Evaluasi penadanaan jaminan kesehatan masyarakat (Jamkesmas) di Puskesmas Kabupaten Purbalingga
MUSLIMIN, Prof. dr. Ali Ghufron Mukti, MSc., PhD
2009 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang : Jaminan kesehatan masyarakat miskin sejak dilaksanakan mulai tahun 1998 sampai tahun 2008 telah mengalami beberapa kali perubahan. Tahun 2008 berganti menjadi Jaminan Kesehatan Masyarakat (Jamkesmas). Hal ini menandakan konsep yang dilakukan pemerintah belum matang. Pedoman Pelaksanaan dan dana yang diberikan Puskesmas sebagai pemberi pelayanan kesehatan selalu terlambat. Hal ini menyebabkan Puskesmas mengalami hambatan dalam pelaksanaan program dan keuangan. Peraturan dibidang keuangan mengharuskan dana yang diterima Puskesmas dari pogram Jamkesmas harus disetor dahulu ke Kas Daerah, disamping itu peran pemerintah daerah dalam pembiayaan kesehatan bagi masyarakat miskin juga belum optimal. Metode penelitian : Penelitian deskriptif kualitatif. Unit analisis adalah dinas/instansi kabupaten yang terkait dengan pembiayaan kesehatan dan Puskesmas untuk mendapatkan gambaran model pembayaran dana, keluwesan pemanfaatan dana, mekanisme pengelolaan dan pemanfaatan dana, kecukupan dana serta peran Pemerintah Kabupaten dalam pembiayaan program Jamkesmas di Puskesmas. Hasil dan Pembahasan : Hasil penelitian diperoleh bahwa, di Kabupaten Purbalingga sejak tahun 2001 – sekarang telah dikembangkan program Jaminan Pemeliharaan Kesehatan Masyarakat (JPKM). Total kepesertaan JPK telah mencapai 79,66% dengan perincian: Jamkesmas 45,89%, JPKM 27,6%, Askes PNS 5,17%, Jamsostek 0,96% dan Asabri/Polri 0,15%. Dana program Jamkesmas untuk pelayanan kesehatan di Puskesmas dan Jaringannya diterima bulan September – Oktober 2008. Masyarakat miskin menurut pendataan BPS tahun 2006 berjumlah 420.972 ditetapkan dengan SK Bupati, seluruhnya masuk kuota dan menjadi peserta Jamkesmas. Pemanfaatan dana Jamkesmas untuk membiayai kegiatan UKP dan UKM yang disusun Puskesmas sesuai kebutuhan. Mekanisme dan tata kelola keuangan mengikuti Permendari Nomor 13 Tahun 2006 seluruhnya disetor ke Kas Daerah dan kembali 100%. Dukungan pembiayaan dari Pemda hanya di RSUD. Kesimpulan : Model pembayaran ke Puskesmas anggaran global, mekanisme pengelolaan dana Jamkesmas disetor ke Kas Daerah, keluwesan pemanfaatan terbatas, terdapat Puskesmas yang kelebihan dana dan terdapat juga Puskesmas yang mengalami kekurangan dana.
Background: Public Health Security for the poor since started in 1998 until the year 2008 has experienced several time of changes: In 2008 the term was switched into Public Health Assurance (Jamkesmas). This indicates that the concept has not been done well by the government. The implementation guidelines, and the fund given to the health centers as health providers always come late. It caused financial and implementation problems to the health centers. Financial regulation states that fund comes from Public Health Assurance received by health centers have to be paid to the local/regional account first. Besides, the role of the local government in health care financing for the poor has not been optimum yet. Objective: The study airmed to explore and evaluation of payment model, the flexibility of the fund spending, the mechanism of the fund's utilization and management, availibility and sufficiency of fund also the role of the local government in financing the public health assurance Jamkesmas program. Research Method: Qualitative descriptive study, analysis units are local government's institutions within the district associated to the health financing, and health centers. Results and discussion: Results of the research is that, in the District of Purbalingga since the year 2001 until present has been developed The Public Health Maintenance Assurance Program (JPKM). The total population insured has reached 79,66% with the details: Public Health Assurance (Jamkesmas) 45,89%; JPKM 27,6%; Askes for civil servants 5,17%; Jamsostek for workers 0,96%; and Asabri for soldiers and the police 0,15%. Jamkesmas fund for health services in health centers is received between September – October 2008. The number of the poor according to the Central Beureu for Statistics (BPS) data collection in 2006 is 420.972. It is declared by the Bupati letter, and all of them are become the participants of Jamkesmas (elligible). The utilization of the Jamkesmas fund is set by health centers according to the needs, and divided into personal health service (UKP) and community health service (UKM). The financial management is according to The Ministry of Internal Affairs regulation number 13 2006 which is all the fund must be prior sent to the local/regional account and then can be withdrawed back 100%. There is a supportive fund availlable at the local hospital. Summary: Payment model use global budget, the mechanism and the management of fund are according to the law, and the utilization is flexible limited to health centers needs, there are some Health Centers wich have more funds, and there are some Health Centers wich have insufficient fund.
Kata Kunci : Jamkesmas,JPK,UKP dan UKM,Mekanisme dan tata kelola keuangan, Jamkesmas, JPK, UKP, UKM, Financial Mechanism and Management
