Analisis pelaksanaan kerjasama pemberi pelayanan kesehatan dengan PT. Askes (Perero) di Kabupaten Kerinci

WIDOTOMO, Edy, Prof.dr. Ali Ghufron Mukti, MSc.,PhD

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

Latar belakang: Bahwa unsur penting dalam penyelenggaraan asuransi kesehatan adalah berbasis pelayanan kesehatan terkendali (managed care). Pelaksanaan kerjasama diharapkan adanya saling menguntungkan masing-masing pihak, sehingga pemberi pelayanan kesehatan merasa puas dengan kerjasama yang diberikan oleh badan penyelenggara. Tujuan penelitian ini adalah menganalisis pelaksanaan kerjasama pemberi pelayanan kesehatan dengan PT. Askes (Persero) Perwakilan Kerinci Cabang Bungo di Kabupaten Kerinci. Metode: Penelitian observasional ini menggunakan rancangan cross sectional. Metode pengumpulan data dilakukan secara kuantitatif dan kualitatif. Subyek penelitian adalah Kepala puskesmas/dokter puskesmas, dokter keluarga dan Direktur, dokter umum & spesialis RSU Mayjen H.A. Thalib yang menjalin kontrak dengan PT. Askes. Variabel yang diamati adalah Naskah kontrak, proses negosiasi, sosialisasi, pemahaman PPK terhadap naskah kontrak, pemenuhan hak dan kewajiban, dan kepuasan PPK I dan PPK II. Data kuantitatif dikumpulkan melalui kuesioner, yang kemudian dianalisis secara deskriptif dan dilakukan uji statistik melalui uji chi square untuk menilai kemungkinan adanya hubungan/perbedaan variabel yang diteliti. Data kualitatif dikumpulkan melalui observasi dokumen kontrak dan wawancara. Instrumen penelitiannya adalah kuesioner dan pedoman wawancara. Hasil: Hasil penelitian menunjukkan bahwa pelaksanaan kerjasama antara PT. Askes dengan PPK tidak ada proses negosiasi, tidak ada sosialisasi, pemahaman PPK terhadap materi kontrak baik, hak dan kewajiban PPK kurang terpenuhi, dan tingkat kepuasan PPK kurang puas. Selanjutnya pada uji statistik dalam perbedaan pelaksanaan kerjasama PPK I dan PPK II dengan PT. Askes adalah mekanisme negosiasi tidak ada perbedaan yang bermakna (p=0,157), sosialisasi terdapat perbedaan yang bermakna (p=0,013), tingkat pemahaman terdapat perbedaan yang bermakna (p=0,042), pemenuhan hak dan kewajiban terdapat perbedaan yang bermakna (p=0,036), tingkat kepuasan PPK tidak ada perbedaan yang bermakna (p=0,205), tidak ada hubungan yang bermakna negosiasi dengan kepuasan (p=0,066), ada hubungan yang bermakna sosialisasi dengan kepuasan (p=0,021), ada hubungan yang bermakna pemahaman dengan kepuasan (p=0,042), dan ada hubungan yang bermakna pemenuhan hak dan kewajiban PPK dengan kepuasan (p=0,040). Kesimpulan: Pelaksanaan kerjasama PPK dengan PT. Askes belum sesuai dengan mekanisme kontrak standar managed care. Beberapa permasalahan dalam hubungan kerjasama antara PT. Askes dengan PPK di Kabupaten Kerinci yang perlu diperbaiki adalah mekanisme kontrak kerjasama, keterbukaan, dan komunikasi.

Background: An important element in the management of health insurance is that it should be based on managed care. The implementation of cooperation is expected to be mutually beneficial, so that the health service providers are satisfied with the cooperation given by the organizing office. Objective: The objective of the study was to analyze the implementation of cooperation between health service providers and PT. Askes (Persero), Kerinci Representative of Bungo Branch at Kerinci District. Method: This observational study used cross sectional design. Data collection method was done both quantitatively and qualitatively. The subject of the study were heads and doctors of community health center, family physicians, director, general practitioners and specialists of Mayjen H.A. Thalib Hospital that made a contract with PT. Askes. Variables observed were contract agreement, negotiation process, socialization, understanding of health service providers about contract agreement, fulfillment of rights and obligation, and satisfaction of health service providers I and II. Quantitative data were obtained through questionnaire, which was then analyzed descriptively and statistically tested using chi square to find out whether there was relationship/difference of variables observed. Qualitative data were obtained through observation of contract document and interview. Research instruments were questionnaire and interview guide. Result: The result of the study showed that in the implementation of cooperation between PT. Askes and health service providers was no negotiation process, was no socialization, understanding of health service providers about contract document was good, right and obligation of health service providers were not completely fulfilled and health service providers were less satisfied. The result of statistical test showed that in the implementation of cooperation between health services providers l and II and PT. Askes there was no significant difference in negotiation mechanism (p=0.157), there was significant difference in socialization (p=0.013), there was significant difference in understanding (p=0.042), there was significant difference in fulfillment of rights and obligation (p=0.036), there was no significant difference in satisfaction of health service providers (p=0.205), there was no significant relationship between negotiation and satisfaction (p=0.066), there was significant relationship between socialization and satisfaction (p=0.021), there was significant relationship between understanding and satisfaction (p=0.042), and there was significant relationship between in fulfillment of rights and obligation and satisfaction (p=0.040). Conclusion: The implementation of cooperation between health service providers and PT. Askes had not been relevant with mechanism of managed care standard contract. Some problems in cooperation relationship between PT. Askes and health service providers at Kerinci District which should be improved were mechanism of cooperation contract, transparancy and communication.

Kata Kunci : Asuransi Kesehatan,Kontrak Kerjasama, cooperation, health service providers, health insurance, managed care