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Endivia Rizki Maghfiroh; Pembimbing: Puput Oktamianti; Penguji: Adang Bachtiar, Vetty Yulianty Permanasari, Evy Febrina Nurpeni, Ari Dwi Aryani
Abstrak:
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Latar belakang. Jumlah Rujukan FKTP ke RSIA Kenari Graha Medika pasien BPJS Kesehatan masih mendapat proporsi kecil dibandingkan dengan rujukan ke FKRTL lain di wilayahnya. Kunjungan poli rawat jalan RSIA Kenari Graha Medika juga belum mencapai target kunjungan pertahun yaitu sebesar 46.080 kunjungan pasien poli rawat jalan dalam satu tahun. Guna meningkatkan kinerja rawat jalan, RSIA Kenari Graha Medika telah menjalin jejaring kerjasama dengan 84 FKTP di wilayah Kabupaten Bogor, namun belum diketahui ada tidaknya hubungan kepuasan kemitraan dengan WOMI. Metode. Desain penelitian cross sectional dengan jumlah sampel 70 sampel dari popuasi semua FKTP yang menjalin kemitraan dengan RSIA Kenari Graha Medika. Enam variabel yang diteliti adalah 5 variabel framework Lui & Ngo, 2005 (yaitu asset specificity dan partner reputation, actions acquiescence, actions simplicity, dan actions reciprocity) dan 1 variabel Komitmen Pelayanan Rujuk Balik (PRB) kemudian dihubungkan dengan keminatan FKTP dalam memberikan rekomendasi (WOMI (Word of Mouth Intentions)) pada pasien. Analisis data dilakukan dengan analisis univariat (deskriptif) dan multivariat dengan SEM PLS. Hasil. Dari analisais data didapatkan seluruh konstruk dinyatakan valid dan reliabel berdasarkan hasil perhitungan loading factor, AVE dan cornbach alpha. Uji hipotesis menunjukkan 3 variabel diterima yakni Action Acquiescence, Action Reciprocity, serta Action Simplicity, sedangkan 3 variabel lainnya ditolak yaitu, asset specificity, partner reputation, dan Komitmen PRB RS. Kesimpulan. Semakin tinggi dari Action Acquiescence, Action Reciprocity, dan Action Simplicity akan semakin tinggi pula WOMI FKTP yang bermitra dengan RSIA Kenari Graha Medika. Sedangkan tinggi rendahnya asset specificity, partner reputation, Komitmen PRB RS tidak berpengaruh pada WOMI.
Background. The number of First Level Health Facilities’s referrals to RSIA Kenari Graha Medika for BPJS Health patients still receives a small proportion compared to referrals to other First Level Health Facilities in the region. RSIA Kenari Graha Medika outpatient clinic visits have also not reached the annual visit target of 46,080 outpatient clinic patient visits in one year. In order to improve outpatient performance, RSIA Kenari Graha Medika has established a collaborative network with 84 First Level Health Facilities in the Bogor Regency area, but it is not yet known whether there is a relationship of satisfaction with WOMI. Method. Cross sectional research design with a sample size of 70 samples from the population of all First Level Health Facilities that have a partnership with RSIA Kenari Graha Medika. The six variables studied were 5 Lui & Ngo, 2005 framework variables (namely asset specificity and partner reputation, actions acquiescence, actions simplicity, and actions reciprocity) and 1 variable Reciprocity Service Commitment (PRB commitment) which was then linked to First Level Health Facilities’s interest in providing recommendations (WOMI (Word of Mouth Intentions)) in patients. Data analysis was carried out using univariate (descriptive) and multivariate analysis with SEM PLS. Results. From data analysis, it was found that all constructs were declared valid and reliable based on the results of loading factor, AVE and Cornbach alpha calculations. Hypothesis testing showed that 3 variables were accepted, namely Action Acquiescence, Action Reciprocity, and Action Simplicity, while 3 other variables were rejected. Conclusion. The higher the Action Acquiescence, Action Reciprocity, and Action Simplicity, the higher the First Level Health Facilities WOMI in partnership with RSIA Kenari Graha Medika. Meanwhile, high or low asset specificity, partner reputation, RS PRB Commitment have no effect on WOMI.
B-2434
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ari Dwi Aryani; Promotor: Adang Bachtiar; Kopromotor: Ali Ghufron Mukti, Fachmi Idris; Penguji: Dumilah Ayuningtyas, Kemal Nazaruddin Siregar, Mardiati Nadjib, Sabarinah, Rizanda Machmud
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Inekuitas pelayanan kesehatan masih terjadi setelah pelaksanaan Jaminan Kesehatan Nasional (JKN). Pemantauan secara berkala Kinerja Fasilitas Kesehatan Tingkat Pertama (FKTP) merupakan kunci untuk menurunkan inekuitas pelayanan kesehatan sebagai tujuan utama JKN. Penerapan Kapitasi Berbasis Kinerja (KBK) dengan tiga indikator sejak tahun 2016, menunjukkan terjadi perbaikan kinerja FKTP dalam meningkatkan kualitas dan efisiensi di pelayanan tingkat pertama. Penelitian ini bertujuan untuk mengembangkan model indikator kinerja, kapasitas FKTP dan indikator ekuitas agar dapat mengukur ekuitas pelayanan kesehatan. Desain penelitian menggunakan exploratory sequential-mixed method. Penelitian dibagi menjadi tiga tahapan. Tahap satu adalah systematic review untuk mengidentifikasi indikator yang dapat digunakan dalam mengukur kapasitas, kinerja FKTP dan ekuitas pelayanan kesehatan. Tahap dua dilakukan dengan pendekatan kualitatif dengan teknik Consensus Decision Making Group (CDMG) untuk menentukan indikator yang dapat dipakai dalam pengukuran kapasitas dan kinerja FKTP serta pengukuran ekuitas pelayanan kesehatan dengan para pakar. Tahap tiga adalah membuat pengembangan model indikator kinerja FKTP berdasarkan skema kapitasi yang dapat mengukur ekuitas akses layanan kesehatan, menggunakan analisis Structural Equation Modelling (SEM). Berdasarkan hasil SR, CDMG dan analisis SEM, indikator terpilih untuk mengukur kapasitas FKTP terdiri dari tiga indikator yaitu rasio dokter umum, sumberdaya sarana dan manusia (skor rekredensialing) dan pembiayaan (persen pembayaran KBK yang diterima). Indikator kinerja terpilih delapan indikator yaitu angka kontak, proporsi penderita DM diperiksa gula darah, proporsi penderita Hipertensi diperiksa tekanan darah, proporsi pasien tidak rujuk RS, proporsi rujukan non spesialistik, proporsi pasien rujuk balik, proporsi skrining penyakit jantung, DM dan Hipertensi, rasio pasien prolanis terkendali. Ekuitas pelayanan kesehatan dilihat dari rate utilisasi peserta FKTP berdasarkan jenis kelamin, usia dan sosial ekonomi (PBI-Non PBI). Analisis SEM menunjukan terdapat hubungan yang positif dan signifikan antara kapasitas dan kinerja FKTP dengan ekuitas pelayanan.
Healthcare inequities still occur after the implementation of the National Health Insurance (JKN). Regular monitoring of the performance of primary healthcare facilities (FKTP) is key to reducing healthcare inequities as the main goal of JKN. The implementation of Performance-Based Capitation (KBK) with three indicators since 2016 has shown improvements in the performance of primary healthcare facilities in improving the quality and efficiency of first-level services. Their capacity influences the performance of primary care facilities and impacts primary care performance outcomes (health service equity). This study objective was to develop a model of performance indicators, FKTP capacity and equity indicators to measure health service equity. The research design utilized an exploratory sequential-mixed method. The study was divided into three phases. Phase one was a systematic review to identify indicators that can be used in measuring capacity, FKTP performance and health service equity. Phase two was carried out by a qualitative approach with the Consensus Decision Making Group (CDMG) technique to determine indicators that can be used in measuring FKTP capacity and performance as well as measuring health service equity with experts. Phase three was the development of a model for FKTP performance indicators based on a capitation scheme that can measure the equity of health service access. This phase was carried out using Structural Equation Modeling (SEM) analysis. The SR, CDMG and SEM analysis show that there are three selected indicators to measure the capacity of primary health care facilities: general practitioner ratio, facility sufficiency(recredentialing score) and financing (percentage of KBK payments received). Eight performance indicators were selected, namely contact rate, proportion of DM patients checked for blood sugar, proportion of Hypertension patients checked for blood pressure, proportion of patients not referred to hospital, proportion of non-specialistic referrals, proportion of patients referred back to primary care providers, proportion of screening for heart disease, diabetes mellitus, and hypertension; and ratio of controlled Prolanis patients. Health service equity was analyzed from the utilization rate of participants based on gender, age and socioeconomic factors(PBI-Non PBI). SEM analysis showed a positive and significant relationship between the capacity and performance of primary health care facilities and equity.
D-508
Depok : FKM-UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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