Perbandingan pengelolaan dana masyarakat miskin di Puskesmas antara yang dikelola PT Askes dengan sistem kapitasi dan Block Grant :: Kajian Kota Ternate

BAHARUDDIN IB, dr. Kristiani, SU

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

Latar Belakang : Pada tahun 2005 terjadi perubahan pada sistem pembiayaan kesehatan dari sistem kapitasi kepada sistem block grant. Perubahan ini memungkinkan Puskesmas untuk secara langsung mengelola dana tersebut, yang pada akhirnya juga berpengaruh terhadap pelayanan kesehatan yang diberikan kepada keluarga miskin. Tujuan Penelitian : Penelitian ini dilakukan untuk mengetahui perbandingan pengelolaan dana masyarakat miskin antara yang dikelola oleh PT.Askes dan sistem block grant yang dananya langsung dikelola oleh Puskesmas, ditinjau dari aspek jumlah dana, pemanfaatan dana, admonistrasi kegiatan dan keuangan. Metode : Penelitian ini merupakan penelitian deskriptif, menggunakan rancangan studi kasus, serta metode kualitatif. Data dikumpulkan dengan melakukan diskusi kelompok terarah (DKT) terhadap 12 orang, terdiri dari 7 kepala Puskesmas dan 5 orang dari tim koordinasi. Wawancara mendalam juga dilaksanakan terhadap 5 orang dari tim koordinasi, terdiri dari Kasubdin perencanaan, Kepala Dinas Kesehatan, Bapeda, Asisten I Sekda, dan kepala cabang Askes Kota Ternate. Data dianalisis secara deskriptif dan di interpretasi secara kualitatif untuk mendapatkan kesimpulan logis. Hasil penelitian : Dari aspek jumlah dana, dana yang diterima melalui sistem block grant selama 6 bulan (31.049 jiwa miskin) adalah sebesar Rp. 1.089.897.000 dan dana unuk Yankes dasar adalah sebesar Rp.520.805.000. Adapun jumlah dana yang diterima dari sistem kapitasi Askes selama 6 bulan (6.695 jiwa miskin) adalah sebesar Rp. 40.140.000 Apabila dihitung berdasarkan kapitasi perjiwa perbulan, dana dari block grant adalah sebesar Rp. 2.655 (Puskesmas rawat jalan) dan 3.550 (Puskesmas rawat inap). Dibanding dengan dana kapitasi Askes (Rp.1000 jiwa perbulan) maka jumlah dana block grantlebih besar 3 kali lipat. Dari Aspek jumlah dana, dana dari block grant lebih luas pemanfaatannya terutama dalam pembiayaan pelayanan luar gedung. dari aspek administrasi kegiatan dan keuangan, sistem block grant lebih rumit. Kesimpulan : Sebagian besar informan lebih memilih sistem block grant dikarenakan jumlah dananya lebih besar dan pemanfaatannya lebih luas, meskipun dari aspek administrasi kegiatan dan keuangannya lebih rumit.

In 2005, there was a change in the system of health funding, from capitation system into block grant system. This change allowed health centers to directly manage the fund and it eventually also influenced health services given to poor people. The research was conducted to compare the management of health funding for poor people, between the fund managed by health insurance office (PT. Askes) using capitation syste and block grant system, where the fund was directly managed by health centers, viewed from the aspects of the amount of fund, fund utilization, activities administration, and financial administration. This research a diccriptive research, using case study design, with qualitative method. The data were collected by conducting focus group discussion with 12 people, consisted of 7 heads of health centers and 5 people from coordinating team. In-depth interview was also conducted towards 5 people consultancy team,they were the head of planning sub-section (Kasubdin Perencanaan) The head of health office, the lokal government planning board (Bapeda) the assistant of the secretary of the city, and the head of Ternate Askes branch office. The data were analyzed descriptively and interpreted qualitatively to get logic conclusion. Viewed from the amount of fund, the fund received from block grant for 6 months (31,049 poor people) was Rp. 1.089.897.000 and Rp. 520.805.000 for basic health services Meanwhile from the capitation system of Askes, the fund received for 6 month (6,695poor people) was Rp. 40.104.000. If it was calculated based on the capitation per person per month, the fund received from block grant was Rp. 2.655 (health centers for ambultory patients) and Rp. 3.550 ( health centers for inpatients) Compared to the fund from capitation system of Askes (Rp. 1000 per person per month), the fund receved from block grant was 3 time larger. From the aspect of fund utilitation,the block grant allowed health centers to utilize the fund for wider coverage of activities and functions, especially for autdoor services funding. From the aspect of activities and financial administrations, block grant was considered more complicated. Most of the informant chose block grant sytem because of the larger amount of fund and the wider coverage of fund utilization, even though its activities and financial administration were more complicated.

Kata Kunci : Pembiayaan Kesehatan,Masyarakat Miskin,Pengelolaan Dana,Puskesmas, Perception, First Level Health Service Providers (PPK 1), Capitation System, Block Grant