Analisis potensi Stakeholder terhadap kebijakan pembiayaan kesehatan bagi keluarga miskin di Kabupaten Sleman

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

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

Latar Belakang: Negara mengupayakan pelayanan kesehatan secara memadai kepada setiap warga negara. Tingkat kesehatan dan usia harapan hidup di Indonesia paling rendah di kawasan Asia Tenggara. Visi Indonesia Sehat 2010 yaitu (1) paradigma sehat, (2) profesionalisme, (3) JPKM, dan (4) desentralisasi. Visi Jogjakarta Sehat 2005 menyatakan bahwa 50% penduduk di Propinsi Daerah Istimewa Jogjakarta telah tercakup pelayanan kesehatan dengan sistem asuransi kesehatan. Pembuatan dan pelaksanaan kebijakan pembiayaan kesehatan tidak lepas dari peran stakeholder yang akan berpengaruh terhadap proses dan keberhasilannya. Tujuan penelitian: Melihat potensi stakeholder untuk melaksanakan kebijakan pembiayaan kesehatan bagi keluarga miskin di Kabupaten Sleman. Metode Penelitian: Jenis penelitian ini merupakan non eksperimental dan menggunakan rancangan penelitian dengan studi kasus. Subyek penelitian meliputi stakeholder pembuat, pelaksana dan pengawas kebijakan pembiayaan kesehatan kabupaten Sleman. Data sekunder diperoleh dengan penelusuran dokumen, sedangkan data primer diperoleh melalui wawancara mendalam kepada responden stakeholder kebijakan pembiayaan kesehatan. Data dikumpulkan dalam bentuk transkrip dari hasil rekaman dan catatan reflektif untuk memberikan gambaran suasana, sikap, dan emosi dari responden. Variabel penelitian yaitu peraturan perundangan, fasilitas meliputi alokasi dana dan sarana fisik yang mendukung program, sumber daya manusia, sistem kebijakan, dan partisipasi masyarakat. Data dianalisis secara deskriptif kualitatif tentang potensi stakeholder terhadap pembiayaan kesehatan bagi keluarga miskin. Hasil: Regulasi lokal cukup mendukung sebagai landasan kebijakan maupun pelaksanaan program pembiayaan Gakin di Kabupeten Sleman. Seringnya pergantian kebijakan pusat menimbulkan kesulitan pelaksanaan program di daerah. Kebijakan pembiayaan pelayanan kesehatan bagi keluarga miskin di Kabupaten Sleman mendapat dukungan stakeholder Pemda Sleman dan masyarakat. Fasilitas pelayanan di tempat Pemberi Pelayanan Kesehatan masih dirasakan stakeholder cukup memadai. Kuantitas dan kualitas SDM pelaksana program masih perlu ditingkatkan. Sosialisasi dan partisipasi masyarakat yang masih kurang dibuktikan dengan keapatisan masyarakat pada pelaksanaan dan tingkat utilisasi program dibawah target. Komitmen Pemda Sleman atas keberlangsungan dana dan fasilitas merupakan peluang untuk mengembangkan program pembiayaan kesehatan dengan sistem JPKM. Kesimpulan: Kabupaten Sleman cukup berpotensi menyelenggarakan program pembiayaan pelayanan kesehatan bagi keluarga miskin karena ada komitmen Pemda dalam memberikan dukungan regulasi dan keberlangsungan dana. Regulasi dari pusat yang konsisten, peningkatan SDM dan partisipasi masyarakat akan menjadi faktor pendukung utama keberhasilan program.

Background: The Government has to provide an adequate health services for its citizens. Compared to people in South East Asian Countries, Indonesian people have the lowest health status and life expectancy age. The 2010 Health Indonesia Visions are (1) health paradigm, (2) professionalism, (3) Healthcare Insurance System (Jaminan Pemeliharaan Kesehatan Masyarakat-JPKM), and (4) decentralization. The 2005 Health Jogjakarta Vision states that 50% of people in Daerah Istimewa Yogyakarta have been covered by health services with healthcare insurance system.The regulation and implementation of the health finance are held by the stakeholders, who will definitely influence its process and level of success. Objective: To know the stakeholders potency in implementing health finance policy for poor family in Sleman Distric. Method: The method of this research was a non–experimental one. It used a case study design. The subjects of the research included all stakeholders: policy makers, operators, and supervisors of the health finance in Sleman District. This research produced qualitative data that is used to measure the stakeholders’ potency in managing poor family health finance in Sleman District. Data collecting used observed and in-depth interview to explore issues around poor family health funds. The source data were transcripts from the recorded interviews and reflective notes describing situation, attitude, and emotional performance of the respondents. The research variables are the government’s regulations on health, health facilities (including budget allocation and supporting physical instruments), human resources, policy systems, and public participation. The data was analyzed using qualitative description about the role of those stakeholders on the poor family health finance. Results: The government regulations are sufficient in supporting either policy planning or implementing of the poor family health finance program in Sleman. The national regulations that are frequently changed have caused local problems in implementing the program. The policy of the poor family health finance has been fully supported by the stakeholders in Sleman, either the community or the District Government. According to the stakeholders, health facilities and services are adequate. However, they need to improve the quality and quantity of the programs’ human resources. It seemed that there are not quite efforts to socialize and stimulate community participation in the program. Those have caused public apathy towards the implementation of the program and have caused the lack of its utilization. The District Government of Sleman’s commitment to sustain the health finance and facilities would be a chance to develop the health finance program with health insurance system (JPKM). Conclusion: The District of Sleman is quite potential to implement poor family health finance program because of its commitment in supporting the regulations and finance sustainability. The main factors to succeed this program are the government’s consistency in implementing the regulations, the human resources increase, and the public participation.

Kata Kunci : Kebijakan Pembiayaan Kesehatan,Keluarga Miskin,Potensi Stakeholder, regulation, stakeholders, social health insurance, participation