Implementasi Program Jaminan Pemeliharaan Kesehatan Bagi Masyarakat Miskin di RSUD Kabupaten Labuhan Batu Propinsi Sumatera Utara

GAOL, Jubeltim Lumban, dr. Kristiani, SU

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

Latar Belakang : Implementasi Penyelenggaraan Program Jaminan Kesehatan Bagi Masyarakat Miskin di RSUD Kabupaten Labuhanbatu hingga saat ini masih perlu dukungan stakeholder, serta pemahaman Pemberi Pelayan Kesehatan tentang Penyelenggaraan PJKMM serta penggunaan kartu Askeskin, kartu sehat, SKTM oleh Gakin untuk mendapatkan pelayanan kesehatan secara gratis di rumah sakit. Jumlah penduduk Kabupaten Labuhanbatu 845.564 jiwa, penduduk miskin yang tercatat sebanyak 194.362 Jiwa, data masyarakat miskin pada Lampiran II Keputusan Menkes No. 56/Menkes/SK/I/2005 Tanggal 12 Januari 2005 sebanyak 131.301 jiwa (Quota askes). Selisih 63.061 jiwa. Fenomena yang terjadi di RSUD Kabupaten Labuhanbatu adalah Pelayanan kesehatan masyarakat miskin yang di rawat inap kelas III masih mengeluarkan dana tambahan (cost sharing). Penelitian ini bertujuan untuk memperoleh gambaran tentang bagaimana pelaksanaan program jaminan pelayanan kesehatan bagi masyarakat miskin di RSUD Kabupaten Labuhanbatu Propinsi Sumatera Utara. Metode : Jenis penelitian ini adalah deskriptif dengan rancangan Study kasus. Unit analisis adalah RSUD Kabupaten Labuhanbatu. Subjek penelitian adalah masyarakat miskin yang mendapatkan pelayanan rawat inap di kelas III RSUD Kabupaten Labuhanbatu, Jumlah sampel yang diambil 50 pasien representatif dari populasi (puposif) yang pernah di rawat inap kelas III selama 1 Januari 2005 s/d 30 Juni 2005, (Quota Sampling). Untuk memperoleh data primer tentang ketepatan kepesertaan, penggunaan kartu Askeskin, kartu sehat, SKTM, keluhan dan hambatan. Dengan cara wawancara mendalam dengan Direktur RSUD, Kepala Dinas Kesehatan, Asisten I Pemda Kabupaten Labuhanbatu serta pengisian kuesioner kepada 50 responden. Hasil Penelitian: Pelaksanaan Program PJKMM di Labuhanbatu dari 50 responden yaitu 28 orang petani, 25 orang tamat SMP, 2 orang tidak punya kartu miskin, 48 orang sesuai kriteria miskin, 36 orang belum punya rumah, 17 orang yang mempunyai anak putus sekolah, 33 orang makan 1X sehari, 25 orang makan hanya pakai telur, 4 orang mebayar dana tambahan untuk keperluan membeli obat dan peralatan medis, 8 orang tidak mendapat pelayanan oleh dokter. Kesimpulan : Pelaksanaan Program Jaminan Kesehatan bagi Masyarakat Miskin di RSUD Kabupaten Labuhanbatu masih dipungut biaya tambahan (cost sharing) untuk keperluan beli obat diluar DPHO atau peralatan medis, walaupun tepat sasaran dan mempunyai dana cadangan.

Background. Health for The Poor Program (PJKMM) is held to improve the health degree of poor people. Yet, in the implementation, there are several things necessary to be notifild. In the Distric of LabuhanBatu, from 194,362, central government only compensates the health fund for 131,301 people (67,56%) and the rest, which is 63,061 people (32.44%), is supported by local government. Specifically, there are complaints from poor patients about health services in Labuhanbatu District Hospital related to the implementation of PJKMM. Objective. The objective of the research was to give a picture of the implementation of PJKMM in Labuhanbatu District Hospital, North Sumatra. Methods. This research was a descriptive research, using case study design. The unit of analysis was Labuhanbatu District Hospital and research subjects were poor patients who were hospitalized at the third class of Labuhanbatu District Hospital. Research samples were 50 patients hospitalized at the third class from January 1 – June 30, 2005 (Quota sampling) that were taken purposively. Primary data on the appropriateness of the program membership, the using of the health insurance card for the poor (Askeskin), health card for the poor (kartu sehat), notification letter for the poor (SKTM), complaints, and obstacles were collected by using questionnaires for poor patients. Meanwhile to dig information on the program policy and procedures, in depth interviews were conducted towards the director of the District Hospital, the head of District Health Office and the assistant of the secretary of the district. Result. Five aspects were notified in this research, they were policy on PJKMM procedures, the appropriateness of program membership, cost sharing, and obstacles. About the policy, local government has been allocating fund hospitals which could be used to support the needs of poor patients. Internally, the District Hospital also gave dispensations for poor patients in their services procedures. For the patients who did not bring complete requirements, the hospital gave 2 X 24 hours for the patients or their families to complete them. Besides, the hospital could give medicines outside the listed medicines (DPHO), especially for surgery patients. About the procedures for poor patients in Labuhanbatu District Hospital have been conducted according to the established procedures. About the appropriateness of program membership, most of the membership of poor patients on the program has been appropriate according to the regulation. There were still found cost sharing for poor patients, which reason to buy medicines. The obstacles of PJKMM implementation were mostly related to the uninformed patients on the function and using of Askeskin and on the health servives procedures for poor patients at hospitals. Conclutions. There were from the local government and District Hospital on PJKMM. Yet in the implementation, tere were still found cost sharing which was burdened to poor patients and the uninformed patients about the function and using of Askeskin and also about the health services procedures for poor patients at hospitals.

Kata Kunci : Program JPKM,Masyarakat Miskin, Health for The Poor Program (PJKMM), Poor People, The Health Insurance card for the poor (SKTM)