Evaluasi pelayanan kesehatan dasar gratis di Puskesmas Kabupaten Banjar Kalimantan Selatan

NORA, Yulvi, drg. Julita Hendrartini, M.Kes

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. Pembiayaan da

Latar belakang : Untuk meningkatkan akses kesehatan kepada masyarakat maka Pemerintah Kabupaten Banjar memberikan pelayanan kesehatan dasar gratis kepada seluruh masyarakat. Guna mendukung kegiatan dimaksud, diperlukan perencanaan terutama dalam alokasi pengadaan dana. Program akan berjalan dengan baik apabila dikelola oleh sumber daya yang profesional. Komponen yang sangat penting dalam penyelenggaraan jaminan sosial ini adalah peran pengelola dalam mengendalikan biaya dan pelayanan kesehatan. Melalui kegiatan Utilization review maka dapat mengurangi moral hazard dari masyarakat dan over utilization oleh petugas yang biasanya terjadi pada penyelenggaraan jaminan kesehatan/asuransi. Penelitian ini bertujuan untuk mengevaluasi program pelayanan kesehatan dasar gratis di Puskesmas Kabupaten Banjar . Metode: Penelitian ini merupakan penelitian deskriptif mengunakan pendekatan kualitatif dan kuantitatif. Subyek penelitian adalah Stakeholders, kelompok kerja program pelayanan kesehatan dasar gratis Kabupaten Banjar, Kepala Puskesmas dan masyarakat yang memanfaatkan pelayanan dasar gratis. Instrumen penelitian adalah kuesioner tertutup dan terbuka melalui wawancara mendalam. Hasil: Pemerintah Kabupaten Banjar melibatkan sektor ketiga dari batu bara dan Comunity Development untuk pengadaan dana dan prasarana. Sebagai badan pengelola adalah Dinas Kesehatan dengan kelompok kerjanya yang sebagian anggotanya pejabat eselon III dan IV. Belum adanya pengelolan secara profesional baik dari sumber daya manusia maupun teknis pelaksanaannya maka kegiatan utilization review belum berjalan secara optimal. Ini ditunjukan dengan masih tingginya rasio kunjungan pada Puskesmas Sungai Tabuk yang mengindikasikan adanya moral hazard dari masyarakat dan over utilization dari PPK. Masih rendahnya rasio kunjungan pada puskesmas dengan akses geografis sulit seperti Puskesmas Aluh Aluh dan Pengaron. Masyarakat cukup puas dengan adanya pelayanan kesehatan dasar gratis walaupun hanya tingkat puskesmas. Kesimpulan: Pemerintah Kabupaten Banjar memberikan jaminan kesehatan kepada masyarakat Kabupaten Banjar dengan melibatkan peran ke tiga sebagai penyandang dana. Belum terkelolanya penyelenggaraan secara optimal baik tenaga maupun pengelolaan menyebabkan utilization review belum berfungsi secara baik sehingga terjadi tingginya rasio kunjungan pada salah satu puskesmas. Akses geografi menghambat masyarakat untuk memanfaatkan fasilitas kesehatan.

Background: To Increase public access to health the local government of Banjar District provides free basic health service for the community. To support the program requires planning, specially in budget allocation. The program will be able to work well if it is managed by professional human resources. A component which has an important role in the running of this social insurance is the management which controls health cost and service. Through activities of utilization review the emergence of moral hazard from the community and over utilization by staff which often happens in the implementation of health insurance is expected to be minimized. Objective: The study was meant to evaluate the program of free basic health service at the community health center of Banjar District. Methode: This was a descriptive study which used qualitative and quantitative approach. Subject of the study were stakeholders, the working group of free basic health service of Banjar District, heads of the community health centers and community utilizing free basic health service. Instruments of the study were closed questionnaire and open questionnaire with indepth interview. Result: In the planning process for funding free basic health service the local government of Banjar District involved the third party, i.e. coal company and community Development for funding and facility procurement. The managing institution of the program was the health office with most of its working groups were executive staff of echelon III and IV. An availability of professional program management both from human resources and technical implementation causes utilization review has not run optimally. This is reflected by high visiting ratio to community health center of Sungai Tabuk wich is indicated that there is society moral hazard and over utilization from health service provider. Additionally, it is evidence that there is low visiting ratio at community health center with relatively difficult geographically access such as Aluh Aluh and Pengaron. However, the community member are relatively satisfy with the availability of free basic health service although it is only provided at the health center. Conclusion: The local government of Banjar District provides health insurance for the community member by involving third party as a financing donor. Unoptimalization of service execution causes the utilization review has not been function well, so consequently, there is tendency of high visit ratio at only are community health center. Geographic access hinders the member of community in utilizing health service facility.

Kata Kunci : Jaminan Pemeliharaan Kesehatan,Program Jaminan Sosial,Layanan Kesehatan, health care insurance, utilization review, health service