Perbedaan pengelolaan dana pelayanan kesehatan keluarga miskin sebelum dan setelah dikelola PT Askes di RSU Kabupaten Buol Propinsi Sulawesi Tengah

SIDJAL, Muhammad Ihsan, Prof.dr. Ali Ghufron Mukti, MSc.,PhD

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. Pembiayaan da

Latar belakang. Pengelolaan Program Kompensasi Pengurangan Subsidi Bahan Bakar Minyak (PKPS – BBM) bidang kesehatan, semula dikelola oleh Rumah Sakit dan sekarang dikelola oleh PT Askes sesuai dengan Keputusan Menteri Kesehatan nomor 1241 tahun 2004. Perubahan tersebut akan berpengaruh terhadap pemanfaatan dana dan kepuasan pemberi pelayanan kesehatan. Tujuan. Untuk mengetahui perbandingan pengelolaan dana Program Kompensasi Pengurangan Subsidi Bahan Bakar Minyak Bidang Kesehatan (PKPS – BBM Bidkes) sebelum dan setelah dikelola PT Askes serta kepuasan PPK terhadap perubahan tersebut. Metode. Penelitian ini menggunakan rancangan crossectional. Kasus yang menjadi perhatian penelitian ini adalah pengelolaan jaminan kesehatan masyarakat miskin. Data kuantitatif diambil dengan melakukan wawancara terhadap semua perawat di RSUD Kabupaten Buol. Data yang diambil dengan menggunakan pendekatan kualitatif dengan subjek penelitian Direktur RSU Buol, Penanggung Jawab Program, semua dokter dan kepala ruangan. Hasil. Setelah dikelola PT Askes jumlah kasus keluarga miskin rawat jalan menurun sekitar 50 persen. Penurunan tersebut menyebabkan jumlah biaya yang dikeluarkan juga mengalami penurunan yang sangat tajam mencapai 90 persen. Rata-rata biaya tindakan medis per kasus di instalasi rawat jalan menurun sekitar 42 persen. Jumlah kasus keluarga miskin rawat inap menurun hanya sekitar 7 persen, namun biaya pelayanan menurun sekitar 71 persen. Rata-rata biaya tindakan medis per kasus di instalasi rawat inap menurun sekitar 67 persen. Tingkat kepuasan Penyedia Pelayanan Kesehatan (PPK) terhadap program PJKMM sebelum dan setelah dikelola PT Askes terdapat perbedaan. Setelah Dana PKPS BBM Bidkes dikelola PT Askes, dokter kurang puas terhadap jumlah dan waktu pemberian jasa medis karena birokrasi yang berbelit-belit serta pembatasan obat berdasarkan DPHO. Manajemen RSU Buol kurang puas terhadap transparansi verifikasi klaim. Kesimpulan. Biaya pelayanan kesehatan keluarga miskin di rumah sakit lebih efisien setelah pengelolaan dana PKPS BBM oleh PT Askes.

Background: The management of Fuel Subsidy Reduction Compensation Program in health sector was formerly done by hospitals and at present by PT. Askes according to the Ministry of Health Decree No 1241, 2004. This change may affect fund utilization and satisfaction of health service providers. Objecticve: To compare fund management of Fuel Subsidy Reduction Compensation Program in health before and after the management of PT. Askes (Persero) and identify satisfaction of health service staff with the changes. Method: The study used a cross sectional design. Main attention of the study was the management of health insurance for poor families. Quantitative data were obtained through interview with all nurses at Buol District Hospital. Qualitative data were obtained from the director of Buol District Hospital, program managers and all doctors and heads of wards. Result: Under the management of the PT. Askes the number of outpatient of poor families was greatly reduced (50%). The decrease consequently led to major cost reduction (90%). Average cost of medical treatment per case at outpatient installation decreased as much as 42%. Number of inpatient cases among poor families decreased only as much as 7%, but cost of service decreased as much as 71%. Average cost of medical treatment per case at inpatient installation decreased as much as 67%. Satisfaction of health service providers with Poor Community Health Insurance Program before and after the management of PT. Askes differed. With the management of Fuel Subsidy Reduction Compensation Program Fund in health sector by PT. Askes, doctors were dissatisfied with amount and time of medical service repayment because of complicated bureaucracy and limitation of drugs based on List of Drug Price Platform. The management of Buol District Hospital was dissatisfied with transparancies in claim verification. Conclusion: The change on management by PT. Askes could reduce cost of health service for poor families but aroused dissatisfaction of health service providers.

Kata Kunci : Pembiayaan Kesehatan,Pengelolaan Dana,Keluarga Miskin