Latar belakang: Sistem jaminan kesehatan bagi masyarakat miskin mempunyai kecenderungan meningkatkan utilisasi layanan kesehatan, hal in dipengaruhi persepsi masyarakat miskin tentang hak mereka, selain itu dapat juga disebabkan oleh prilaku pemberi pelayanan kesehatan yang menggunakan peluang untuk mendapatkan keuntungan financial. Tujuan: Untuk mengetahui tingkat utilisasi layanan kesehatan Askeskin di RSUD Undata Palu apakah under utilisasi atau over utilisasi dan apa yang mempengaruhi tingkat utilisasi layanan tersebut. Metode: Penelitian deskriptif kualitatif dengan subyek peserta Askeskin dan beberapa tenaga kesehatan. Instrumen yang digunakan adalah data laporan rekam medik, laporan JPKMM Askeskin dan wawancara. Hasil: Cakupan utilisasi rawat jalan Askeskin di RSUD Undata 10,67%per bulan dan rata-rata biaya perkunjungan Rp 77.063,-, dengan jumlah kunjungan rawat jalan 18.060 kunjungan. Angka cakupan rawat inap 3,34% per bulan dengan Av LOS 6,01 hari, dan biaya rata-rata per kasusnya Rp 1.290.707,-. Rujukan dari PPK I di RSUD Undata rata-rata 8% per bulan. Cakupan utilisasi rawat jalan Kota Palu dari 12 puskesmas dan 3 rumah sakit yang menerima Askeskin sebesar 28,10% dan rawat inap sebesar 1,91% per bulan. Kesimpulan: Tingkat utilisasi rawat jalan Askeskin Kota Palu di RSUD Undata Palu under utilisasi disebabkan adanya efektifitas dan optimalisasi layanan di puskesmas, pengendalian utilisasi Askeskin yang membawa SKTM oleh pihak rumah sakit serta rendahnya penghasilan masyarakat juga penyebab rendahnya utilisasi rawat jalan. Tingkat utilisasi rawat inap Askeskin over utilisasi disebabkan mudahnya mendapatkan SKTM, pemilihan dokter ahli dan adanya fasilitas kesehatan yang lebih lengkap di RSUD Undata Palu. Saran: Pemerintah daerah membuat sistem jaminan untuk masyarakat yang tidak mendapatkan jaminan kesehatan, membuat utilisasi review di rumah sakit, membayar rumah sakit dengan kapitasi.

Background: Health insurance system for poor communities tends to increase the utilization of health service. This condition happen due to the perception of poor communities about their rights and the behavior of health service providers that use the opportunity to gain financial benefits. Objective: To identify the utilization of health service through health insurance for poor communities at Undata Hospital Palu and finding out the factors affecting the utilization. Method: The study was descriptive qualitative with participant of health insurance for poor communities and health staff as subject of the study. Research instruments used were medical records, reports of health care insurance for poor communities and interview. Result: The utilization coverage of outpatient of health insurance for poor communities at Undata Hospital Palu was 10.67% a month and average cost per visit was Rp 76,415. and totally there were 18,060 visits. The coverage of inpatient was 3.34% a month with average length of stay was 6.01 days and average cost per case was Rp 1,290,707. Referring datas from primary health service providers at Undata Hospital was shown 8% a month in average. The utilization coverage of outpatient at 12 health centers and 3 hospitals that accepted health insurance for poor communities in Palu Municipality was 28.10% and inpatient was 1.91% a month. Conclusion: The utilization of outpatient service by poor communities at Undata Hospital of Palu Municipality was low due to effectiveness and optimalization service at the health center as well as control of utilization of health insurance for poor communities by hospitals and low income of the community. The utilization of inpatient service was high because it was too easy to gain certificate for poor communities and also the availability of specialist doctors and health facilities at Undata Hospital Palu. Suggestion: The local government should establish insurance system for the community who do not have access to government health insurance in the form of Jamkesda, Its also important to make a review of utilization in hospitals, and pay hospitals using capitation.

Kata Kunci : Evaluasi,Under utilisasi,Over utilisasi,Askeskin, evaluation, under utilization, over utilization, health insurance for poor communities