Komitmen stakeholder terhadap kebijakan pelayanan kesehatan gratis puskesmas di Kota Denpasar Propinsi Bali
MAYENI, I Gusti Ayu Rai, dr. Choirul Anwar, M.Kes
2009 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang: Dalam era desentralisasi dinyatakan bahwa kewenangan daerah untuk menyelenggarakan pemerintahan yang mencakup kewenangan disemua bidang termasuk dibidang kesehatan yang merupakan kewenangan wajib. Kota Denpasar dengan PAD terbesar nomor 2 di Provinsi Bali telah mengratiskan biaya Pelayanan Kesehatan pada Puskesmas di Kota Denpasar, berlaku bagi semua penduduk yang memiliki KTP maupun Kipem Kota Denpasar sebesar Rp. 3000,- yang meliputi karcis kunjungan dan tarif pelayanan rawat jalan sesuai dengan Keputusan Walikota Denpasar No. 75 tahun 2003. Tujuan Penelitian: Mendiskripsikan komitmen stakeholder terhadap kebijakan pelayanan kesehatan gratis, menghitung pembiayaan sektor kesehatan, dan mengamati utilisasi pelayanan kesehatan sebelum dan sesudah dilaksanakan kebijakan gratis di Puskesmas. Metode: Jenis penelitian ini menggunakan rancangan penelitian secara kualitatif dengan analisa deskriptif, lokasi penelitian di Kota Denpasar dengan subyek penelitian adalah Wakil Walikota, Kepala Bappeda, Kepala Dinas Kesehatan Kota Denpasar, Kepala Sub Din Pelayanan Kesehatan, Kepala Sub Din Binkesmas, Kepala Bagian Perencanaan Dinas Kesehatan Kota Denpasar, Kepala Puskesmas dan perawat Puskesmas. Instrumen penelitian adalah pedoman wawancara mendalam. Variabel penelitian adalah komitmen stakeholder, pembiayaan sektor kesehatan dan utilisasi pelayanan kesehatan di Puskesmas Kota Denpasar. Hasil: Anggaran sektor kesehatan dalam empat tahun terakhir sebagian besar bersumber dari APBD II dengan jumlah yang berfluktuasi dan belum mencapai 2,5% dari PDB, demikian juga halnya untuk enam kegiatan pokok Puskesmas. Biaya operasional Puskesmas belum mendapatkan alokasi anggaran sesuai dengan kebutuhan. Puskesmas di Kota Denpasar mempunyai jumlah kunjungan tertinggi dengan rata-rata mencapai 143 orang setiap harinya, dengan jumlah terbesar adalah kunjungan gratis oleh masyrakat yang memiliki KTP dan Kipem Kota Denpasar. Kesimpulan: Pemerintah Kota Denpasar secara verbal mempunyai komitmen tinggi terhadap sektor kesehatan, namun dalam realitanya komitmen tersebut masih tergolong sedang. Walaupun belum mencapai 2,5% dari PDB. Pemerintah Kota Denpasar berkomitmen bahwa kebijakan mengenai pembiayaan dapat berubah dan meningkat apabila ada permasalahan kesehatan yang memerlukan penanganan segera. Kunjungan ke Puskesmas sebelum dan sesudah dilaksanakan kebijakan gratis menunjukan fluktuasi.
Background: In decentralization era, regional government authority cover all fields included health which considered as complusary authority. Denpasar municipality that is considered as number 2 biggest of PAD (regional income) in Bali province had special regulation for health service cost in Primary Health Care of Denpasar municipality that was given for those who possessed KTP or Kipem of Denpasar municipality and it costed Rp 3000,00 which cover visit voucher and tarif of out patient treatment that suitable with letter of decision from the Mayor of Denpasar municipality No.75 year of 2003. Objective: This study was aimed to described commitment of stakeholder toward free of charge health service policy, calculated the funding of health sector, and observed the utilization of health service before and after the implementation of free of charge policy in Primary Health Care. Method: This study was qualitative that used descriptive analysis method and it was located in Denpasar municipality with research subjects were Vice Mayor of Denpasar municipality, head of Bappeda (regional development board), head of municipality health office of Denpasar, head of sub division of health service, head of sub division of Binkesmas (public health supervision), head of planning division of municipality health office of Denpasar, head of Primary Health Care and nurse of Primary Health Care. The research instrument was guidance of indepth interview and the research variable was stakeholder’s commitment, funding of health sector and utilization of health service in Primary Health Care of Denpasar municipality. Result: Funding of health sector in the past four years were mostly originated from APBD II with fluctuated amount and not yet achieved up to 2,5% as well as the sixth main activity of Primary Health Care. Operational funding of Primary Health Care was not yet obtained budget allocation based on the need. Primary Health Care in Denpasar municipality had highest visit number with average number of visit was 143 people daily and with biggest portion was free of charge visit communities who had KTP and Kipem of Denpasar municipality. Conclusion: The government of Denpasar municipality had high commitment toward health sector and yet in the reality, the commitment was considered as medium. Although it hasn’t achieved up to 2,5%, the government of Denpasar municipality committed that policy on the funding could be changed and improved when there is a health problem occurred that need immediate response. Indeed, there was fluctiation visit to Primary Health Care before and after the free of charge policy.
Kata Kunci : Komitmen stakeholder,Pembiayaan kesehatan,Utilisasi, stakeholder’s commitment, health funding, utilization
