Evaluasi kerjasama antara PT Askes Indonesia dengan pemberi pelayanan kesehatan primer di Kota Palu

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

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Unsur penting dalam penyelenggaraan asuransi kesehatan berbasis pelayanan kesehatan terkendali (managed care) adalah adanya kerjasama antara organisasi penyelenggara kesehatan dengan Pemberi Pelayanan Kesehatan Primer. Tujuan penelitian ini adalah mengevaluasi kontrak kerjasama antara PT. Askes Indonesia dengan pemberi pelayanan kesehatan primer serta tingkat kepuasan PPK tingkat I terhadap kontrak kerjasama pada PT. Askes Indonesia Cabang Kota Palu. Metode: Penelitian ini adalah deskriptif dengan rancangan cross sectional. Metode pengumpulan data dilakukan secara kuantitatif dan kualitatif. Subyek penelitian adalah 23 Dokter Keluarga dan 12 Kepala Puskesmas yang menjalin kontrak kerjasama dengan PT. Askes Indonesia Cabang Kota Palu. Variabel yang diamati adalah naskah kontrak, proses negosiasi, sosialisasi, pemahaman PPK terhadap naskah kontrak dan pemenuhan hak dan kewajiban serta kepuasan pemberi pelayanan kesehatan primer terhadap naskah kontrak kerjasama. Alat ukur pedoman wawancara dan kuesioner. Hasil: Dokter Keluarga (73,91%) dan Kepala Puskesmas (100%) menyatakan masih sangat kurang proses negosiasi. Sosialisasi materi kontrak sudah dilakukan namun belum optimal, pemahaman PPK I terhadap materi kontrak cukup baik, pemenuhan hak-hak dan kewajiban PPK I masih kurang terpenuhi serta 78,26% Dokter Keluarga dan 58,33% Kepala Puskesmas kurang puas terhadap naskah kontrak kerjasama yang dibuat oleh PT. Askes Cabang Kota Palu. Kesimpulan: Kerjasama antara PT. Askes dengan Pemberi Pelayanan Kesehatan Primer belum sesuai dengan ketentuan kontrak standar Managed Care. Beberapa kelemahan dalam kerjasama antara PT. Askes dengan PPK I di Kota Palu yang perlu diperbaiki adalah mekanisme kontrak, proses negosiasi dan sosialisasi, keterbukaan, pembinaan dan supervisi.

Background: One important aspect in the running of managed care based health insurance is the establishment of a cooperation between health organizing council and primary health service providers (PPK I). Objectives: The study was meant to evaluate cooperation contract relationship between PT. Askes Indonesia and primary health service providers and the satisfaction of PPK I about cooperation contract with PT. Askes Indonesia, Branch of Palu City. Methods: This was a descriptive study which used a cross sectional design. Data were qualitatively and quantitatively collected. The subject of the study were 23 family physicians and 12 Heads of Community Health Center having cooperation contract with PT. Askes Indonesia, Branch of Palu City. Variables observed were contract documents, negotiation process, publicity, understanding of PPK I about contract documents and the fulfilment of rights and duties as well as the satisfaction of primary health care providers about cooperation contract documents. Instruments of measurement were guided interview and questionnaires. Results: Both family physicians (73.91%) and Heads of Community Health Center (100%) stated the lack of negotiation process. Contract material publicity had been conducted but it had not been optimum yet, understanding of PPK I about contract materials was adequate, fulfilment of rights and duties of PPK I was inadequate and 78.26% of family physicians and 58.33% of Heads of Community Health Service were dissatisfied with cooperation contract documents made by PT. Askes , Branch of Palu City. Conclusion: Cooperation between PT. Askes and PPK I had not yet been relevant with managed care standard contract stipulation. Some weaknesses in the cooperation relationship that needed improvement were contract mechanism, negotiation process and publicity, transparency, nurture and supervision.

Kata Kunci : Asuransi Kesehatan,Kerjasama Askes dan Pelayanan Kesehatan