Mutu pelayanan Puskesmas dengan pembebasan tarif retribusi di Kabupaten Simalungun Propinsi Sumatera Utara

HARTATI, dr. Tjahjono Kuntjoro, MPH.,DrPH

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. dan Manaj. Pe

Latar belakang: Sejak diberlakukannya Undang-Undang No.34 Tahun 2004 tentang pemberian otonomi yang luas kepada daerah. Ditindaklanjuti oleh Pemerintah Daerah Kabupaten Simalungun Propinsi Sumatera Utara dengan memberlakukan Peraturan Daerah No.13 Tahun 2004 tentang pembebasan tarif retribusi puskesmas kepada seluruh pengunjung puskesmas tanpa dibedakan status ekonominya. Setelah berjalan 2 (dua) tahun ternyata jumlah kunjungan bukan meningkat dan masih tetap dibawah 30%, pendapatan puskesmas berkurang dan adanya keluhan pasien terhadap rendahnya mutu pelayanan. Oleh karena itu perlu dilakukan penelitan untuk mengetahui mutu pelayanan puskesmas dengan pembebasan tarif retribusi di Kabupaten Simalungun. Tujuan penelitian: Untuk mengetahui mutu pelayanan puskesmas, pembiayaan puskesmas dan penerapan sistem manajemen mutu ISO 9001;2000 di puskesmas yang membebaskan tarif dan yang menerapkan tarif retribusi. Metode: Jenis Penelitian ini adalah quasi experimental design menggunakan rancangan post-test only with control group design, dengan metode kuantitaf dan kualitatif. Unit analisis adalah puskesmas yang membebaskan tarif dan puskesmas yang menerapkan tarif. Sedangkan subjek penelitian adalah pasien yang berkunjung ke puskesmas dan petugas yang diamati antara lain (1) dokter dan petugas di BP umum, (2) loket pendaftaran, (3) loket obat. Sampel ditentukan dengan rumus Lameshow didapatkan jumlah sampel 408 orang dari 6 unit puskesmas yang terpilih dari Kabupaten Simalungun (kelompok perlakuan) dan Kabupaten Asahan (kelompok kontrol). Instrumen penelitian: Kuesioner harapan-kenyataan dari Servqual, Sistem Manajemen Mutu ISO 9001;2000 dan formulir pengamatan pelayanan. Analisa data kuantitatif dengan uji t-independen. Sedangkan data kualiatif, informasi didapatkan melalui wawancara mendalam terhadap 6 orang kepala puskesmas dan 12 pasien serta check dokumen. Hasil penelitian: Dari Uji t-independen menunjukkan ada perbedaan signifikan (p < 0.05), antara mutu pelayanan puskesmas yang membebaskan tarif (Kabupaten Simalungun) dan yang menerapkan tarif (Kabupaten Asahan). Ada perbedaan pembiayaan puskesmas dan penerapan sistem manajemen mutu ISO 9001;2000 di puskesmas yang membebaskan tarif dan yang menerapkan tarif. Kesimpulan: Mutu pelayanan di puskesmas yang membebaskan tarif lebih rendah daripada di puskesmas yang menerapkan tarif. Jumlah dana lebih banyak di puskesmas yang membebaskan tarif daripada di puskesmas yang menerapkan tarif. Penerapan sistem manajemen mutu ISO 9001:2000 lebih rendah di puskesmas yang membebaskan tarif.

Background: Since implementation of Undang-Undang No. 34 year 2004 about granting widely autonomy for the local government and responded by Local Government of Regency of Simalungun North Sumatera Province by implementing of local regulation No. 13 year 2004 about retribution tariff free on community health center toward all visitor regardless their economical status. After 2 years of implementation turn out that the visiting quantity was not increasing and still below 30%, primary health service income decreased, and complains from patients about its poor quality services. Therefore, a research is needed to learn about the service quality on community health center with retribution tariff ree at Simalungun District. Object: To know the community health center service quality, the community health center financing, implementation of quality management system ISO 9001;2000 on community health center with retribution tariff free and applying retribution tariff. Method: This research type is quasy experimental design using post-test only with control group design with quantitative and qualitative methods. Unit analyzed were community health center with retribution tariff free and community health center applying retribution tariff. The research subjects are individual visiting at the community health center and observation toward staff’s, which are (1) doctor and staf BP.Umum, (2) registration counter, (3) pharmacy counter. Sample measured by Lameshow and resulted that sample quantity were 408 people from 6 community health center unit that have been chosen at Simalungun District (treatment group) and at Asahan District (control group). Research Instrument: Hope-fact questioner of servqual, quality management system ISO 9001;2000 and service observation form. Quantitative data were analyzed with t-test independent sample. As the qualitative data, information were collected from indepth interview toward 6 people lead the community health center and 12 patients and also check document. Result: From t-test independent sample testing, the result shows a significant differences (p < 0.05) between quality services on community health center with retribution tariff free and applying retribution tariff. There are differences in community health center financing, and implementation of quality management system ISO 9001;2000 on community health center that does. Conclusion: Quality of service on community healt center with retribution tariff free lower than in community health center applying tariff. Sum up the surplus funds a lot of in community health center with retribution tariff free and implementation of quality management system ISO 9001;2000 lower in community healt center with retribution tariff free.

Kata Kunci : Layanan Kesehatan, Mutu Puskesmas, Pembebasan Tarif Retribusi