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Pembangunan kesehatan adalah proses yang terus menerus dan progresif untuk meningkatkan derajat kesehatan masyarakat. Dengan di berlakukannya Amandemen I - IV UU Dasar Negara Republik Indonesia tahun 1945, tujuan negara sudah semakin jelas di mana secara eksplisit menempatkan kesehatan sebagai bagian dari kesejahteraan rakyat yang. harus tersedia merata. Konsekwensinya daerah-daerah harus mengalokasikan pendanaan.. yang lebih besar terhadap sektor kesehatan. Pendanaan kesehatan merupakan kunci utama dalam suatu sistem kesehatan di berbagai negara. Penelitian Oleh WHO di Indonesia yang selama bertahun-tahun prihatin bahwa masalah kesehatan di Indonesia mengalami kemandegan akibat pendanaan, sebagai salah satu masukan (input) yang penting kurang mendapat perhatian. Dinas Kesehatan Kabupaten Muaro Jambi dengan jumlah anggaran kesehatan yang masih rendah di tambah lagi dengan belum teratasinya beberapa masalah kesehatan, penting dilakukan analisis pembiayaan kesehatan. Tujuan penelitian ini adalah untuk mengetahui gambaran tentang peta pembiayaan kesehatan bersumber pemerintah di Dinas kesehatan Kabupaten Muaro Jambi tahun 2006. Jenis penelitian ini adalah penelitian dengan desain deskriptif operasional di bidang analisis pembiayaan kesehatan Masyarakat yang bersumber dari pemerintah di Dinas Kesehatan, Puskesmas dan Gudang Farmasi dalam wilayah Kabupaten Muaro Jambi, Penelitian ini adalah telaah dokumen Dalam DASK yang di kelompokan menurut, sumber, provider, Fungsi biaya, program Prioritas dan realiasasi angearan. Hasil penelitian ini menunjukan bahwa total anggaran untuk pembiayaan kesehatan masyarakat bersumber pemerintah sebesar Rp 21,052,017,064,- dan nilai per kapita adalah Rp 71,104,11,- per tahun, yang bersumber dari APBD Kabupaten Rp 13,448,602,038 (65 %), Pinjaman Luar Negeri/Bantuan Luar Negeri PLN/BLN adalah sebesar Rp 4,300,000,000,- (21%) dan APBN sebesar Rp 3,015,000,000,(15 %). Dari 7 Provider, Bagian Tata Usaha mendapat porst terbesar Rp 7,013,652,601,- (34%) sedangkan terkecil alokasi biaya Bidang Pelayanan Kesehatan dasar Rp 919,380,000,- (4%). Pengelompokan menurut biaya pelayanan kesehatan yang terbesar adalah suporting Rp 12,770,145,438,- (62%). Fungs) pembiayaan Line Htem dengan alokasi dana terbesar adalah biaya Operasional yaitu Rp 16.121,935,838,(78%). Pembiayaan program kesehatan alokasi terbesar adalah program kesehatan kuratif Rp, 6,543,320,200,- (32%). Pembiayan 9 program kesehatan prioritas sesuai Standar Pelayanan Minimal (SPM) alokasi terbesar untuk program pelayanan kesehatan dasar sejumlah Rp 4,695,774,960,- (23%). Realisasi dana yang sudah di alokasikan adalah sejumlah 92% terdiri dari: Dana yang bersumber APBN 99%, realisasi anggaran bersumber APBD adalah 98%, dana yang besumber dari BLN/PLN mempunyai realisasi dana terrendah hanya 68% dani total alokasi anggaran. Di sarankan bagi pemerintah Kabupaten Muaro Jambi dalam menyusun kebijakan pembiayaan sektor kesehatan kiranya lebih memperhatikan distribusi per Provider, Program prioritas dan standar pelayanan minimal bidang kesehatan maupun distribusi sesuai fungsi pembiayaan pelayanan kesehatan. Hal ini harus di ikuti dengan peningkatan pembiayan sektor kesehatan terutama untuk pelayanan publik untuk menunjang visi dan misi kesehatan serta visi Pemerintah daerah Kabupaten Muaro Jambi tercapai. Dinas Kesehatan perlu memaksimalkan penyusunan Disirict Health Account (DHA) sehingga diperoleh bahan evaluasi dan penentuan alokasi pembiayaan program yang lebih memudahkan dalam pengelompokan pembiayaan kesehatan Masyarakat. Dinas Kesehatan dan Rumah Sakit Daerah lebih meningkatkan advokasi kepada Pemerintah Daerah, DPRD dan sektor swasta serta masyarakat dalam memobilisasi sumber pembiayaan kesehatan.
Development of health is progressive and continuous process to increase degree of health of public. With in the doing of Amendment I - [VY UU Dasar Negara Republic Indonesia year 1945, purpose of state have been progressively clear where explicitly place health as part of prosperity of people to be be available flatten. The consequence of allocation areas have to financing of larger oneses to health sectors. Financing of health is main key in health system in various states. According To Thabrani H" Research By WHO in Indonesia which during through years concerned that problem of health in Indonesia experience stag as result of financing, as one of input ( input) important less getting attention " The purpose of this research is to know about defrayal of health from duty of health government of Sub-Province Muaro Jambi year 2006. This research type is descriptive operational research design in deftayal analysis of Public health which stemming from government in health of duty, Puskesmas (public health centre) and Pharmacy warehouse in Sub-Province of Muaro Jambi, this research is DASK document study which grouped according, source, provider, cost function, Priority program and budget realization. This research result show that total budget for defrayal of public health from government equal to Rp 21,052,017,064,,- and assess per capita is Rp 71,104,11,- per year, from Sub-Province District Revenue Plan (APBD) Rp 13,448,602,038 (65%), Foreign Loan /Foreign Aid (PLN/BLN) is equal to Rp 4.300,000,000,- (21%) and State Revenue Plan (APBN) equal to Rp 3,015,000,000,- (15%). From 7 Provider, Arranging Effort get the biggest portion Rp 7,013,652,601,- (- 34%), smallest cost allocation is Base Health Service Rp 919,380,000,- (- 4%). Subdividing according to the service health budget the biggest is supporting Rp 12,770,145,438,- (- 62%). Line Item defrayal function with the biggest fund allocation is Operational expense that is Rp 16,121,935,838,- (78%). The biggest allocation health program defrayal is curative Medicare Rp 6,543,320,200, (32%). Defrayal of 9 priorities Medicare according to Minimum Standard Service (SPM) the biggest allocation for base health service program is Rp 4.695.774.960, (23%). Fund Realization which allocated was 92% consisted: Fund from APBN 99%, budget realization from APBD 98%, fund from BLN/PLN have low fund realization which is only 68% from total budget allocation. In suggesting for government of Sub-Province of Muaro Jambi in compiling policy of health defrayal sector presumably more pay attention to distribution per Provider, Priority program and Minimum Standard Service and also distribution according health service defrayal function. This thing must follow with increasing of health defrayal sector especially public service for supporting health mission and vision and also to reach the vision of Sub-Province Muaro Jambi Government. Duty of Health enquires to maximize compilation of District Health Account (DHA) so that can obtained a material for evaluation and determination of defrayal allocation of program which more facilitate in subdividing of health public defrayal. Duty of Health and district hospital needs more advocating to local government, private sector and Local Parliament and also public in mobilization source of health defrayal.
Kata Kunci: Kesenjangan biaya, Program Gizi, Perencanaan & Penganggaran
Increasing nutrition and overcoming the issues surrounding it is essential in increasing the quality of human resources in Indonesia. One of the important input aspects to achieve minimum standard services (SPM) is sufficient budget allocation. This study aims to uncover the discrepancy between budget realization and budget estimations of minimum standard services (SPM) for the nutrition program in 2016 and 2017; as well as to understand the planning and budgeting process. This was a qualitative study with a cross sectional design, utilizing resources of financial data and program implementation. Results of the study revealed that budget realization of nutrition program at Bekasi Municipal Health Office in 2016 and 2017 were Rp 3,931,449,461 and Rp. 9,146,251,165 respectively. The majority of the budget was directed to preventive programs where in 2016 comprised of 66.55% and in 2017 was 59.35% of the total nutrition budget. Total spending realized was higher than the yearly total budget estimations based on minimum standard services (SPM). There was excess in budget in 2016 of Rp. 2,152,354,011 and Rp. 6,798,429,672 in 2017. In-depth interviews revealed the planning process already includes extensive problem analysis, objective determination and activities identification. The budgeting process is already based on work performance due to it priority scale budgets and established. Bekasi Municipal Health Office should continue to pursue its commitment in improving health budget planning and budget efficiency.
Key words: Budget Gap, Nutrition Program,Health Planning and Budgeting
Malaria merupakan penyakit menular yang masih menjadi masalah kesehatan di dunia. diperkirakan ± 1,5 juta - 2.7 juta jiwa meninggal setiap tahunnya. Di Indonesia Pada tahun 2002 dilaporkan ada 15 juta kasus klinis. Dilaporkan bahwa dibeberapa daerah malaria masih endemis terutama daerah terpencil dan sebagian besar penderitanya dari goIongan ekonomi lemah. Dari 2 I kabupaten /kota di NAD,66 6% merupakan daerah endemis malaria. Kabupatcn Aceh Tenggara yang merupakan daerah pegunungan dengan jarak 900 km dari ibu kota provinsi selama empat tahun berturut-turut megalami kenaikan kasus malaria. Pada tahun 2003 teroatat 741 kasus, 2004 tercatat 531 kasus, 2005 tercatat 1.112 kasus dan 2006 tercatat l.787 kasus kejadian malaria. Perhatian dunia terhadap malaria cukup besar. Hal ini ditandai dengan penandatanganan perjanjian antara Global Fund, pemerintah Jerman dan pemerintah Indonesia yang berbunyi menghapus hutang Indonesia sebesar 50juta euro (600 milyar) dengan syarat setengah dari dana tersebut digunakan untuk program pemberantasan penyakit menular termasuk malaria. Program pemberantasan penyakit malaria merupakan palayanan esensial yang harus disubsidi oleh pemerintah dalam upaya mencapai ?kesehatan untuk semua? (health for all) sesuai dengan kemampuan Negara Indonesia. Diharapkan Dinas Kesehatan Kaabaupaten dapat mempengaruhi para pengambil keputusan di daerah untuk mendapaatkan prioritas dana APBD Kabupaten guna membiayai program malaria. Penelitian ini ingin melihat anggaran program pemberantasan penyakit malaria di Dinas Kesehatan Kabupaten Aceh Tenggara pada tahun 2005 s/d 2007 dimulai dari proses perencanaan penerimaan anggaran dari berbagai sumber peruntukan anggaran tersebut, siapa pegelolanya dan bagaimana dukungan pemangku kepentingan. Penelitian ini merupakan penelitian operasional dengan pendekatan kualitatif dan kuantitalif yang bersifiat deskriftif. Hasil penelitian menemukan pembiayaan program pemberantasan penyakit malaria di Dinas Kesehatan Kabupeten Aceh Tenggara pada tahun 2005 sld 2007 menunjukan hanya terdapat dua sumber yaitu ABPD Kab dan BLN yang jumlahnya cenderung naik yaitu tahun 2005 Rp 314,480.000, tahun 2006 Rp 444.380.000 dan tahun 2007 Rp 2.806.450.000. Pembiayaan operasional hampir tidak ada perubahan dari tahun ketahun. Komponen biaya terbesar adalah pemberian kelambu sebesar Rp. 2.512.200.000. Biaya untuk kuratif sangat sedikit yaitu hanya Rp 86.970.000. selama tahun 2005 s/d 2007. Dari hasil wawancara mendalam dengan peieabat terkait diperoleh gambaran bahwa keinginan mereka untuk memberantas: penyaki.t malaria cukup tinggi hanya saja belum diikuti dengan jumlah anggaran. Penelitian ini menyarankan agar pengelola Program pemberantasan penyakit malaria Dinas Kesahatan Kabupaten Aceh Tenggara lebih aktif lagi mencari sumber pembiayaan lain, tidak hanya bertumpun pada sumber yang ada sekarang dengan cara membuat perencanaan yang tepat dan melakukan advocasi ke pemerintah daerah.
Malaria is a communicable disease that is still be one of health problem throughout tbe world. There are estimated ± I ,5 - 2,7 million people died every year because of malaria. It has been reported that there were 15 miliion cases in Indonesia in 2002. Malaria is still be an endemic disease in rural area and most of patients are the poor people. There are 21 districts in NAD and 66 6%malatia. Aceh Tenggara District is a mountainous area in the distance of 900 km from capital city. For 4 years malaria cases increased year to year. In 2003, it was recorded that there were 741 cases, 842 cases in 2004, !.!12 cases in 2005 and 1.787 cases in 2006. The international contribution toward malaria is great enough. The MOU bertween global fund, German and Indonesia has been signed, it stated they agreed to eliminate Indonesia debt at anount 50 million Euro (600 million) with a specific condition that half of that loan should be used to eliminate communicable disease including malaria. Malaria elimination program is an essential service subsidized by government to achieve "health for all" in accordance with government ability. It's expected that District Health Office (Dinas Kesehatan Kabupaten) could influence the district policy stake holder to get a priority budget from Annual district budget called ?APBD? for malaria program This study was aimed to describe the budget of malaria program in district health office in Aceh Tenggara in 2005 to 2007. This study enrolled the planning budgeting process, financing sources, agent, provider and beneficiary for malaria program. This study was on descriptive operational study with qualitative and quantitative approaches. The results of study showed that the sources of fund are District APBD and BLN. The funding tends to increase from Rp. 314.480.000 in 2005, Rp. 444.380.000 in 2006 to Rp. 2.806.450.000 in 2007. The major component of 1hat funding waspurchasing mosquito net and it cost 2.512.200.000. Curative funding component is only 86.970.000 from 2005 to 2007. The result of study recommended 1hat the District Hea1th Office ( Dinkes ) ofAceh Tenggara should proactively find others potential resources, not only depending on the available resourcesby making a better planning process and advocate district government.
RSUD Tanjung Uban experience delays in claims submission of UHCparticipants to BPJS approximately 32 days from the deadline that been regulated withPMK 28 tahun 2014. The aim of this research is to evaluate the claims delay. Thisresearch use qualitative with methode in-depth interviews and documents review.The results indicate that the delay claims due to a lack of coordination,understanding socialization of UHC patient service regulations so there is a differencein diagnosis and make the claim requirement complience takes a long time. Theres a lackof human resources with skill especially supported with lack of information system andpower supply disruption that often occur make a disruption of hospital operationalmanagement service.The conclusion is necessary to increase communication, coordination,socialization with BPJS. Hospital need human resources needs analysis, increasing inclaim management, operational control of information systems and supply sufficientelectricity to expedite claims.Key Word : UHC, Claim handling, Acurate and timely
Indonesia's health development geared to achieve national health insurance scheme (JKN).However, funding of health in Indonesia is still dominated by domestic funding through out-of-pocket (OOP). Catastrophic health expenditure of households will disrupt householdconsumption and can lead to poverty. By using secondary data of the National Social Surveys(Susenas) 2012, this study aims to prove health insurance ownership lowers catastrophic healthexpenditure of households in Indonesia in 2012. This study used a cross-sectional study designwith models probit and bivariate probit. The results found that the health insurance ownershiplowers catastrophic health expenditure in the amount 12.97% at the threshold 10% of totalexpenditure and 18.42% at 20% of total non-food expenditure. Health insurance ownershipprovides protection for catastrophic health expenditure in Indonesia in 2012.Keywords: Health insurance, Catastrophic health expenditure, Probit, Bivariate probit, Susenas.
Dinas Kesehatan Provinsi Sulawesi Tengah memiliki berbagai masalah dart keterbatasan antara. lain menyangkut SDM perencana, S1K, dan dana. Belum adanya dana yang khusus dialokasikan untuk membiayai proses perencanaan dan penganggaran merupakan salah satu masalah yang penting diperhatikan. oleh sebab itu, penelitian ini bertujuan melakukan analisis biaya menggunakan konsep Activity Based Costing (ABC) terhadap proses perencanaan dan penganggaran program kesehatan tahunan Dimas Kesehatan Provinsi Sulawesi Tengah serta menganalisis berbagai faktor yang mempengaruhinya dan hambatan masalah yang dihadapinya. Penelitian ini adalah penelitian studi kasus, dengan pendekatan deskriptif menggunakan metode kualitatif. Melalui vvawancara. mendalam, Focus Group Discussion (FGD), telaah dokurnen danobservasi langsung. Seluruh tahapan aktivitas pereneanaan, mulai dari analisis situasi, identifikasi masalah, penetapan prioritas masalah, penetapan tujuan„ penentuan altematif pemeeahan masalah, penyusunan Reneana Operasional Proyek/Program (ROP), pengerjaan RICA—KL dan RKA—SKPD, asistensi, Koreksi dan revisi serta finalisa.si dokumen perencanaan dan penganggaran sarnpai penyu.sunan draft DIPA dan DPA Dinas Kesehatan Tahun 2007. walaupun implementasinya, tidak selalu dilakukan seeara berumtan atau terpisah tahap demi tahapnya. Beberapa aspek yang mempengaruhi perencanaan dan penganggaran adalah ketersediaan, kecukupan dan kesesu.aian serta kelengkapan berbagai sumber daya, seperti SDM perencana, saran; waktu, dana, jadwal, juklak, Kebijakan OTDA yang mendukung, Sistem Informasi Kesehatan (SIK) dan standar harga satuan barangijasa. Kegiatan perencanaan dan penganggaran selanria ini, merupakan bagian dari Prograrn Kebijakan dan Manajemen Pembangunan Kesehatan (PICMPK). Alokasi dana tahun anggaran 2007 sebesar Rp. 6.706.789.494,- terdiri dari Rp. 5.166.347.000,- APBN dan Rp. 1.540.442.494,-. APBD. Hasil perhitungan dan analisis biaya yang dilakukan temyata diperoleh biaya total proses perencanaan dan penganggaran Dinas Kesehatan Provinsi Sulawesi Tengah sebesar Rp. 259.794.844,- yang keseluruhannya merupakan biaya operasional kegiatan per tahapan aktivitas tersebut. Permasalahan dan hambatan yang dihadapi dalam proses perencanaan dan penganggaran adalah 1)sektor kesehatan belurn menjadi prioritas 2)Belum optimalnya S1K, 3)belum adanya SK Kadis tentang SDM perencanaitim penyusun dokumen perencanaan dan penganggaran dinas. 4)Da.ftar harga satuan barangijasa belum sepenuhnya dimanfaatkan sebagai acuan.5) Belum adanya Juklak perencanaan clan penganggaran, 6)belum semua personil yang terlibat proses perencanaan dan penganggaran belum teriatih secara tehnis maupun. manajerial. 7)Koordinasi Lintas Program (LP) belum optimal. 8) Perencanaan & penganggaran yang dilakukan selama ini belum terpadu, terpisah antara perencanaan APBN dengan APBD. Begitu pula dengan tenaga perencananya. APBN oleh Seksi Penyusunan Program sedangkan APBD oleg Subag Keuangan. 9)Belum adanya dana yan khusus dialokasikan untuk aktivitas perencanaan clan penganggaran. 10)Belum adanya risetistudi sejenisnya mengenai analisis biaya programikegiatan untuk acuaniperbandingan kearah perbaikan. 11)Masalah yang sifatnya spesifik lokal yakni seringkali terjadi pemadarnan lampu oleh PLN. Penelitian ini menyimpulkan perlu dilakukan berbagai upaya dan penataan sena pembenahan baik secara temis maupun manajerial dala.m proses perencanaan dan penganggaran. Upaya sosialisasi dan advokasi yang lebih intensif kepada stakeholder/decision maker setempat juga masih perlu ditingkatkan.
Central Sulawesi Provincial Health Office, have many problems and scarcity of many aspect like planning officer, SIK and budget. Have not budget allocaction for the planning and budgeting process. This study aim to conduct a special cost analysis for the process of health planning and budget by using Activity Based Costing (ABC) concept. This study is a qualitative design, researcher used a framework system which covered input, process and output to analyze various aspect which related to planning and budget process. Public Health Service in the Central Sulawesi Province has conducted all planning activities steps, starting from situation analysis, identify problem, decision of problem priority, decision of aim, determination of trouble-shooting alternative, arrangement of Project Operational Planning. (ROP), Making of RICA - ICL and RICA - SKPD, assistance, correction and revision, final document of planning and budget until draft arrangement of DIPA and DPA at Public Health Service in 2007. Although their implementation are not always conducted alternately or separated step by step. Some aspects which affected to planning and budget at Public Health Service in the province of Sulawesi Tengah is availability, sufficiency, compatible and also the equipment of various resources, such as Human Resources Development planner, medium, timing, fund, schedule, implementation guide (Juklak), supported decentralisation policy, Health Information System (5I1C) and standard price of service unit. Available planning and budget activity is part of Policy Program and Health Development Management at Public Health Service. Available fund allocation in this program is destined for some Subdin, department, section and sub section at Public Health Service in the province of Sulawesi Tengah. Fund allocation of this prograrne in 2007 are 6.706.789.494,- rupiahs which consist of 5.166.347.000,- rupiahs from APBN and 1.540.442.494,- rupiahs from province APB1). From calculation result and cost analysis which has conducted was obtained total cost of planning and budget process at Public Health Service in the province of Sulawesi Tengah are 259.794.844,- rupiahs which all of them are operational cost in every activities steps. Problems and resistances which are faced on planning and budget process such as: 1) Health sector does not become a priority yet concerning a local OTDA policy, because Kamtibrnas is more important aspect. 2) SIK is not optimal yet, 3) There is no SK ICadis concerning Human Resources Development of planner or compiler team of planning and budget document at Health Service. 4) Price list of material or service unit is not fully exploited as reference yet 5) There is no Juklak of planning and budget, 6) All personals who concerned on planning and budget process are not trained yet both technically and managerial. 7) Program pass coordination (LP) is not optimal yet. 8) Planning and budget which conducted are not solid yet, separated between APBN and APBD planning and also their planner. APBN is arranged by section of program arrangement while APBD is arranged by sub department of financial. 9) There are no funds which are allocated especially for planning and budget activity. 10) There is no study which concerns on cost analysis program or activity for reference on repair. 11) Local problems specifically are often happen extinction of electric by PLN. This study concluded that it was important to be conducted various effort and administration and also correction both technique and managerial on planning and budget process at Public Health Service in the province of Sulawesi Tengah. Socialization effort and more intensive advocation to stakeholder or decision maker is also improved.