Pengaruh Asuransi Kesehatan Masyarakat Miskin terhadap utilisasi persalinan oleh tenaga kesehatan di Kecamatan Nan Sabaris Kabupaten Padang Pariaman
ZAIRIL, Prof.dr. Ali Ghufron Mukti, MSc.,PhD
2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebj. Pembiayaan danLatar Belakang: Kesehatan adalah hak fundamental setiap warga. Asuransi kesehatan masyarakat miskin (Askeskin) bertujuan untuk meningkatkan akses pelayanan kesehatan masyarakat miskin yang masih rendah. Utilisasi persalinan oleh tenaga kesehatan bagi ibu miskin di Kecamatan Nan Sabaris Kabupaten Padang Pariaman tahun 2006 relatif masih rendah yakni 68,2%. Keberhasilan program Askeskin dalam peningkatan utilisasi persalinan ditolong oleh tenaga kesehatan bagi ibu miskin ditentukan dengan indikator cakupan yakni 90%. Tujuan penelitian ini adalah untuk mengukur hubungan kepemilikan askeskin dengan utilisasi persalinan oleh tenaga kesehatan. Metode : Rancangan penelitian ini case control study dengan populasi ibu miskin yang melahirkan periode Januari 2006 - Juli 2007. Besar sampel 140 orang terdiri dari 70 ibu bersalin ditolong oleh dukun bayi (kasus) dan 70 ibu bersalin ditolong oleh tenaga kesehatan (kontrol). Teknik sampling secara simple random sampling. Variabel bebas yakni kepemilikan askeskin dan variabel terikat adalah utilisasi persalinan oleh tenaga kesehatan. Variabel luar meliputi umur, pendidikan, pengetahuan ibu tentang paket pelayanan askeskin, sikap/pandangan terhadap pelayanan kesehatan, jarak ke fasilitas pelayanan kesehatan dan sarana transportasi. Analisis data secara univariabel dan bivariabel dengan uji statistik chi square. Analisis pemodelan multivariabel dengan uji statistik regresi logistik untuk mengukur hubungan kepemilikan askeskin dengan utilisasi persalinan oleh tenaga kesehatan dengan mengendalikan beberapa variabel luar. Keeratan hubungan variabel diukur dengan nilai rasio odds dengan tingkat kepercayaan (IK) 95% dan α = 0,05. Hasil : Analisis multivariabel dengan uji regresi logistik menunjukan bahwa ada hubungan yang signifikan antara kepemilikan askeskin dengan utilisasi persalinan oleh tenaga kesehatan pada ibu miskin (p<0,05). Keeratan hubungan dengan nilai rasio odds = 6,43 (95% IK: 2,79 – 14,79) setelah variabel pendidikan dikendalikan pada tingkat analisis. Kesimpulan : Ada hubungan antara kepemilikan askeskin dengan utilisasi persalinan oleh tenaga kesehatan. Probabilitas persalinan ibu miskin dengan pertolongan dukun bayi pada ibu yang tidak memiliki askeskin yakni 6 kali lebih tinggi dibanding persalinan ibu miskin yang tidak memiliki askeskin dengan pertolongan tenaga kesehatan. Disarankan program askeskin sebaiknya tetap dilanjutkan dan sosialisasi askeskin perlu langsung kepada masyarakat miskin yang menjadi sasaran terkait dengan pendistribusian dan penggunaan kartu askeskin serta sosialisasi tentang paket pelayanan kesehatan.
Background: Health is a basic human right. Health insurance for poor community aims to increase access to health service by poor community. The utilization of childbirth service provided by health professionals among poor mothers at Subdistrict of Nan Sabaris, District of Padang Pariaman in 2006 was relatively low (68.2%). Meanwhile the success of health insurance program for poor community is indicated by coverage of childbirth service assisted by health professionals for poor mothers as much as 90%. Objective: The study aimed to assess the effect of health insurance for poor community to the utilization of childbirth assisted by health professionals. Method: This was a case control study using the population of poor mothers who gave birth during January 2006 – July 2007. There were 140 samples consisting of 70 mothers assisted by traditional childbirth attendants (as cases) and 70 mothers assisted by health professionals (as control). Samples were chosen using simple random sampling technique. The independent variable was ownership of health insurance for poor community and the dependent variable was the utilization of childbirth service provided by health professionals. External variables consisted of age, education, knowledge of mothers about service package of health insurance for poor community, attitude/view about health service, distance to health service facilities and transportation facilities. Data analysis used univariable and bivariable technique with chi square statistical test. Model analysis used multivariable technique with logistic regression statistical test to measure the relationship between ownership of health insurance for poor community and the utilization of childbirth provided by health professionals by controlling some external variables. Closeness of the relationship between variables was measured using odds ratio (OR) with CI 95% and α= 0.05. Result: The result of multivariable analysis using logistic regression test showed that there was significant relationship between ownership of health insurance for poor community and the utilization of childbirth provided by health professionals among poor mothers (p<0.05). Closeness of the relationship indicated OR= 6.43, CI 95%= 2.79 – 14.79 after variable of education was controlled at the analysis level. Conclusion: There was relationship between ownership of health insurance for poor community and the utilization of childbirth provided by health professionals.The probability of childbirth provided by traditional childbirth attendants being utilized by poor mothers who are not covered by health insurance was 6 times higher than poor mothers who are not covered by health insurance gave birth with health professionals.The program of health insurance for poor community should be continued and wider socialization should be made directly to poor community as target through the distribution and utilization of health insurance as well as socialization on health service packages.
Kata Kunci : Askeskin,Utilisasi Persalinan,Tenaga Kesehatan, health insurance, utilization, childbith, health professionals
