EVALUASI HASIL IMPLEMENTASI PROGRAM JKN PADA PELAYAN TERHADAP PASIEN PENYAKIT STROKE YANG DIRAWAT DI UNIT STROKE RS PPK III

MUHAMMAD DAHLAN, Prof. dr. Laksono Trisnantoro, M.Sc., Ph.D.; DR.dr. Ismail Setyopranoto, Sp.S(K).

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Era baru program asuransi kesehatan nasional mulai 1 Januari 20l4 yang diselenggarakan oleh BPJS Kesehatan dengan target seluruh masyarakat telah menjadi peserta BPJS pada tahun 20l9. Apresiasi diberikan kepada pemerintah atas usahanya melaksanakan JKN. Dalam pelaksanaannya para pemberi pelayanan kesehatan perlu diketahui tingkat penerimaan dan mutu pelayanan yang diberikan. Stroke sebagai salah saru penyakit yang banyak dijangkit oleh masyarakat perlu dilihat mutunya. Bagaimana hasil implementasi pelayanan penyakit stroke pada pelaksanaan program JKN. Tujuan: (1) Mengukur kinerja pelayanan; (2) mengukur kinrqa keuangan; (3)Mengetahui penerimaag dan ketaatan pemberi piuyurrui terhadap ui r.uo. Metode: Mixed method dengan pendekatan sekuensial eksplanasi pada unit Stroke RSUP Dr Sardjito. Data yang dipergunakan menggunakan alat primer berupa observasi dan wawancara. Hasil: Mutu pelayanan penyakit stroke sudah sesuai dengan mutu standar. Rasionalisasi pemberian obat, maupun pemulangan pasien tetap sesuai standar. Performa keuangan unit Stroke mengalami selisih negatif. Penerimaan dari para dokter terkait beberapa aturan seperti system rujukan dan standar tarif belum diterma sepenuhnya. Kesimpulan: Permasalahan program Jaminan Kesehatan Nasional masih terjadi. Perbedaan persepsi antara pembuat aturan dengan pemberi pelayanan masih menonjol. Performa keuangan dari unit sroke mengarami kerugian walaupun mutu pelayanan sudah dilakukan secara optimal. Sistem rujukan terutama rujuk balik belum dirasa layak oleh para dokter karena keterbatasan di PPK I. Pelayanan home care yang biasa digunakan tidak bisa optimal karena peserta asuransi belum mendapatkan jaminan untuk memperoleh pelayanan home care.

Background: Since 2014, Indonesia has implemented universal health coverage. In Indonesia, it was named as Jaminan Kesehatan Nasional or JKN. Quality control and cost control is the tagline of these program. Health provider such as doctors, nurses and the others health provider must control the quality and the cost of the patients treatment. Stroke, as one of the disease which needed such a complex treatment, must be treated as effective as possible. Aim: The aim of this study is evaluating the implementation of the JKN in stroke care especially in Central hospital. Measuring the quality of the care in stroke unit is compulsory in implementation research. Knowing acceptability and fidelity of the rules from JKN by the doctors must be described. Method: This study is mixed method with sequential explanatory design. The qualitative research was a cross sectional research which began in June 15 - July 31st. Interview from three doctors in stroke unit Sardjito General Hospital were performed to know the acceptability of the program. Result: The quality of care in Unit Stroke RSUP Dr. Sardjito from the doctors are good. Rationalization of the drugs and safety of the patients were prioritized. From that conditions the unit got a debt condition. The financial performance from one patient could get debt up to eleven million rupiahs. From the qualitative research, the acceptability of the national formulation slightly did not accept by the doctors. Neuro protector and another kind of drugs is not on the list. rtPA which can be found in the list is too expensive. Reimbursement from the BPJS was too low. Homecare as one the rehabilitation is not covered by BPJS. Back referral system to general practitioner is not accepted by the neurologist because of the lack of the facility in puskesmas or PPK I. Research and education in academic hospital did not do well because of the lack of patients. Conclusion: National formularies are needed to revised based on the patients need. Reimbursement from BPJS should be higher than before. Homecare patients should be guaranteed by BPJS.

Kata Kunci : Jaminan Kesehatan Nasional, Stroke, Kualitas Pelayanan, Universal health coverage, stroke, quality care, implementation research