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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.
Tujuan : Penelitian ini bertujuan untuk mengetahui apakah pemanfaatan dana Program Jaminan Pemelihaan Keluarga Miskin (JPK-Gakin) di Puskesmas sudah sesuai dengan peruntukannya atau tidak, dan bagaimana pengaruh kebijakan yang berlaku.
Disain : Penelitian ini adalah riset evaluasi (evaluative research). Populasi adalah 27 Puskesmas yang menyampaikan Laporan Pelaksanaan Kegiatan dan Keuangan PKPS BBM Bidang Kesehatan kepada Dinas Kesehatan kota Depok untuk tahun 2004, yang secara purposif di pilih 6 (Enam) puskesmas yang merupakan sample penelitian. Enam Puskesmas yang di pilih adalah 3 (tiga) Puskesmas dengan jumlah Keluarga miskin (Gakin) tertinggi dan 3 (tiga) Puskesmas dengan jumlah Keluarga miskin (Gakin) terendah di kota Depok, dan di lakukan kajian pada data sekunder yang bersifat kuantitatif, serta di lakukan penelusuran kepada data primer (wawancara, dan diskusi dengan pihak puskesmas) yang bersifat kualitatif. Pengolahan data kuantitatif menggunakan analisis univariat, analisis bivariat (uji T Independent).
Hasil : penelitian menunjukkan bahwa pemanfaatan dana pada jenis pelayanan kesehatan dasar (yankesdas) dan revitalisasi posyandu (revipos) tidak terkait dengan jumlah keluarga miskin (gakin) yang terdaftar pada masing-masing puskesmas, karena sebagian besar pemanfaatan dana dialokasikan kepada biaya yang bersifat non pelayanan medis kepada pasien Jaminan Pemeliharaan Keluarga Miskin (JPK-Gakin). Sementara untuk persalinan, di ketahui bahwa dari laporan yang di sampaikan oleh masing-masing puskesmas kepada Dinas Kesehatan kota Depok masih belum sesuai dengan standar cost yang ditetapkan untuk setiap ibu bersalin (bulin) dari keluarga miskin yang di tolong bidan, yakni Rp. 200.000,-.
Kesimpulan : Dalam analisa kesesuaian pemanfaatan dana kesehatan program JPK-Gakin untuk Pelayanan Rawat Jalan Tingkat Pertama (RJTP) pada 6 (Enam) Puskesmas di kota Depok tahun 2004, masih belum sesuai dengan kebijakan yang di tetapkan, proporsi kunjungan terhadap jumlah peserta keluarga miskin (gakin) pada masing-masing puskesmas belum optimal, hal ini di tunjukkan oleh adanya perbedaan yang signifikan expenditure per unit kunjungan untuk pelayanan kesehatan dasar pada masing-masing puskesmas yang di teliti.
Kata Kunci : RJTP, JPK-GAKIN, Expenditure, Yankesdas, Revipos, riset evaluasi.
Background : First Level Outpatient Services provided by a community health center are Primary Health Care (Yaskandes), giving birth services, and revitalization of community-based integrated service posts (Posyandu) (Revipos). The proportion of poor family visit to the number of poor families registered at each community health center and the policies established are expected to be related to the utilization of the Poor Family Care Guarantee Program (JKP-Gakin) health funds for first level outpatient services in the health centers. This is revealed by the research on Analysis of the Conformity of Health Fund Utilization of Poor Family Care Guarantee Program for First Level Outpatient Services at six community health centers in Depok, in 2004.
Aim : This research is aimed at knowing whether the utilization of the fund at health centers has conformed to what it is meant for or not, and how the policy influences are.
Design : This research is an evaluative research. The population is 27 community health centers giving the Report of Activity Implementation and Subsidy Reduction Compensation Program Finance (PKPS BBM) in health to Health Office in Depok in 2004. Six community health centers were purposively selected as research samples. Three of the health centers are the highest poor family number's health centers and the rest are the lowest in Depok. The secondary data were analyzed quantitatively, while the primary one (interview, discussion with health center personnel) were studied qualitatively. The quantitative data were processed using univariate and bivariate analyses (Independent T test).
Result : The results show that the fund utilization for Primary Health Care and revitalization of community-based integrated service posts is not related to the number of poor families registered in each health center because the funds are mostly allocated to finance non-medical services for poor family care guarantee outpatients. Meanwhile, for giving birth, it was known from reports given by each of the health centers to Depok Health Offices that the utilization has still not conformed to the standard cost determined for every giving birth mother of poor families helped by midwives, namely Rp 200,000.
Conclusion : Hence, it is concluded that the utilization of the health funds has not complied with the policy determined; the proportion of visit to the number of poor family participants at each health center has not been optimum. This is indicated by significant difference of expenditure per unit of visit for primary health care at every community health centers studied.
Pembangunan kesehatan bertujuan untuk meningkatkan kesadaran, kemauan dan kemampuan untuk hidup sehat bagi setiap orang sehingga dapat mewujudkan derajat kesehatan yang optimal. Rumah Sakit sebagai sarana pelayanan kesehatan, meskipun dengan dana terbatas dituntut tetap survive dan siap melayani masyarakat umum dan peserta Askes. Untuk menjaga kelangsungan pelayanan Rumah Sakit menyesuaikan tarif yang harus dibayar oleh pasien. Tarif pasien Askes lebih rendah dari tarif pasien umum.Data RS Persahabatan menunjukkan bahwa pendapatan sesuai tarif umum tahun 2001 meningkat cukup bermakna sebesar 52% dari tahun 2000, pendapatan terbesar dari Rawat Inap yang meningkat 39%. Meskipun pendapatan Rawat Inap meningkat, namun terdapat kesenjangan dimana pendapatan yang diterima (sesuai tarif Askes) hanya 32%. Hal ini terjadi akibat tarif pasien Askes lebih rendah dari tarif pasien umum. Akibat kesenjangan tersebut Rumah Sakit menanggung subsidi cukup besar, sehingga dapat mengganggu likuiditas dan terjadi deficit anggaran Rumah Sakit. Untuk itu perlu dikaji lebih lanjut perhitungan pendapatan berdasarkan tarif Askes. Hal inilah yang melatarbelakangi penelitian ini.Penelitian ini bertujuan mendapatkan gambaran seberapa besar kesenjangan pendapatan dan besarnya subsidi sesuai hasil perhitungan kembali serta distribusinya pada Unit Instalasi Rawat inap, akibat perbedaan tarif Askes dengan tarif umum dan bagaimana kebijakan penetapan tarif dimana yang akan datang. Penelitian ini bersifat kualitatif dengan cara observasi dan evaluasi dengan melakukan estimasi perhitungan data sekunder dan diskusi/wawancara.Dari hasil penelitian ini dapat disimpulkan (1) terdapat perbedaan hasil (output) antara perhitungan pendapatan dan subsidi oleh rumah sakit, dengan hasil perhitungan yang dilakukan pada penelitian ini, dimana kesenjangan menurut Rumah Sakit sebesar 68%, sedangkan menurut hasil perhitungan kembali sebesar 54%; (2) terdapat pasien Askes yang menggunakan kelas perawatan melebihi haknya tanpa membayar selisih tarif secara penuh, akibatnya Rumah Sakit menanggung biaya bagi pasien tersebut, dan seharusnya Rumah Sakit membukukannya sebagai beban pasien bukan Subsidi Askes; (3) subsidi bagi pasien Askes terjadi secara progresif yaitu makin tinggi golongan PNS dan Penerima Pensiun makin besar subsidi yang dinikmati; atau subsidi Rumah Sakit saat ini dinikmati oleh siapapun yang dirawat, baik pasien miskin maupun mampu; (4) kelemahan pembukuan terdapat pada sistem akuntansi, dimana rekening (account) yang ada belum menjangkau jenis tindakan yang jumlahnya banyak (comprehensive), seperti tindakan pelayanan pasien Askes belum seluruhnya dibukukan dalam akuntansi Rumah Sakit; (5) Pola tarif RS Perjam sampai saat ini belum ditetapkan oleh Menteri Kesehatan.Saran yang dapat diberikan adalah agar Rumah Sakit dapat mengembangkan jenis pelayanan luar paket, karena tarifnya mendekati tarif Rumah Sakit. Secara aktif memberikan masukan kepada PT. Askes agar dilakukan peninjauan kembali tarif paket. Pengolahan dan pencatatan transaksi keuangan agar dilakukan secara terintegrasi antara Bagian Keuangan dan Bagian Akuntansi sehingga laporan keuangan dapat diuji kelayakannya dan wajar. Selanjutnya perlu dilakukan percepatan penagihan (klaim) biaya pelayanan kepada PT. Askes, karena akan membantu likuiditas Rumah Sakit. Depkes perlu segera menetapkan Pola Tarif Rumah Sakit Perjam dan mengupayakan penambahan premi peserta Askes.
Analysis of Service Subsidies to Obligatory Participating Patients in PT. (Persero) Asuransi Kesehatan Indonesia at the In-Patient Installation Unit of Persahabatan Hospital Jakarta Year 2001 Health development aims to improve individual awareness, willingness and ability to lead a healthy-life in order achieve an optimum status of health. Hospital as the facility of health care service is required, although in limited funds, to survive and get ready to serve general public and members of Askes. To keep it survive, the hospital should adjust the rate to be paid by patients. Well, the rate charged on the Askes-member patients is usually lower than that on general patients.Data collected from the Persahabatan Hospital of common rate-based income in 2001 show that the income raised significantly on to 52% from that in the previous year (2000), and the largest income is drawn from In-Patient service, raised 39%. Although In-Patient Income raised, less difference still occurred since the income (according to the rate of Askes) is only 32%. This is because lower rate of Askes-member patients than that of general patient. Such a thing makes the Hospital bear relatively larger subsidies and thus troubles its liquidity and leads to budget-deficit. Therefore, further review of the income needs an Askes-based estimation. It is this which underlies the research.This research aims at revealing the picture of difference between income and amount of subsidies according to its re-estimation and distribution at the In-Patient Installation Unit due to the different rate of Askes from that of general patient and considering rate policies in the future. This research is qualitative in manner carried out through observation and evaluation by reviewing secondary data estimates and discussion/interview.From results of research, one may come to the following conclusions that (1) difference of output exists between income and subsidy estimates by the hospital party and that in this research; 68% in the former and 54% in the latter, respectively (2) Askes patients using service facilities extend their rights without paying any full different rate. It becomes, therefore, a subsidy charged on the Hospital whereas the hospital should, otherwise, impose this charge on the patients rather than Askes subsidies, (3) Subsidy for Askes patients occurs progressively, viz., the higher level of Civil Servant and Pension receiver, the greater the subsidy he or she enjoys and that it draws a conclusion that hospital subsidy are currently received by any patient, be poor or able patients, (4) weak book-keeping entries occur in the accounting system in which the existing account does not yet record comprehensively such as Askes-patient care service. Rate schemes for Public-Owned Hospital have not been determined by the Minister for Health.A suggestion that may be proposed is to get the Hospital develop services included in the fist of external package, since rate of the Askes approaches that of the Hospital. Another suggestion is to provide active input to PT. Askes in order to have rate of package reviewed. Financial data processing and account should be integrated between Finance Department and Accounting Department and therefore financial statement is allowable to test its reasonable feasibility. Further, claim for service costs should be accelerated to PT. Askes for it would help the hospital liquidity. The Department of Health should really determine the Rate Schemes for Public-Owned Hospital and exert to increase premium for Askes-members.
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
Penelitian ini bertujuan untuk mendapatkan gambaran karakteristik dan factor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan dasar puskesmas oleh keluarga miskin peserta JPKMM di Kecamatan Warungkondang Kabupaten Cianjur Tahun 2005. Penelitian ini menggunakan rancangan cross sectional dengan tujuan melihat hubungan ll variabel independent sikap petugas, keberadaan dokter, jam buka pelayanan, ketersediaan dan kecukupan obat, pendidikan, pengetahuan, persepsi sakit, persepsi tentang kualitas puskesmas,jarak, sarana transportasi dan biaya transport dengan pemanfaatan puskesmas. Responden pada penelitian ini adalah keluarga miskin peserta JPKMM yang tersebar di Kecamatan Warungkondang Kabupaten Cianjur dengan jumlah sample sebanyak 100 responden dari 5 desa yang dipilih secara acak sederhana. Penelitian ini memiliki banyak kelemahan antara lain jumlah responder; yang terbatas, reslko selection bias dan recall bias yang tinggi dibandingkan dengan penelitian kohort dan case control. Hasil penelitian menunjukkan bahwa factor sikap petugas, keberadaan dokter, pengetahuan, persespsi sakit dan persepsi tentang kualitas puskesmas berhubungan dengan pemanfaatan puskesmas. Sementara factor jam buka pelayanan, ketersediaan dan kecukupan obat, pendidikan, jarak, sarana transportasi dan biaya transport tidak berhubungan dengan pemanfaatan puskesmas. Dari kelima faktor yang berhubungan dengan pemanfaatan puskesmas, ternyata sikap petugas, pengetahuan dan keberadaan dokter yang paling dominan hubungannya dengan pemanfaatan puskesmas dengan nilai OR masing-masing 10,261 ; 5,722 ; dan 3,481. Melihal hal diatas maka perlu ditingkatkan akses keluarga miskin terhadap pelayanan kesehatan dasar puskesmas. Hal ini dapat ditingkatkan melalui pendekatan supply dan demand. Dari sisi supply adalah dengan cara mendekatkan akses keluarga miskin terhadap pelayanan kesehatan scpcrti penempatan dokter di puskesmas, adanya bidan di desa dan mengaktifkan kembali puskesmas keliling serta meningkatkan pemberdayaan masyarakat dengan melibalkan masyarakat menjadi fasilitator masyarakat dalam bidang kesehatan. Dari sisi demand adalah dengan meningkatkan pembinaan ke puskesmas dari Dinas Kesehatan Kabupaten Cianjur dan penyuluhan-penyuluhan yang bemanfaat dalam meningkatkan pengetahuan masyarakat tentang JPKMM dan hak-haknya.
This research aims to gain a picture of the characteristics and factors related to the utilization of Primary Health Care service by poor families participated in HMSPC in Warungkondang sub district, Cianjur District in 2005. The research used the cross sectional metl1od in order to observe the relations of eleven independent variables considered reliable in the utilization of PHC service. These eleven variables are the attitude of service providers (officers, nurses, and doctors), doctor?s availability, the opening hours, medicines availability, education background (of the service users), perception of illness, perception of the quality of the service, distance, transportation methods and transport fees. The respondents of the research were the poor families who join the HMSPC in Warungkondang in Cianjur District. There are 100 respondents taken randomly from live villages in that sub district. However, this study has several flaws such as the limited number of respondents, high risks of selection and recall bias compared to research using cohort and case control. The research shows that the factors of the attitude of the service givers, doctors availability, knowledge, perceptions on illness and on the quality of the PHC are related to the utilization of the clinic. Whereas factors such as opening hours, medicines availability, education background, distance, means of transport and transportation fees are not related to the utililization of the health center. From the five related factors above, it appears that the attitude of service providers, knowledge and doctors? availability are the most dominant factors here, each with the following OR value: 10,261 (for attitude of service providers), 5,722 (for knowledge) and 3,481 (forthe doctor?s availability). Based on the finding above, it is necessary to improve the access of poor families in receiving, the basic health service in PHC, and this can be achieved through the supply and demand approach. By supplying, we bring the services closer to them such as providing doctors in PHC and midwives in villages, reactivating the mobile clinics and improving the empowemient of communities by involving them as health facilitators. On the demand, we can cultivate trainings in PHC by the Health Council of Cianjur District. and administer educational sessions for the community in order to improve their knowledge about HMSPC and their rights.
Pelaksanaan program Jaminan Kesehatan Nasional (JKN) telah berjalan sejak tahun 2014, dalam pelaksanaanya masih ditemui tantangan khususnya dari sisi pemanfaatan pelayanan kesehatan. Tuberkulosis merupakan penyakit pernafasan menular penyebab utama kematian akibat infeksi di dunia yang penyebarannya terus mengalami peningkatan, Indonesia sendiri berada pada posisi kedua kasus terbesar setelah India. Tujuan penelitian ini adalah melakukan analisis pemanfaatan pelayanan kesehatan serta mengkaji faktor-faktor yang mempengaruhi pemanfaatan pelayanan rawat jalan pada peserta JKN dengan diagnosis tuberkulosis paru. Penelitian ini menggunakan data sekunder data sampel BPJS Kesehatan kontekstual tuberkulosis tahun 2022. Data dianalisis secara univariat, bivariat dan multivariat dengan model regresi Negative Binomial. Hasil uji statistik menunjukan terdapat hubungan yang signifikan antara kelompok umur, status pernikahan dan status pulang pada pelayanan FKTP dengan pemanfaatan layanan rawat jalan. Pengaruh jenis kepesertaan terhadap pemanfaatan layanan rawat jalan signifikan pada pelayanan RJTP dan RJTL dimana peserta PBI lebih banyak dalam memanfaatkan pelayanan RJTP sedangkan pada peserta Non PBI lebih banyak dalam memanfaatkan pelayanan RJTL.
The implementation of the National Health Insurance (JKN) program has been running since 2014, in its implementation there are still challenges, especially in terms of the use of health services. Tuberculosis is an infectious respiratory disease that is the main cause of death due to infections in the world whose spread continues to increase, Indonesia itself is in the second position with the largest cases after India. The purpose of this study is to analyze the use of health services and examine the factors that affect the use of outpatient services in JKN participants with a diagnosis of pulmonary tuberculosis. This study uses secondary data from BPJS Kesehatan contextual tuberculosis sample data in 2022. The data were analyzed univariately, bivariately and multivariate with a Negative Binomial regression model. The results of the statistical test showed that there was a significant relationship between age groups, marital status and discharge status in FKTP services and the use of outpatient services. The effect of the type of membership on the utilization of outpatient services was significant in RJTP and RJTL services where PBI participants were more in utilizing RJTP services while Non-PBI participants were more in utilizing RJTL services.