Analisis kecukupan biaya obata pelayanan kesehatan dasar sebelum dan sesudah desentralisasi di Kabupaten Muna Propinsi Sulawesi Tenggara

IDHAM, Prof.dr. Ali Ghufron Mukti, MSc.,PhD

2004 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Implementasi desentralisasi kebijakan obat membawa implikasi berupa perubahan mekanisme pembiayaan. Sebelum desentralisasi anggaran obat dihitung berdasarkan jumlah penduduk dan persentase penduduk miskin, pasca desentralisasi anggaran ditetapkan masing-masing daerah menurut kebutuhan dan permasalahan kesehatan yang dihadapi. Perubahan ini menimbulkan masalah dalam alokasi dan distribusi terutama di daerah dengan PAD (Pendapatan Asli Daerah) relatif kecil. Alokasi menjadi sangat dipengaruhi oleh besar kecilnya DAU (Dana Alokasi Umum) serta kemampuan manager obat di daerah mengelola dana obat seefisien dan seefektif mungkin untuk menjamin ketersediaan dan kesinambungan pelayanan kesehatan. Tujuan: Mengetahui tingkat kecukupan biaya obat pelayanan kesehatan dasar antara sebelum dan sesudah desentralisasi serta pengaruh desentralisasi itu sendiri terhadap kecukupan biaya obat. Metode penelitian: Penelitian ini dilakukan dengan rancangan studi kasus, menggunakan data kuantitatif dan dianalisis terhadap kecukupan biaya obat. Penelitian diawali dengan penghitungan indikator masingmasing variabel penelitian dan realisasi biaya obat berdasar konsumsi obat di puskesmas serta kebutuhan biaya obat pada terapi 10 penyakit terbanyak tahun 1999-2002 menggunakan metode morbiditas. Hasil simulasi penghitungan kebutuhan biaya obat dilakukan analisis ABC, dan dibandingkan dengan realisasi biaya obat pada periode yang sama serta diinterpretasi untuk menilai kecukupan biaya obat sebelum dan sesudah desentralisasi (1999-2002). Hasil: Rata-rata kemampuan dana pengadaan obat berdasar konsumsi memenuhi kebutuhan biaya obat berdasar morbiditas sebelum desentralisasi sebesar 31,33%, setelah desentralisasi meningkat menjadi 78,51%. Rata-rata kemampuan biaya obat berdasar konsumsi, sebelum desentralisasi sebesar 15,14%, setelah desentralisasi meningkat menjadi 60,67%, akan tetapi peningkatan tingkat kecukupan dana dan biaya obat tersebut tidak bermakna (p>0,05) antara sebelum dan sesudah desentralisasi. Kesimpulan: Meskipun tingkat kecukupan dana dan biaya obat antara sesudah desentralisasi meningkat secara signifikan, akan tetapi peningkatan itu belum mampu memenuhi kebutuhan hingga 100% dengan kata lain desentralisasi belum berpengaruh terhadap tingkat kecukupan biaya obat pelayanan kesehatan dasar di daerah.

Background: Implementation of decentralized drug policy brings an impact in the form of finance mechanism changes. Before decentralization, drug budget was calculated by the amount of resident and indigent resident percentage. After decentralization, the budget is specified by each regional government according to needs and existing health problems. This change leads to problems of allocation and distribution especially in some areas where Original Earnings of Area (PAD) is relatively small. The allocation is strongly influenced by the amount of Common Allocation Fund (DAU) and the drug manager ability in the area to manage the fund of drugs as efficient and effective as possible to assure the availability and sustainability of health service. Objectives: To calculate the adequacy rate of drug cost before and after decentralization and to determine the influence of decentralization itself toward the adequacy of drug cost in the area. Methods: A case study was conducted using quantitative data and the result was analyzed with regard to drug cost adequacy. The study began with calculating indicator of drug management and drug cost requirement on the therapy of top 10 diseases using morbidity method during 1999- 2002. The result was analyzed with ABC analysis and compared to realization of drug cost on the same periode and interpreted to assess the drug cost adequacy before and after decentralization. Results: The average of ability on the drugs cost procurement based on comsumtion method to fullfill drug cost requirement based on morbidity method before decentralization was 31,33%, after decentralization increased to 78,51%. And then the average of ability on the drugs cost based on comsumtion method to fullfill drug cost requirement based on morbidity method before decentralization was 15,14%, after decentralization increased to 60,67%. Nevertheless, the increase of fund adequacy and drug cost rate was not significant (p>0,05) between before and after decentralization. Conclusion: Although the adequacy rate of drugs cost and fund has increased significantly after decentralization, it was not able to fulfill the requirement up to 100%. In other words, decentralization has not influenced the cost adequacy rate of primary health care drugs in the area.

Kata Kunci : Kebijakan Kesehatan,Desentralisasi Obat,Pembiayaan