Analisis stakeholders terhadap model jaminan kesehatan daerah (Jamkesda) di Kabupaten Luwu Utara Propinsi Sulawesi Selatan

KIRAMANG, Napisah, Prof. dr. Ali Ghufron Mukti, MSc, PhD

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Kabupaten Luwu Utara menempatkan kesehatan sebagai prioritas pembangunan daerah. Penduduk yang belum memiliki jaminan kesehatan sebesar 64,82% (193.777 orang). Persiapan pengembangan jamkesda telah dilaksanakan sejak tahun tahun 2006. Dalam DAK-SKPD Dinas kesehatan telah terakomodir berbagai kegiatan diantaranya sosialisasi, need assessment jamkesda. Dengan komposisi status ekonomi penduduk miskin 29%, penduduk sejahtera 54%, penduduk kaya 17% akan dirumuskan model jaminan kesehatan yang akan mengakomodir seluruh masyarakat dengan berpartisipasi mandiri sehingga terjadi subsidi silang. Untuk menfasilitasi tersebut dibutuhkan dukungan dan komitmen pengambil kebijakan. Tujuan Penelitian: Penelitian ini bertujuan untuk mengeksplorasi dan mengidentifikasi persepsi, filosofi dan komitmen stakeholder serta untuk mendeskripsikan model jaminan kesehatan daerah di Kabupaten Luwu Utara. Metode Penelitian: Jenis penelitian ini adalah penelitian Kualitatif. Data diperoleh melalui indepth interview dengan responden yang dipilih secara purposive sampling. Validitas data dilakukan contant analysis serta triangulasi terhadap sumber data. Hasil Penelitian: Stakeholders Kabupaten Luwu Utara berpersepsi bahwa jamkesda bermanfaat bagi masyarakat dan pemerintah, berprinsip pada filosofi equity egalitarian, berkomitmen mengalokasikan dana pengembangan jamkesda melalui APBD setiap tahun, membuat regulasi yang mendasari dan mendukung pelaksanaan jamkesda. Model jamkesda total coverage bersifat wajib, manfaat sesuai kebutuhan di PPK pemerintah secara berjenjang di seluruh kabupaten dalam propinsi, premi dari pemerintah dan masyarakat, besarannya berdasarkan prosentase pendapatan, dikelola oleh pemerintaah daerah dan menggunakan KTP sebagai identitas peserta. Kesimpulan dan Saran: Stakeholders Kabupaten Luwu Utara berprinsip pada filosofi equity egalitarian. Jamkesda yang tepat dikembangkan di Kabupaten Luwu Utara adalah jaminan kesehatan sosial. Pemerintah Daerah segera membuat aturan sebagai payung hukum jamkesda, juga tentang besaran dan mekanisme pembayaran premi, pembayaran ke PPK dan paket manfaat serta PPK yang dijamin. Melakukan koordinasi dengan pemerintah kabupaten lain dan propinsi untuk menjamin portabilitas.

Background: District of Luwu Utara puts health as a local development priority that is implemented in stages. There are 193,777 people (64.82%) who do not have health insurance. Preparation for the development of local health insurance has been made since 2006. In the list of activities and budget of local working unit of the health office, some activities have been accommodated such as socialization, and need assessment of local health insurance. Considering the composition of economic status of the population that belongs to poor (29%), average (54%) and wealthy (17%), an insurance model will be formulated that accommodates all community through cross subsidy that results from participation and self support of the community. Support and commitment of stakeholders are needed to facilitate the implementation of the model. Objective: The study aimed to explore and identify perception, philosophy and commitment of stakeholders and describe model of local health insurance of District of Luwu Utara. Method: The study was qualitative. Data were obtained from indepth interview with respondents that were selected through purposive sampling technique and from secondary data. Data validity using contant analysis and triangulation of data sources. Result: Stakeholders of District of Luwu Utara perceived that local health insurance was beneficial for the community and the government. They had equity egalitarian philosophy, were committed to allocate local health insurance development budget through local revenue and expenditure budget every year, made regulation that become the foundation and supported the implementation of local health insurance. Total coverage local health budget model was mandatory; its advantages were relevant with needs of governmental health services providers in stages all over districts within the province; the premi came from the government and the community; the amount was based on the percentage of income; was managed by the local government using population identity card as identity of participants. Conclusion and Suggestion: Stakeholders of Luwu Utara District had equity egalitarian philosophy. Local health service that could be relevantly developed at District of Luwu Utara was social health insurance. The local government should make regulation as legal foundation of local health insurance, that included the amount and mechanism of premium payment, payment to health service providers and benefit packages as well as health service providers covered. The local government should also coordinate with other districts, provinces and national to ensure portability.

Kata Kunci : Stakeholders,Persepsi,Filosofi,Komitmen dan model jamkesda,perception,stakeholders,commitment,local health insurance