Korelasi Disparitas Ketersediaan Tenaga Medis Gigi Antardaerah Terhadap Pemanfaatan Layanan Gigi dan Mulut di Indonesia

ALZERESSY PUTRI I S, Dr. Diah Ayu Puspandari Apt., MBA., MKes; dr. Tiara Marthias, MPH., PhD

2022 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Prevalensi masalah gigi mulut yang tinggi di Indonesia tidak diikuti dengan pemanfaatan layanan gigi mulut yang adekuat. Salah satu penyebab utamanya yaitu kurangnya tenaga medis gigi dan adanya disparitas terhadap distribusi tenaga medis gigi, yang juga menyebabkan ketidaksetaraan geografis dan sosial ekonomi dalam pemanfaatan layanan gigi mulut di Indonesia. Tujuan: Mengukur hubungan pemanfaatan layanan kesehatan gigi mulut dengan ketersediaan tenaga medis gigi serta mengkaji faktor-faktor lainnya yang berhubungan dengan ketidaksetaraan geografis dalam pemanfaatan layanan gigi mulut di Indonesia. Metode: Penelitian cross-sectional menggunakan Data Sampel BPJS Kesehatan 2017-2018 dan data rutin Kementerian Kesehatan tahun 2017. Dataset terdiri dari diagnosis primer dan klaim pelayanan kesehatan gigi rujukan tingkat Rumah Sakit yang mencakup 2.580 peserta BPJS Kesehatan. Faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan gigi mulut berdasarkan jumlah diagnosis dan besaran klaim dianalisis menggunakan model regresi linear multivariat. Hasil: Terdapat disparitas yang signifikan dalam pemanfaatan layanan gigi mulut antardaerah di Indonesia. Ketersediaan dokter gigi (umum dan spesialis) memiliki korelasi positif dengan jumlah diagnosis dan klaim. Ketersediaan dokter gigi memiliki korelasi positif dengan jumlah diagnosis (0.30, 95% CI: 0.28-0.32) dan besaran penggantian biaya klaim (Rp 565.909, 95% CI: 89.425-1.042.385). Ketersediaan dokter gigi spesialis menunjukkan korelasi tertinggi terhadap jumlah diagnosis (0.54, 95% CI: 0.53-0.55) dan besaran penggantian biaya klaim (Rp 1.194.741, 95% CI: 662.468-1.727.014). Kesimpulan: Disparitas ketersediaan tenaga medis gigi dapat berkontribusi terhadap ketidaksetaraan pemanfaatan layanan gigi dan besaran penggantian biaya klaim yang dibayarkan oleh BPJS Kesehatan untuk pelayanan kesehatan gigi mulut antardaerah di Indonesia.

Background: The high prevalence of oral health problems in Indonesia is not followed with adequate use of oral health services. One of the principal causes include the lack of and disparity in the distribution of dental health workers, which may also contribute to geographical and socioeconomic inequality in the utilization of oral health services in Indonesia. Objectives: To assess the association between the utilization of dental health services and the availability of dental health workers and to explore other factors related to the geographical inequality in the utilization of oral health services in Indonesia. Methods: This is a cross-sectional study that uses nationally-representative 2017-2018 BPJS Health Sample Data and the 2017 routine Ministry of Health datasets. The dataset contains primary diagnosis and claims reimbursement data for referral oral health services at the hospital-level and included 2.580 BPJS Health participants. Factors associated with the utilization and the amount of claims reimbursement of oral health services were assessed using multivariate linear regression model. Results: There were significant disparities in the use of oral health services across Indonesia regions. The availability of dentist (general and specialist) positively correlated with the number of diagnosis and the amount of claims reimbursement. The availability of general dentist was positively associated with higher number of diagnosis (0.30, 95% CI: 0.28-0.32) as well as higher amount of reimbursement (Rp 565.909, 95% CI: 89.425-1.042.385). The availability of specialist dentist showed higher correlation with the number of diagnosis (0.54, 95% CI: 0.53-0.55) and the amount of reimbursement (Rp 1.194.741, 95% CI: 662.468-1.727.014). Conclusion: Disparities in the availability of dental health workers may contribute to the inequality in the use of essential oral health services as well as the amount of reimbursement paid by BPJS Health for oral health services across Indonesia regions.

Kata Kunci : Jaminan Kesehatan Nasional, Pemanfaatan Layanan Gigi Mulut, Ketidaksetaraan Geografis, Tenaga Medis Gigi, Indonesia