMR) that is integrated with telemedicine services, telemedicine literacy and competency of health workers, market share mapping is also needed. community needs and adequate and appropriate payment for medical services, so as not to cause resistance from health workers. Meanwhile, for the determination of units that provide guidance and supervision, there needs to be uniformity based on applicable regulations
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Penelitian ini adalah penelitian kualitatif dengan desain deskriptif. Hasil penelitian menyarankan bahwa perpustakaan perlu dilibatkan dalam pengembangan kurikulum; materi pendidikan pemakai perpustakaan harus dikembangkan sesuai dengan komponen-komponen yang ada dalam information literacy; perpustakaan juga harus menyediakan sarana dan fasilitas yang mendukungpeningkatan literacy mahasiswa. Perkembangan dunia saat ini sudah memasuki revolusi industri 4.0 yang merupakan fenomena dimana terjadinya kolaborasi antara teknologi siber dengan teknologi otomatisasi. Hal ini membuka peluang bagi praktisi kedokteran dan masyarakat untuk melakukan konsultasi kesehatan, diagnosa praktik kedokteran dalam ruang virtual, tanpa mengurangi esensi pelayanan kesehatan yang biasa dikenal dengan Telemedisin. Beberapa manfaat Telemedisin dalam pelayanan yaitu efektifitas dan efisiensi dalam Pelayanan kesehatan tanpa batasan jarak geografis, pasien juga dapat menghemat waktu dan ongkos biaya perjalanan, serta meningkatkan akses ke Pelayanan kesehatan. Telemedisin juga dimanfaatkan oleh sesama praktisi kesehatan dalam mendapatkan saran atau rencana pengobatan lanjutan bagi seorang pasien. Pemanfaatan selama pandemik COVID-19 dirasakan paling nyata yakni mampu menyediakan pelayanan kesehatan dari jarak jauh karena mengurangi paparan virus SARS-CoV-2. Dengan manfaat yang nyata terutama dalam hal aksesibilitas dan kenyamanan, Telemedisin juga menimbulkan permasalahan terkait implementasi, keamanan data, dan kepuasan pasien. Banyak negara belum mengembangkan kerangka peraturan yang menyeluruh, hal ini juga yang menghambat adopsi Telemedisin dalam sistem pelayanan kesehatan. Di Indonesia, peraturan Permenkes No. 20/2019 masih dianggap umum, namun tidak menjawab persoalan menyeluruh seperti adanya resiko hukum, ketidakjelasan skema pembiayaan, kebijakan lain untuk keberlangsungan Telemedisin yang efektif, luas dan etis. Tujuan penelitian ini menganalisis model pelayanan Telemedisin di Rumah Sakit jejaring Nahdlatul Ulama. Desain penelitian yang digunakan adalah deskriptif kualitatif dengan pendekatan Interpretatif Deskriptif. Penelitian kualitatif ini menggunakan metode wawancara mendalam dari 14 pimpinan rumah sakit jejaring NU, Dokter pelaksana, pimpinan Asosiasi yang menaungi seluruh anggota RS NU serta Kepala Dinas Kesehatan. Informasi-informasi yang diperoleh digunakan untuk dianalisis secara komprehensif guna mendapatkan faktor-faktor determinan yang mempengaruhi penerapan layanan Telemedisin di RS. Model layanan Telemedisin pada RS – RS jejaring NU didapatkan jenis Telemedisin berupa telekonsultasi dan teleradiologi dengan basis yang digunakan adalah WhatsApp / hotline RS, Ponsel pribadi serta aplikasi tambahan seperti zoom meeting dan google-meeting. Faktor yang mempengaruhi layanan ini antara lain adanya pembuatan SOP oleh pimpinan RS, Infrastruktur internet yang memadai (> 200 Mbps), Adanya Rekam Medis Elektronik (RME) yang terintegrasi dengan layanan Telemedisin, literasi Telemedisin dan kompetensi tenaga kesehatan, Diperlukan juga pemetaan pangsa pasar / kebutuhan masyarakat serta Pembayaran jasa medis yang layak dan berkesesuaian, sehingga tidak menimbulkan resistensi dari kalangan tenaga kesehatan. Sedangkan untuk penetapan unit yang memberikan pembinaan dan pengawasan (binwas) perlu ada keseragaman berdasarkan peraturan yang berlaku
Current world developments have entered industrial revolution 4.0, which is a phenomenon where collaboration occurs between cyber technology and automation technology. This opens up opportunities for medical practitioners and the public to carry out health consultations, medical practice diagnoses in virtual space, without reducing the essence of health services commonly known as Telemedicine. Some of the benefits of Telemedicine in services are effectiveness and efficiency in health services without geographical distance restrictions, patients can also save time and travel costs, as well as increase access to health services. Telemedicine is also used by fellow health practitioners to get advice or further treatment plans for a patient. The most obvious use during the COVID-19 pandemic is being able to provide health services remotely because it reduces exposure to the SARS-CoV-2 virus. With obvious benefits especially in terms of accessibility and convenience, telemedicine also raises problems related to implementation, data security and patient satisfaction. Many countries have not developed a comprehensive regulatory framework, which also hinders the adoption of telemedicine in the health care system. In Indonesia, Minister of Health regulation no. 20/2019 is still considered general, but does not address comprehensive issues such as legal risks, unclear financing schemes, other policies for the continuation of effective, widespread and ethical telemedicine. The aim of this research is to analyze the telemedicine service model at the Nahdlatul Ulama network of hospitals. The research design used is descriptive qualitative with a descriptive interpretive approach. This qualitative research used in-depth interview methods with 14 leaders of NU network hospitals, implementing doctors, leaders of the Association which oversees all members of NU Hospitals and the Head of the Health Service. The information obtained is used for comprehensive analysis to obtain determinant factors that influence the implementation of telemedicine services in hospitals. The telemedicine service model at NU network hospitals is telemedicine in the form of teleconsultation and teleradiology with the basis used being WhatsApp / hospital hotline, personal cell phone and additional applications such as zoom meetings and google-meeting. Factors that influence this service include the creation of SOPs by hospital leaders, adequate internet infrastructure (> 200 Mbps), the existence of an Electronic Medical Record (EMR) that is integrated with telemedicine services, telemedicine literacy and competency of health workers, market share mapping is also needed. community needs and adequate and appropriate payment for medical services, so as not to cause resistance from health workers. Meanwhile, for the determination of units that provide guidance and supervision, there needs to be uniformity based on applicable regulations
D-540
Depok : FKM UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Andi Afdal Abdullah; Promotor: Budi Hidayat; Kopromotor: Pujiyanto; Penguji: Atik Nurwahyuni, Mardiati Nadjib, Soewarta Kosen, Ali Ghufron Mukti; Mahlil Ruby; Teguh Dartanto
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Latar belakang: Kemudahan akses pelayanan kesehatan bagi peserta Jaminan Kesehatan Nasional (JKN) merupakan salah satu upaya untuk meningkatkan derajat kesehatan penduduk Indonesia. Kemudahan akses ini terwujud dengan bertambahnya fasilitas kesehatan yang melayani peserta JKN. Indikator kemudahan akses terlihat dari bertambahnya jumlah peserta yang berkunjung ke fasilitas kesehatan baik di tingkat pelayanan rawat jalan maupun rawat inap. Kunjungan peserta JKN per 1.000 penduduk dikenal dengan isitilah rate sebagai salah satu indikator utilisasi pelayanan kesehatan untuk menjaga kesinambungan program JKN. Tujuan: penelitian ini bertujuan menganalisis faktor yang mempengaruhi rate rawat jalan tingkat lanjutan (RJTL) maupun rawat inap inap tingkat lanjutan (RITL) dan pemodelan prediksi rate RJTL dan rate RITL. Data yang digunakan berasal dari database BPJS Kesehatan dan Survei Sosial Ekonomi Nasional (SUSENAS) tahun 2016 – 2019 yang diolah berdasarkan faktor predisposing, faktor enabling, dan faktor need dimana semua data digunakan dalam penelitian atau total sampling. Metode: analisis data panel dinamis yang ditujukan untuk membuat model prediksi rate RJTL dan rate RITL. Hasil: model prediksi yang digunakan pada rate RJTL dan rate RITL adalah estimator First Difference Generalized Method of Moment (FDGMM). Kesimpulan: rate RJTL dipengaruhi oleh variabel nilai tagihan klaim dibayar per kunjungan RJTL; jumlah rumah sakit kelas A, B, C, D; jumlah peserta pria; jumlah peserta berusia > 50 tahun; jumlah peserta dengan jumlah anggota keluarga > 3 orang; jumlah peserta berpengeluaran di bawah garis kemiskinan; jumlah peserta dengan penyakit tidak menular; rasio fragmentasi; rasio rujukan; dan jumlah peserta berpendidikan SMP. Sedangkan, rate RITL dipengaruhi oleh variabel nilai tagihan klaim dibayar per kunjungan RITL; jumlah rumah sakit kelas A, B, C, D; jumlah peserta pria; jumlah peserta berusia > 50 tahun; jumlah peserta dengan jumlah anggota keluarga > 3 orang; rate readmisi; jumlah peserta berpendidikan SMP; dan jumlah peserta berpendidikan Perguruan Tinggi. Saran: hasil penelitian menyarankan agar Pemerintah Daerah turut mendukung pemenuhan sarana prasarana pelayanan kesehatan agar masyarakat dapat menjangkau pelayanan kesehatan dengan mudah, mengelola perencanaan penambahan rumah sakit sesuai kebutuhan; Kementerian Kesehatan dapat memberikan regulasi terkait pemenuhan dan pemerataan fasilitas kesehatan maupun tenaga medis, terutama pada daerah dengan keadaan geografis yang sulit; BPJS Kesehatan dapat menggunakan model prediksi rate RJTL dan rate RITL sebagai alat bantu dalam menilai kebutuhan penambahan kerjasama dengan rumah sakit. Peneliti selanjutnya dapat melakukan penelitian dengan faktor utilisasi yang lebih luas dan lengkap serta melakukan kajian yang lebih mendalam pada satu wilayah tertentu dengan mempertimbangkan pengaruh aspek geografis, seperti jarak antar fasilitas kesehatan, luas wilayah dan kondisi akses ke fasilitas kesehatan.
Background: easy access to health services for participants of the National Health Insurance (JKN) is one of the efforts to improve the health status of the Indonesian population. This accessibility is achieved through an increase in health facilities serving JKN participants. The indicator of accessibility can be observed from the rising number of participants visiting health facilities, both at the outpatient and inpatient levels. The rate of visits by JKN participants per 1.000 population is considered an indicator of health service utilization, which contributes to the continuity of the JKN program. Objective: this study aims to analyze the factors that influence the advanced level of outpatient care (RJTL) and inpatient care (RITL) and to model the prediction of RJTL rates and RITL rates. The data used is derived from the BPJS Kesehatan database and the 2016-2019 National Socioeconomic Survey (SUSENAS), which are processed based on predisposing factors, enabling factors, and need factors. All data is utilized in the research, employing total sampling. Method: dynamic panel data analysis is employed to develop prediction models for RJTL rates and RITL rates. Results: the prediction model used for the RJTL rate and RITL rate is the First Difference Generalized Method of Moment (FDGMM) estimator. Conclusion: RJTL rate is influenced by several variables: value of claims bills paid per RJTL visit, number of class A, B, C, and D hospitals, number of male participants, number of participants aged over 50 years, number of participants with more than 3 family members, number of participants with expenditures below the poverty line, number of participants with non-communicable diseases, fragmentation ratio, referral ratio, and number of participants with junior high school education. On the other hand, the RITL rate is affected by value of claim bills paid per RITL visit, number of class A, B, C, and D hospitals, number of male participants, number of participants aged over 50 years, number of participants with more than 3 family members, readmission rate, number of participants with junior high school education, and number of participants with university education. Recommendations: the results of this study suggest that the Regional Government should also support the fulfillment of health service infrastructure so that partisipant can reach health services easily, manage plans for adding hospitals as needed; The Ministry of Health can provide regulations regarding the fulfillment and equity of health facilities and medical personnel, especially in areas with difficult geographical conditions; BPJS Kesehatan can use RJTL rate prediction model and RITL rate as a tool in assessing the need for additional collaboration with hospitals. Future researchers can conduct research with broader and more complete utilization factors and conduct more in-depth studies in a particular area by considering the influence of geographical aspects, such as the distance between health facilities, area size and conditions of access to health facilities.
D-483
Depok : FKM-UI, 2023
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Atikah Adyas; Promotor: Ascobat Gani; Ko-promotor: Azrul Azwar; Penguji: Sudijanto Kamso, Hasbullah Thabrany, Soekidjo Notoatmodjo, Soewarta Kosen, Sudarsono Hardjo Soekarta, Mardiati Nadjib, Prastuti C. Soewondo
D-204
Depok : FKM-UI, 2007
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Marsaulina Olivia Panjaitan; Promotor: Amal Chalik Sjaaf; Kopromotor: Anhari Achadi, Dwiana Ocviyanti; Penguji: Atik Nurwahyuni, Mardiati Nadjib, Pujiyanto, Supriyantoro, Chairul Radjab Nasution
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Implementasi Program Jaminan Kesehatan Nasional mendapatkan berbagai tantangan salah satunya adalah peningkatan utilisasi pelayanan kesehatan yang berakibat tingginya beban biaya pelayanan kesehatan. Tren persalinan dengan metode bedah caesar mengalami peningkatan setiap tahunnya. Disertasi ini bertujuan untuk menganalisis kebijakan dan menyusun suatu usulan kebijakan untuk pengendalian utilisasi tindakan bedah caesar dalam penyelenggaraan program Jaminan Kesehatan Nasional. Jenis penelitian adalah analitik dengan mixed method melalui analisis data kuantitatif dan data kualitatif, analisis kebijakan menggunakan Eugene Bardach’s eightfold framework yang dimodifikasi oleh Collins. Penelitian kuantitif melalui analisis data rekam medis tahun 2019 pada pasien bedah caesar di tiga rumah sakit dengan aspek bisnis yang berbeda di Provinsi Jakarta. Penelitian kualitatif dilakukan dengan wawancara mendalam dengan para pemangku kepentingan. Hasil penelitian menunjukkan bahwa Proporsi persalinan caesar dibanding normal di RSSP Y 99,3% di RSSK Z 63,66%, dan di RSUD X 13,42%. Tidak terdapat perbedaan karakteristik sosial dan karakteristik medis pasien bedah caesar di ketiga rumah sakit. Tidak terdapat perbedaan upaya pengendalian utilisasi operasi bedah caesar di ketiga rumah sakit. Bekas SC 1x memiliki persentase tertinggi sebagai indikasi SC dengan persentase 41,67% di RSUD X, di RSSK Z 39,48% dan di RSSP Y 24,11%. Terdapat hubungan antara usia, adanya komplikasi dalam kehamilan, malposisi janin, hipertensi, diabetes mellitus, penyakit jantung, dengan metode persalinan ibu secara caesar. Hasil penelitian kualitatif menunjukkan belum terdapat metode/tools khusus untuk pengendalian utilisasi caesar. Berdasarkan analisis kebijakan menggunakan Bardach’s eightfold framework yang dimodifikasi oleh Collins terdapat skenario/alternatif kebijakan pengendalian utilisasi bedah caesar diantaranya penyusunan program promotive preventif yang melibatkan organisasi-organisasi profesi terkait (seperti: Kebidanan Kandungan, Penyakit Dalam, Gizi, Penyakit Jantung) dengan sasaran wanita usia subur yang merencanakan kehamilan dan ibu hamil, yang khususnya berfokus untuk meminimalisir adanya penyulit kehamilan seperti: Hipertensi, Diabetes mellitus, obesitas, penyakit jantung. Hal ini penting dalam upaya menekan penyulit kehamilan yang dapat berpotensi meningkatkan angka utiliasi bedah caesar.
The implementation of the National Health Insurance Program faces various challenges, one of which is the increase in the utilization of health services which results in high health service costs. The trend of childbirth by Caesarean section method has increased every year. This dissertation aims to analyze the policy and prepare a policy proposal for controlling the utilization of Caesarean section procedures in the implementation of the National Health Insurance program. The type of research is analytical with a mixed method through quantitative and qualitative data analysis, policy analysis using Eugene Bardach's eightfold framework modified by Collins. Quantitative research through analysis of medical record data in 2019 on caesarean section patients in three hospitals with different business aspects in Jakarta Province. Qualitative research was conducted through in-depth interviews with stakeholders. The results showed that the proportion of caesarean deliveries compared to normal in RSSP Y was 99.3% in RSSK Z 63.66%, and in RSUD X 13.42%. There were no differences in the social characteristics and medical characteristics of caesarean section patients in the three hospitals. There were no differences in efforts to control the utilization of caesarean section operations in the three hospitals. Former 1x CS has the highest percentage as an indication for CS with a percentage of 41.67% in RSUD X, in RSSK Z 39.48% and in RSSP Y 24.11%. There is a significant influence between age, complications in pregnancy, fetal malposition, hypertension, diabetes mellitus, heart disease, and the method of maternal delivery by caesarean section. The results of qualitative research indicate that there are no specific methods/tools for controlling caesarean section utilization. Based on policy analysis using Bardach's eightfold framework modified by Collins, there are scenarios/alternative policies for controlling caesarean section utilization including the preparation of promotive preventive programs involving related professional organizations (such as: Obstetrics and Gynecology, Internal Medicine, Nutrition, Heart Disease) targeting women of childbearing age who are planning pregnancy and pregnant women, which specifically focus on minimizing pregnancy complications such as: Hypertension, Diabetes mellitus, obesity, heart disease. This is important in an effort to reduce pregnancy complications that can potentially increase the rate of caesarean section utilization.
D-561
Depok : FKM UI, 2025
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Unting Patri Wicaksono Pribadi; Promotor: Ascobat Gani; Kopromotor: I Made Wiryana; Penguji: Amal Chalik Sjaaf, Mardiati Nadjib, Anne Agustina Suwargiani, Enrico Aditya Rhinaldi
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Penelitian ini dilatarbelakangi oleh meningkatnya beban administrasi pengelolaan Perjanjian Kerja Sama antara BPJS Kesehatan dan fasilitas kesehatan dalam Program JKN. Sistem kontrak manual masih menghadapi masalah keterlambatan penyelesaian dokumen, kebutuhan sumber daya besar, risiko kesalahan administrasi, dan kerentanan penyimpanan arsip fisik. Penelitian ini bertujuan menjawab apakah kontrak elektronik dapat meningkatkan efektivitas, efisiensi, dan keamanan pengelolaan kerja sama fasilitas kesehatan, serta apakah kepemilikan dan kelas rumah sakit memengaruhi implementasinya. Hipotesis penelitian menyatakan bahwa kontrak elektronik lebih efektif, efisien, dan aman dibandingkan kontrak manual, serta implementasinya dipengaruhi oleh kepemilikan dan kelas rumah sakit. Penelitian menggunakan desain non-eksperimental komparatif dengan pendekatan mixed-method. Unit analisis adalah pengelolaan dokumen kerja sama antara BPJS Kesehatan dan FKRTL. Data diperoleh dari data sekunder monitoring 2.650 rumah sakit, wawancara mendalam, dan observasi lapangan. Analisis dilakukan secara deskriptif dan inferensial menggunakan Mann–Whitney U dan Chi-Square, serta diperkuat dengan analisis kualitatif. Hasil penelitian menunjukkan bahwa hipotesis efektivitas terbukti karena kontrak elektronik lebih tepat waktu dan konsisten. Hipotesis efisiensi juga terbukti pada sebagian besar indikator, terutama biaya, durasi, beban kerja, dan rasio efisiensi waktu-biaya, meskipun indikator Time Efficiency Ratio tidak menunjukkan perbedaan signifikan. Hipotesis keamanan terbukti secara kualitatif melalui penyimpanan digital, tanda tangan elektronik, e-meterai, dan kontrol akses. Kepemilikan serta kelas rumah sakit juga terbukti berhubungan dengan implementasi kontrak elektronik. Kesimpulannya, kontrak elektronik lebih unggul dibandingkan kontrak manual dalam mendukung tata kelola kerja sama fasilitas kesehatan. BPJS Kesehatan disarankan memastikan implementasi nasional, memperkuat pelatihan pengguna, keamanan akses, integrasi sistem, dan kebijakan teknis pendukung.
This study was motivated by the increasing administrative burden in managing Cooperation Agreements between BPJS Kesehatan and healthcare facilities under the National Health Insurance Programme. The manual contract system continues to face several problems, including delays in document completion, high resource requirements, administrative errors, and vulnerabilities in physical document storage. This study aimed to examine whether electronic contracts can improve the effectiveness, efficiency, and security of healthcare facility partnership management, and whether hospital ownership and class influence their implementation. The research hypotheses stated that electronic contracts are more effective, efficient, and secure than manual contracts, and that their implementation is influenced by hospital ownership and class. This study used a comparative non-experimental design with a mixed-methods approach. The unit of analysis was the management of cooperation agreement documents between BPJS Kesehatan and referral healthcare facilities. Data were obtained from secondary monitoring data involving 2,650 hospitals, in-depth interviews, and field observations. The analysis was conducted descriptively and inferentially using the Mann–Whitney U test and Chi-square test, supported by thematic analysis. The findings showed that the effectiveness hypothesis was supported, as electronic contracts were more timely and consistent. The efficiency hypothesis was also supported for most indicators, particularly cost, completion duration, workload, and the cost-time efficiency ratio, although the Time Efficiency Ratio indicator did not show a statistically significant difference. The security hypothesis was supported qualitatively through digital storage, electronic signatures, e-stamps, and access control. Hospital ownership and class were also found to be associated with electronic contract implementation. In conclusion, electronic contracts are superior to manual contracts in supporting the governance of healthcare facility partnerships. BPJS Kesehatan is advised to expand national implementation, strengthen user training, improve access security, enhance system integration, and develop supporting technical policies.
D-626
Depok : FKM-UI, 2026
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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