Analisis pembiayaan kesehatan bersumber pemerintah di Kabupaten Batang Hari Propinsi Jambi pasca desentralisasi tahun 2001-2006

GINTING, Adil, Prof. dr. Laksono Trisnantoro, MSc, PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang : Pembiayaan kesehatan melalui pendekatan district health account perlu dilakukan agar setiap daerah dapat mengetahui kecenderungan pembiayaan kesehatan setiap tahun. Demikian juga dapat diketahui bagaimana penggunaan dana pelayanan kesehatan sehingga dapat mempengaruhi pengambil kebijakan dalam penyusunan dan pengalokasian anggaran kesehatan tersebut. Tujuan Penelitian : Penelitian ini secara umum bertujuan untuk mengetahui gambaran pembiayaan kesehatan bersumber pemerintah di Kabupaten Batang Hari. Metode Penelitian : Penelitian deskriftif dengan menggunakan metode pengumpulan data secara kuantitatif dan kualitatif yang bertujuan untuk mendapatkan gambaran tentang pembiayaan kesehatan bersumber pemerintah di Kabupaten Batang Hari. Subjak penelitian ini adalah data alokasi anggaran sektor kesehatan yang bersumber pemerintah tahun 2001 - 2006 dan wawancara mendalam dengan berbagai pihak yang terkait dengan pembiayaan untuk kesehatan diantaranya anggota DPRD, Kepala Dinas Kesehatan, Kepala Bappeda, Bagian anggaran Kabupaten. Instrumen penelitian berupa pedoman wawancara sebagai panduan wawancara mendalam. Formulir digunakan untuk pemeriksaan dokumen. Rencana analisa data adalah data sekunder dengan memakai table National Health Account dan data primer dengan cara menganalisa isi data kemudian kedua data di interpretasikan sesuai tujuan penelitian. Hasil Penelitian : Pembiayaan kesehatan di Kabupaten Batang Hari Tahun 2001- 2006 bersumber dari DAU, APBN dan APBD. dengan jumlah Rp. 109.467.029.575, Alokasi bersumber DAU tahun 2001-2006 sebesar Rp.17.614.980.125,- sementara itu alokasi bersumber APBN tahun 2001- 2006 sebesar Rp.28.221.166.000,-. Alokasi bersumber APBD sebesar Rp. 63.630.883.450,. Biaya Per-Kapita untuk tahun 2001 adalah Rp. 42.052., tahun 2002 adalah Rp. 59.127., tahun 2003 adalah Rp. 94.581., tahun 2004 adalah Rp. 89.363., tahun 2005 adalah Rp. 97.512. dan tahun 2006 adalah Rp. 148.423. Dari Hasil wawancara di Kabupaten Batang Hari bahwa pengajuan pembiayaan tidak di dasari atas program prioritas. Alternatif pembiayaan kesehatan di Kabupaten Batang Hari menggunakan sistem asuransi sosial sedangkan bagi masyarakat miskin menggunakan Jaminan Pelayanan Kesehatan Masyarakat Miskin. Kesimpulan : Untuk memperoleh sumber pembiayaan kesehatan Kabupaten Batang Hari perlu meningkatkan sistem pendataan baik dari sumber maupun jumlahnya. Saat advokasi kepada pihak Pemda serta DPRD Batang Hari untuk meningkatkan jumlah anggaran Kesehatan perlu di dukung data pembiayaan dan data kesehatan lainnya, Dinas Kesehatan dalam menyusun perencanaan disesuaikan dengan program prioritas setiap tahunnya, Dengan sistem pendataan yang lebih baik diharapkan pembiayaan per-kapita akan lebih tinggi. Pembiayaan kesehatan berbasis asuransi sosial perlu dilakukan pentahapan yang siap baik dari sisi pemerintah, masyarakat, penyelenggara maupun PPK sehingga lebih memantapkan memilih jenis asuransi, sosialisasi dan dukungan semua pihak

Background. Health Costing through district health account approach needs to be made in order that each area could identify tendency of health cost annually and how to use health service fund as to affect policy making of health budget allocation. Research Objectives: To identify how commitment of District, Provincial, and Central Governments allocated health cost related to decentralization from 2001 to 2006 in the District of Batang Hari. Research Method: Descriptive research used qualitative and quantitative data collection method to obtain illustration of health cost from the governmental source in the District of Batang Hari in post-decentralization from 2001 to 2006. Research subjects were data of health sector budget from the district, province and center and in-depth interview with the parties associated with health costing such as members of DPRD, Health Department Head, Bappeda Head, District Budget Personnel. Research instruments were interview guidelines as in-depth interview manual. Forms were used for document examination. Data analyzed were secondary data using table of National Health Account and primary data analyzing data content and both secondary and primary data were interpreted according to research objectives. Results of research: In decentralization, the central government was expected to support and delegate regulation role in the local government. The local government could increase its ability to structure and anlyze health policy. Policy, planning, budgeting and performance of the center and weak activity arrangement in changing a thinking pattern from project orientation to into budgeting based on problems, were asynchrous, also labor ability to support the local development planning was limited. De-concentrated fund was no matter, but, in terms of time and menu of activities, it was less effective and efficient and characteristic of costing centralization. In Health Insurance Program, it seemed that communication was not optimum between the center and local, the local personnel was less professional to implement health insurance affairs despite direct subsidy model service to be insurance model had not been customized and criteria of poor family had not been uniform. Epidemiologic surveillance Program Costing from the central government seemed to be dominant in the local, so that it needed regulation and follow-up in the local. Health Workforce and Services Project in the District of Batang Hari increased Health Human Resources and supported routine activities in the health department, there was conflict of functional role between the district and province, but expectation of stakeholders of District continued the activities with local fund. The local government should respond to the family health program whose fund was from the central government, although the central government was impressively unready in the local family health program. Conclusion: Decentralization of Indonesia in reformation nuance led to the local government. It needed deep policy so that the decentralization was clearer and all locals (poor and rich) remained to implement a controlled health service so that the local played a role in action and increased ability to structure and analyze the health policy. The role of provincial government served “rationally” than followed a system to assure health and asked the local and supported birth of local initiative to make local health assurance. Surveillance personnel and organizational structure were required to get fund to regulate. HWS project required stronger central government support to solve personnel condition and local costing, including weak local government group. Family health program was innovation program, central costing source was implemented in the local and the local provided fund to continue the program.

Kata Kunci : Pembiayaan kesehatan, Komitmen stake holder, Health Costing, commitment of stakeholders