Estimasi penghematan biaya pengobatan diare akut pada Balita di Puskesmas dan Rumah Sakit Kabupaten Purworejo

WINARTI, Eko, dr. Siswanto A. Wilopo, SU.,MSc.,Sc.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kes. Ibu dan Anak-Ke

Latar Belakang: Upaya pemberantasan penyakit diare sudah dilakukan sejak dulu, namun hingga saat ini masih merupakan masalah kesehatan baik di negara maju maupun negara berkembang. Selain masih tingginya angka morbiditas dan kematian balita akibat diare akut, masalah lain yang dihadapi yaitu penatalaksanaan penderita diare di pelayanan kesehatan yang belum memadai yaitu masih luasnya penggunaan obat-obatan tanpa indikasi yang tepat (pengobatan yang irasional). Tujuan: Penelitian ini bertujuan untuk mengkaji seberapa besar biaya yang bisa dihemat jika pengobatan diare akut pada balita dilakukan secara rasional. Metode: Penelitian ini merupakan penelitian observasional, dengan rancangan cross sectional. Dilakukan di puskesmas dan rumah sakit Kabupaten Purworejo. Populasi adalah semua balita diare akut yang di bawa berobat ke puskesmas atau rumah sakit Kabupaten Purworejo yang telah ditetapkan sebagai tempat penelitian. Subjek penelitian adalah balita diare akut dan keluarganya yang memenuhi kriteria inklusi, besar sampel sebanyak 222 responden. Variabel bebas adalah balita diare akut, variabel antara status pengobatan dan variabel terikat biaya pengobatan. Penelitian ini menggunakan data sekunder dari rekam medis dan data primer melalui interview pada keluarga balita. Data di analisis dengan analisis univariabel, bivariabel menggunakan anova dan t-test dengan p<0,05 dan CI 95% serta analisis multivariabel dengan linear regression. Hasil: Dari 222 responden, hanya 1(0,5%) responden yang benar-benar mendapatkan pengobatan sesuai standar WHO dan Depkes RI, 108 (48,7%) responden mendapatkan oralit, 195 (87,9%) mendapatkan antibiotika. Perhitungan biaya terendah, biaya pengobatan irasional dengan peresepan antibiotik pada balita diare akut 2 kali lebih besar dibandingkan biaya pengobatan yang irasional tanpa antibiotik dan 2,4 kali lebih besar dibandingkan biaya pengobatan yang rasional. Kesimpulan: Pola pengobatan diare akut masih jauh dari standar yang ada, hampir seluruh responden mendapatkan pengobatan irasional. Biaya pengobatan irasional pada balita diare akut lebih besar dibandingkan pengobatan yang rasional.

Background: Efforts for the eradication of diarrhea have been made for a long time; however, until today diarrhea is still a problem in both developed and developing countries. Nearly all over the world including Indonesia acute diarrhea causes high morbidity and mortality rates in under-five children. Another problem is that the management of acute diarrhea in health services is still inappropriate because of the wide use of drugs without proper indication (irrational medication). Objective: The study aimed to assess the cost that could be saved if medication for acute diarrhea among under-five children was done rationally. Method: The study was observational with a cross sectional design carried out at the health centers and hospitals in Purworejo District. Population was all children suffering from acute diarrhea who were taken for the treatment at the health centers or hospitals of Purworejo District chosen as location of the study. Subject of the study was under-five children suffering from acute diarrhea and their family (222 samples). The independent variable of the study was under five children with acute diarrhea, the intermediate variable was medication status and the dependent variable was the treatment cost. Primary data were obtained from an interview with the family of the children and secondary data were obtained from medical records. Data analysis used univariable, bivariable, i.e. anova and t-test with p<0.05 and CI 95% and multivariable with linear regression. Result: Out of 222 under-five children with acute diarrhea, only 1 (0.5%) received treatment according to the standard of WHO and the Ministry of Health, 108 (48.7%) reveived oral rehydration, 195% (87.9%) received antibiotics. Based on the lowest calculation of the cost, irrational medical expenses with antibiotic at acute diarrhea was two times greater than irrational medical expenses without antibiotic and 2,4 times greater than rational medical expenses. Conclusion: Many therapy patterns of acute diarrhea are still far from the existing standard. Almost all respondents receive irrational therapy. Expenses of acute diarrhea irrational therapy for under-five children are greater than those of acute diarrhea rational therapy.

Kata Kunci : Diare Akut,Balita,Biaya Pengobatan, rational and irrational treatment, acute diarrhea, cost of therapy