Analisis kecukupan biaya operasional Puskesmas Swakelola berdasarkan rencana pola tarif baru di Kota Yogyakarta

YANTA S.B., Salmon Urung, dr. Kristiani, SU

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

Yogyakarta, Peraturan Walikota Yogyakarta No. 02 tahun 2005 tentang Penetapan Puskesmas Ujicoba Swakelola, dan Keputusan Walikota No.48/KEP/2005 Keputusan Kepala Dinas Kesehatan Kota Yogyakarta No.32 tahun 2005. Pelaksanaan ujicoba swakelola puskesmas masih terkendala, karena usulan tarif baru masih belum disahkan Dewan Perwakilan Rakyat Daerah (DPRD), melalui penelitian ini, akan di analisis kemampuan tarif baru dalam memenuhi kecukupan biaya operasional rutin Puskesmas Ujicoba Swakelola Kota Yogyakarta. Penelitian dilakukan secara retrospektif serta mengetahui dan menganalisa bagaimana persepsi stakeholder terhadap penerapan tarif baru tersebut. Tujuan Penelitian : mengetahui Potensi penerapan tarif baru dalam memenuhi kecukupan biaya operasional Puskesmas (cost recovery rate) serta persepsi stakeholder terhadap tarif baru dan cost recovery rate. Metode penelitian: Penelitian ini analitik dengan rancangan studi kasus. Penelitian dilakukan di puskesmas rawat jalan Mantrijeron dan puskesmas rawat inap Tegalrejo, dipilih secara purposive sampel, mempunyai kunjungan tinggi. Subjek penelitian ini : DPRD (Komisi . D), BAPPEDA, Kepala Dinas Kesehatan, Kepala Puskesmas Ujicoba Swakelola Kota Yogyakarta dengan Variabel bebas tarif baru, variabel terpengaruh pendapatan fungsional, variabel moderator biaya operasional. Pengumpulan data primer dilakukan dengan wawancara kepada stakeholder, pengumpulan Data Sekunder di peroleh dengan cara penelusuran data-data/laporan, kearsipan dan keuangan di Dinas Kesehatan dan di Puskesmas. Data yang terkumpul di analisis secara regresi dan analisis deskriptif kualitatif , Untuk menjamin validitas data dilakukan tehnik triangulasi data . Hasil : Prediksi berdasarkan tarif baru, Penerimaan fungsional puskesmas Mantrijeron Rp.95.617.226,25 dan puskesmas Tegalrejo Rp.303.896.821,95. Besar biaya operasional Puskesmas Mantrijeron Rp.410.307.575,57, puskesmas Tegalrejo Rp.512.439.482,16 Cost Recovery Rate (CRR) puskesmas Mantrijeron sebesar 23,30% di katagorikan kurang baik dan puskesmas Tegalrejo 59,30% di katagorikan baik Stakeholder berpendapat kenaikan tarif baru merupakan tindakan logis untuk pemenuhan pembiayaan kesehatan. Kesimpulan : Penerapan pengembalian tarif baru belum mampu meningkatkan persentase kemapuan pendapatan fungsional guna menanggulangi biaya operasional Puskesmas karena belum berdasarkan unit cost, sehingga perlu mengkaji kembali penerapan pemberlakuan dan pengembalian pendapatan fungsional puskesmas

Background. The establishment of self-managed health centers is supported by the city mayor regulation No. 02 year 2005 about the establishment of the tested self-managed health centers, the city mayor decision letter No. 48/KEP/2005, and Yogyakarta City Health Office decision letter No. 32 year 2005. Nevertheless, there is obstacle in the implementation since the new tariff plan was yet to be officially approved by the city parliament (DPRD). This research was conducted to analyze the capability of the new tariff in fulfilling the needs of routine health centers’ operational costs. Objective. The objective of the research was to figure out the potency of new tariff implementation in fulfilling the health centers’ operational costs (Cost Recovery Rate) and the perception of the stakeholders on the new tariff and the Cost Recovery Rate (CRR). Methods. This research was a descriptive research, using case study design, and conducted retrospectively. The research was conducted at Mantrijeron Health Center with ambulatory patients and Tegalrejo Health Center with in-patients. Research samples were chosen purposively, which were self-managed health centers with high rate of visitation. The research subjects were city parliament (commission D), local government planning board (BAPPEDA), head of city health office, and head of the self- managed health centers in Yogyakarta. The independent variable of the research was new tariff, the dependent variable was functional income, and the moderator variable was operational costs. Primary data were collected through interviews with the stakeholders, and secondary data were collected through tracing the reports/data, archives, and financial reports in City Health Office and health centers. The data were analyzed using regression method and descriptive analysis. To assure data validity, data triangulation was implemented in the research. Result. The prediction based on new tariff: the functional income of Mantrijeron Health Center was Rp.95,617,226.25 and Tegalrejo Health Center Rp.303,896,821.95. The amount of operational costs of Mantrijeron Health Center was Rp.410,307,575.57 and Tegalrejo Health Center Rp. 512,439,482.16. The CRR of Mantrijeron Health Center was 23.30% and was categorized as not good, while the CRR of Tegalrejo Health Center was 59.30% and was categorized as good. In the mean time, the stakeholders considered the implementation of new tariff as a logic action in fulfilling the health funding. Conclusion. The implementation of new tariff and the recompense of health centers’ income were not yet able to increase the percentage of functional income capability in order to cover health centers’ operational costs since it was not calculated based on unit cost. Thus, it was necessary to restudy the implementation and the recompense of health centers’ functional income.

Kata Kunci : Pembiayaan Kesehatan,Puskesmas,Biaya Operasional