Perbandingan pembiayaan pelayanan kesehatan keluarga miskin oleh Jamkesos dan PT Askes di RS Dr. Sardjito Yogyakarta

IRWAN, Muhamad Syah, drg. Julita Hendrartini, M.Kes

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebijakan Pembiayaan

Latar Belakang: Pengelolaan pelayanan kesehatan Gakin sejak tahun 2003 di Propinsi DIY menggunakan pendekatan Asuransi Sosial yang dilaksanakan oleh Jamkesos. Terbitnya SK Menkes No. 1241 tentang Penugasan PT. Askes dalam Pengelolaan Program Pemeliharaan Kesehatan bagi Masyarakat Miskin, maka mulai 1 Januari 2005 pengelolaan Pelayanan Kesehatan Gakin dilaksanakan oleh PT. Askes. Perubahan pengelolaan tersebut menimbulkan berbagai perbedaan dalam pengelolaan pelayanan kesehatan Gakin. Tujuan: Penelitian ini untuk melihat perbandingan pengelolaan pelayanan rawat inap Gakin pada saat dikelola Jamkesos dan PT. Askes dalam hal rerata biaya pelayanan, komponen biaya dan penerapan iur biaya di RS Dr. Sardjito Yogyakarta. Metode: Penelitian ini mengunakan metode quasi-eksperimen dengan desain deret berkala kelompok.. Sampel dalam penelitian ini adalah pasien Gakin rawat inap kasus Partus Normal, Sectio Caesarea dan Ca. Cervix. Objek penelitian adalah data rekam medis dan rekapitulasi biaya pasien Gakin rawat inap sejak bulan Januari 2004 sampai dengan Oktober 2005. Data yang terkumpul dilakukan tabulasi dan diolah kemudian disajikan secara deskriptif dan di analisis komparatif dengan menggunakan uji t. Hasil : Rerata biaya rawat inap pelayanan kesehatan Gakin pada saat dikelola Jamkesos Rp 1.413.076,- dan PT. Askes Rp 1.605.901,- Perbandingan antara keduanya menunjukkan bahwa rerata biaya pada saat dikelola Jamkesos lebih rendah dari pada saat dikelola PT. Askes (p=0,174), dengan selisih 21,16%. Komponen biaya obat/BMHP memiliki komponen biaya tertinggi baik pada saat Jamkesos (32,17%) dan PT. Askes (36,88%). Besaran iur biaya pada saat dikelola Jamkesos 53,41% dan pada saat dikelola PT. Askes, pada bulan Januari s/d April 2005, 17,05%. Total besaran biaya yang ditanggung Rumah Sakit pada saat dikelola Jamkesos 2,72% dan pada saat dikelola PT. Askes 7,70%. Kesimpulan : Rerata biaya pelayanan rawat inap Gakin pada saat dikelola Jamkesos lebih rendah dari pada saat dikelola PT. Askes. Komponen biaya yang tertinggi pada saat dikelola Jamkesos dan PT. Askes adalah biaya obat/BMHP. Pada saat Jamkesos diterapkan iur biaya pasien yang cukup besar, sedangkan pada saat dikelola PT. Askes iur biaya pasien dibebankan pada rumah sakit.

Background: Since 2003 the management of health service for poor families in Province of Yogyakarta Special Territory had used social insurance approach which was carried out by Social Health Insurance. Since January 2005 PT. Askes has been taking over the management following the decree No. 1241 issued by the Ministry of Health about the responsibility of PT. Askes in the management of health care program for poor families. Such managerial change brings about differences in health service for poor families. Objective: The objective of the study was to make comparison in health service for poor families under the management of Social Health Insurance and PT. Askes in aspects of average amount of service cost, cost components and implementation of cost sharing at Dr. Sardjito Hospital, Yogyakarta. Method: The study was used quasi-experimental method with time series design. Samples were inpatients from poor families with cases of normal partus, sectio caesarean and ca-cervix. Object of the study were medical records and recapitulation of cost for poor family inpatients from January 2004 to October 2005. Data were collected using data collection forms, tabulated, processed and presented descriptively and analyzed comparatively using t-test. Result: Average inpatient cost of health service for poor families under the management of Social Health Insurance was as much as Rp 1,413,076 and of PT. Askes was Rp 1,605,901. Average cost under the management of Social Health Insurance was lower than the cost under the management of PT. Askes (p=0.174) with 21.16% difference. Drug cost/used up medical cost was the highest component, 32.17 under Social Health Insurance and 36.88% under PT. Askes. Cost sharing was as much as 53.41% under Social Health Insurance and 17.05% under PT. Askes from January to April 2005. Total amount of cost paid by Dr. Sardjito Hospital under PT. Askes was 7.70% and under Social Health Insurance was 2.72%. Conclusion: Average cost of health service for poor families under Social Health Insurance was lower than the cost under PT. Askes. Highest cost component was drug cost/used up medical cost both under Social Health Insurance and PT. Askes. Under the management of Social Health Insurance cost sharing paid by patients was quite high, whereas under PT. Askes cost sharing was paid by the hospital.

Kata Kunci : Asuransi Kesehatan,Layanan Kesehatan,Jamkesos dan Taspen,Keluarga Miskin