Efektivitas regulasi perijinan rumah sakit di Propinsi Daerah Istimewa Yogyakarta

HIKMATIN, Inni, dr. Adi Utarini, MSc.MPH.PhD

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manajemen Rumah Saki

Latar Belakang : Dalam konteks good governance pelayanan kesehatan, pemerintah memiliki peran sebagai regulator dimana aspek keamanan pasien (patient safety) menjadi hal yang utama. Strateginya adalah dengan mengembangkan aturan main bagi penyedia pelayanan kesehatan publik dan swasta yang mendorong kompetisi mutu pelayanan, salah satunya melalui perijinan RS. Sejak diberlakukannya desentralisasi bidang kesehatan, membawa konsekuensi harus ditegakkannya sistem regulasi bidang kesehatan oleh pemerintah daerah. Dengan kewenangan baru tersebut maka perlu diketahui pengembangan sistem regulasi perijinan RS serta menilai efetivitas implementasi perijinan rumah sakit di Kabupaten/Kota. Tujuan : Penelitian ini bertujuan menilai efektivitas perijinan rumah sakit umum di Propinsi Daerah Istimewa Yogyakarta dan mengeksplorasi faktorfaktor yang mempengaruhi efektivitas implementasi perijinan rumah sakit dari sisi regulator dan yang diregulasi. Metode : Penelitian ini merupakan penelitian studi kasus deskriptif, dengan rancangan multi kasus terpancang, dengan menggunakan observasi, dan dilakukan wawancara secara mendalam terhadap 2 direktur RSUD, 3 direktur RS Swasta, 1 Kepala Subdin Dinas Kesehatan dan 1 Kepala Seksi yang menangani perijinan RS, dan 1 LSM bidang kesehatan. Seluruh rumah sakit yang diteliti, dinilai kepatuhannya terhadap standar perijinan. Hasil penelitian : Kepatuhan rumah sakit terhadap persyaratan perijinan di wilayah yang telah memiliki Peraturan Daerah tentang perijinan penyelenggaraan sarana kesehatan dibandingkan dengan yang belum memiliki Peraturan Daerah, hasilnya sama-sama tidak mencapai nilai seratus persen, artinya rumah sakit tidak patuh terhadap standar perijinan rumah sakit. Sedangkan menurut stakeholder yang terlibat dalam regulasi perijinan rumah sakit, regulasi perijinan saat ini belum efektif dikarenakan: keterbatasan sumber daya, belum ditegakkannya aturan yang ada, serta monitoring perijinan setelah ijin diterbitkan belum dilakukan dengan optimal. Kesimpulan : Regulasi perijinan rumah sakit yang menjadi kewenangan dinas kesehatan Kabupaten/Kota belum dilaksanakan dengan baik, sehingga efektifitas regulasi perijinan rumah sakit belum sesuai dengan tujuan.

Background: In the context of good governance, government plays a role as the regulator where patient safety is the main focus. The strategy is by developing the “rule of the game” for public as well as private health services to urge the competition of service quality through hospital licensing. The impact of decentralization implemented on health is the enforcement of regulation system on health by local government. This new authority brings about the needs to understand the regulation system of hospital licensing and to evaluate the effectiveness of hospital licensing implemented in the Regency/City. Objective: This research aims to evaluate the effectiveness of hospital licensing in the province of Yogyakarta and to explore factors influencing the effectiveness of implemented hospital licensing from the point of view both the regulator as well as the regulated. Method: This is a descriptive case study research with embedded case study design, employing observation and in-depth interview to two district hospital directors, four private hospital directors, one Head of Health Sub-Department, one Head of Hospital Licensing Section, and one NGO focusing on health. All hospitals observed in this research were evaluated especially concerning their adherence toward licensing standard. Result: When compared, hospital adherence towards licensing requirements in the area with Regional Regulation on licensing for health facilities and hospitals in the area without Regional Regulation did not reach 100%, which means that hospitals did not obey hospital licensing standard. Meanwhile, according to stakeholders involved in hospital licensing regulation, licensing regulation is not effective because of the limitation of human resources, lack of existing regulation enforcement, and monitoring of licensing after its issued was not conducted optimally. Conclusion: Hospital licensing regulation, which is under the authority of Regency/City Health Department, did not implement well. Therefore, the effectiveness of hospital licensing regulation did not meet the goal.

Kata Kunci : Manajemen Rumah Sakit,Regulasi Perijinan,Layanan Rumah Sakit, health service regulation, hospital licensing, effectiveness, case study research.