Abstrak: Fasilitas Kesehatan Tingkat Pertama (FKTP), idealnya merupakan gatekeeper padasistem kesehatan dimanapun, termasuk di Indonesia. Hal ini mengingat upaya kendalimutu dan kendali biaya harus di lakukan sejak kontak pertama pasien dengan pelayanankesehatan yaitu di tingkat pelayanan ini. BPJS-Kesehatan berupaya memaksimalkan mutudan fungsi pelayanan primer pada seluruh FKTP dari berbagai kategori, juga memotivasiFKTP untuk berlomba menjadi yang terbaik, oleh karena itu BPJS-Kesehatan PrimaryCare Award 2014 diadakan. BPJS-Kesehatan Primary Care Award 2014 diselenggarakansejak April hingga Oktober 2014, proses pemilihan FKTP terbaik dilakukan denganpendekatan pemilihan yang berjenjang dari tingkat kantor cabang, divisi regional hinggake tingkat nasional, menghasilkan 5 (lima) FKTP terbaik tingkat nasional, FKTP hasilpemilihan tersebut menarik untuk diteliti sebagai FKTP percontohan bagi FKTP lain diseluruh Indonesia.

Ditinjau dengan pendekatan Malcolm Baldrige, FKTP percontohan dapat dianalisis faktor-faktor yang menghantarkannya sebagai pemenang, hasilmenunjukkan bahwa enam variabel independen dari tujuh kriteria Malcolm Baldrige,yaitu kepemimpinan, perencanaan strategis, fokus pada pelanggan dan pasar, sisteminformasi manajemen, fokus pada staf dan fokus pada proses, memiliki hubungan denganvariabel dependen yaitu hasil kinerja organisasi.

Studi kualitatif penelitian inimenunjukkan bahwa masing-masing kategori FKTP yaitu Klinik Pratama, Dokter PraktekPerorangan, Puskesmas dan klinik TNI/POLRI memiliki keunggulannya masing-masingditinjau dari Kriteria Malcolm Baldrige, hal ini merupakan sebuah bahan rekomendasisekaligus evaluasi bagi penyelenggara Jaminan Kesehatan (BPJS-Kesehatan) danregulator sistem kesehatan (Kemkes) agar membenahi FKTP yang ada dan menciptakanFKTP yang ideal di seluruh Indonesia.

Kata Kunci: FKTP, BPJS-Kesehatan, Pelayanan Kesehatan Primer, Dokter LayananPrimer, Malcolm Baldrige

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Fasilitas Kesehatan Tingkat Pertama (FKTP), ideally be the gatekeepers on healthsystems in all states, including in Indonesia. effective efforts to quality control and costcontrol should be done since patients do the first contact with health services in PrimaryHealth care. BPJS- Kesehatan strives to maximize the quality and function of the primaryservice on the whole FKTP of various categories, as well as motivate FKTP for a race tobe the best, therefore the BPJS-Kesehatan Primary Care Award 2014 was held. BPJS-Kesehatan Primary Care Award 2014 held since April to October 2014, the best FKTP selection process conducted with a selection of tiered approaches starts from the level ofbranch offices, regional division offices to the national level, producing five best nationallevel FKTP, FKTP election results are interesting for research, FKTP as for the examinedFKTP throughout Indonesia.

Reviewed by Malcolm Baldrige approximation, Bestpractices of FKTP can be analyzed by factors that passed it as the winner, the resultsshowed that six of the seven independent variables Malcolm Baldrige, leadership,strategic planning, customer and market focus, information systems management,focusing on staff and focus on the process, have a correlation to the dependent variablei.e. performance results of the organization.

Study of the qualitative research indicatesthat each category of FKTP i.e. the Clinic Pratama, individuals Practice Doctor,PUSKESMAS and clinics TNI/POLRI have respective advantages in terms of MalcolmBaldrige Criteria, this Result is a recommendation and evaluation materials forHealthcare providers (BPJS-Kesehatan) and regulators of health systems (Kemkes) inorder to restructure the existing FKTP and create the ideal FKTP throughout Indonesia.

Key Words : Primary Health Care, BPJS-Kesehatan, Health Practitioner, medical doctor,FKTP, DLP, Malcolm Baldrige

Abstrak: Perubahan kebijakan pemberian jasa medis RSIA Buah Hati Ciputat di era Jaminan Kesehatan Nasional menyebabkan keresahan di kalangan staf medis, oleh karena itu penelitian ini bertujuan menyusun rancangan sistem remunerasi staf medis dengan menggunakan pedekatan kuantitatif dilanjutkan dengan kualitatif. Hasil penelitian menunjukkan bahwa pemberian jasa medis di RSIA Buah Hati Ciputat sudah memenuhi prinsip remunerasi seperti yang diungkapkan oleh 79 % staf medis dan telah meningkatkan kenyamanan kerja bagi staf medis. Besaran gaji pokok staf medis masih lebih rendah daripada ketentuan pemerintah. Tunjangan jabatan belum diberikan kepada semua jabatan struktural yang melibatkan staf medis. Pay for performance diberikan kepada semua staf medis dengan menggunakan sistem persentase, menyebabkan peningkatan jumlah kunjungan laboratorium. Pay for people diberikan hanya pada saat tertentu misal saat baru memulai pelayanan JKN dan cukup efektif untuk meningkatkan jumlah kunjungan pasien JKN rata-rata sebesar 50 %. Nilai pekerjaan staf medis spesialis ditentukan berdasarkan standar yang lazim berlaku di rumah sakit yang memiliki level yang sama. Kesimpulannya adalah penerapan sistem remunerasi di RSIA Buah Hati Ciputat sudah memenuhi prinsip-prinsip remunerasi namun pemberian komponen remunerasi belum sesuai dengan ketentuan pemerintah. Peneliti menyarankan agar RSIA Buah Hati Ciputat dapat melakukan perbaikan sistem remunerasi staf medis yang sesuai dengan peraturan pemerintah, memperbaharui formula penghitungan insentif, menyusun formula baku penghitungan bonus, melakukan survey gaji secara rutin dan melakukan penentuan nilai pekerjaan dengan mengkombinasikan hasil analisis dan evaluasi pekerjaan dengan survey gaji. Kata kunci : prinsip remunerasi, komponen remunerasi, analisis dan evaluasi pekerjaan, survey gaji, penentuan nilai pekerjaan Changes in the policy of providing medical services RSIA Buah Hati Ciputat in the era of National Health Insurance caused anxiety among the medical staff, therefore this research aims to design the system of remuneration of medical staff by using quantitative approaches followed by qualitative. The results showed that the provision of medical services at RSIA Buah Hati Ciputat has fulfilled the principle of remuneration as revealed by 79% of medical staff and has improved the working comfort for medical staff. The amount of basic medical staff salaries is still lower than the government requirement. Job allowances have not been granted to all structural positions involving medical staff. Pay for performance is given to all medical staff using a percentage system, leading to an increase in the number of laboratory visits. Pay for people is given only at certain times for example when just starting JKN services and effective enough to increase the number of visits JKN patients on average by 50%. The value of the work of a specialist medical staff is determined by standards that are common in hospitals of the same level. The conclusion is that the application of remuneration system at RSIA Buah Hati Ciputat has fulfilled the principles of remuneration but the remuneration component has not been in accordance with government regulation. The researcher suggested that RSIA Buah Hati Ciputat can repair the remuneration system of medical staff in accordance with the government regulation, update incentive calculation formula, prepare the formula of bonus calculation, conduct salary survey routinely and do the job value determination by combining the result of analysis and job evaluation with survey salary. Keywords: remuneration principle, remuneration component, job analysis and evaluation, salary survey, job value determination

Abstrak:

Instalasi Farmasi RSUD Pasar Rebo merupakan pusat pendapatan RS, Namun, realisasi anggaran Instalasi Farmasi selalu lebih tinggi dari perencanaannya selama lima tahun terakhir sejak 2007 sampai 2011 yang mungkin dipengaruhi oleh cost awareness, cost management, cost monitoring, dan cost incentive sebagai faktor-faktor dari cost containment. Tujuan penelitian ini untuk menganalisis cost containment di Instalasi Farmasi RSUD Pasar Rebo dengan mengetahui cost awareness, cost management, cost monitoring, dan cost incentive dan juga upaya cost containment yang dilaksanakan secara keseluruhan. Penelitian ini merupakan penelitian kualitatif dengan memanfaatkan dua teknik pengumpulan data yaitu data sekunder dan wawancara mendalam kepada pegawai level manajemen RS yang terkait erat dengan Instalasi Farmasi RSUD Pasar Rebo. Penelitian ini dilaksanakan selama Juli 2011 sampai Juli 2012. Hasil penelitian menunjukkan variabel cost awareness yaitu pelatihan belum mengarah pada efisiensi, serta pengkomunikasian harga melalui spanduk dengan slogan yang memotivasi pegawai ataupun acara khusus untuk pengenalan harga sediaan farmasi bagi pegawai pun belum ada. Variabel cost management yaitu budget dengan realisasi budget lebih tinggi dari perencanaan, pengkonsolidasian dokter melalui forum ?reboan? dihadiri sekitar 30 persen dokter, e-prescribing belum diaplikasikan, penyediaan obat dihitung dengan stok minimum dan maksimum tetapi belum ada pegawai yang ditunjuk untuk bertanggung jawab menghindari obat expired, pengurangan biaya operasional diterapkan dengan mematikan AC dan lampu yang tidak digunakan, pemanfaatan ulang kertas bekas, serta penyiapan obat dengan tepat, sementara dukungan eksekutif masih dipandang sebagai supervisi. Variabel cost monitoring yaitu pemonitoran keuangan berkelanjutan dalam hal ini cash flow masih belum mampu dimanfaatkan sebagai alat untuk memberi peringatan kepada Instalasi Farmasi untuk sejalan dengan perencanaan budget, selain belum kuatnya bargaining position RS walaupun margin obat generik dan obat non generik di atas 30 persen, dan masih terjadi selisih saat stock opname, pelayanan terintegrasi masih birokratis serta belum dapat meraih sense of belonging pegawai karena tidak sampainya informasi yang cukup, pengamanan obat penting dilakukan dengan pembedaan lemari serta adanya kartu stok. Variabel cost incentive yaitu pemberian insentif belum ditentukan oleh output kinerja melainkan kompetensi. Hal tersebut di atas menunjukkan upaya pengendalian biaya yang masih memprihatinkan di RSUD Pasar Rebo khususnya di Instalasi Farmasi. Kesimpulannya bahwa Instalasi Farmasi RSUD Pasar Rebo belum mengimplementasikan cost containment (cost awareness, cost management, cost monitoring, cost incentive) secara tepat.

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 The Pharmacy Installation of RSUD Pasar Rebo is a revenue centre for the hospital. Therefore, the Realisation of Budget of Pharmacy Installation had been higher than its planning for five years since 2007 until 2011 that might be influenced by cost awareness, cost management, cost monitoring and cost incentive as factors of cost containment. The objective of this research was to analyze the cost containment at The Pharmacy Installation of RSUD Pasar Rebo by knowing cost awareness, cost management, cost monitoring, and cost incentive and also the cost containment efforts for overall. This research was a qualitative research, conducted by utilizing two data collection techniques which were secondary data and in-depth interview on the entire management level of hospital which was related directly to The Pharmacy Installation of RSUD Pasar Rebo. This research conducted throughout the months of July 2011 ? July 2012. The result of the study revealed variables of cost awareness were the training program had not directed to efficiency and there were not the price communication by putting motivation statement on working area nor special event for making pharmacy staff knowing about price of pharmacy things. Variables of cost management were the budget which was realization higher than it plan, the doctor consolidation through "reboan" had admitted around 30 percent, the e-prescribing had not applied, the medicine reservation calculated by minimum and maximum stock but there was not a responsible staff to avoid expired medicine, the reducing operational cost was applied by turning off AC and lamp when unused, reuse paper, and preparation medicine correctly, the executive support was adjusted like a supervision not a support. Variables of cost monitoring were the monitoring financial continuely by cash flow was disable to warn The Pharmacy Installation strict to the budget planning nor had bargaining position in medicine principal even the generic and non generic margins upper 30 percent, moreover stock opname still had dismatch, the integrated service was birocratic and staff`s sense of belonging can?t be reached cause not enough information can be achieved, the security of important medicine through differentiating cupboard and stock card. Variable of cost incentive was the Insentive given had not determined by output of work but competences. It was revealed that cost containment efforts were still poorly implemented at RSUD Pasar Rebo especially at The Pharmacy Installation. The conclution was The Pharmacy Installation of RSUD Pasar Rebo had not yet properly implemented cost containment (cost awareness, cost management, cost monitoring, and cost incentive).