USULAN TARIF PAKET PERSALINAN NORMAL PADA PELAYANAN KESEHATAN PRIMER DI KABUPATEN JEMBRANA
Ni Luh Gede Ari Natalia Yudha, dr. Ova Emilia, SpOG., M.M.Ed., Ph.D.
2011 | Tesis | S2 Ilmu Kesehatan MasyarakatLatarBelakang: Salahsatu sasaranMDGske-5ialah meningkatkankesehatan ibu. KabupatenJembranasalah satu kabupatendi Provinsi Bali yang menaruh perhatian besar terhadap kesehatanibu melalui program Jaminan Kesehatan Jembrana (JKJ). JKJ mengcoverpelayanankesehatanibu berupa persalinan normal,ANC dan KB. Pelayananyang mengalamipeningkatanbesaran klaim tiap tahunnya ialah pelayanan persalinan normal. Keterbatasan anggaran menuntut penerapan efisiensi sumber daya sehingga diperlukan kajian unit cost, mengetahui berapa besar biaya yang diperlukan khususnya pelayanan persalinan normal. Tujuan Penelitian : Mengidentifikasi perbedaan sumber daya yang digunakan untuk menghasilkan pelayanan persalinan normal, menghitung unit cost menggunakanmetode Activity Based Costing,menentukanbesaran tarif dan mendeskripsikan persepsi stakeholder mengenai tarif persalinan normal JKJ. Metode : Rancanganpenelitian studi kasus. Unit analisis ialah BPS (Bidan Praktek Swasta) dan Puskesmas. Karakteristik pemilihan BPS berdasarkan utilisasi persalinan normal dan puskesmasberdasarkan kategori puskesmas yaitu puskesmasrawat inap. Subjek penelitianialah bidan, kepala puskesmas, direktur BadanPenyelenggaraJKJ dan KepalaBidang PelayananMedik Dinas Kesehatan Kabupaten Jembrana. Hasil Penelitian\":Perbedaanaktifitas da/am persalinannormal mempengaruhi jumlah biayayangdikeluarkan.Perbedaanpenggunaanobat,bahanmedishabis pakai dan alat medisdi puskesmasRp. 143.868, bidan praktek swasta Rp. 147.136 sedangkan berdasarkan standar asuhan persalinan normal Rp. 136.983. Perbedaan ini disebabkan oleh aktifitas yang diluar standar yaitu aktifitas periksa dalam yang berulang kali dan penggunaan obat-obatan. Eliminasi non value added activity akan mengefisiensi 9,8% dari direct tracing. Besarnya biaya yang terlibat langsung dan overhead akan mempengaruhi unit cost dan besaran tarif. Kesimpulan dan Saran: Perbedaan aktifitas akan mempengaruhi sumber daya yang digunakan meliputi perbedaan pelaksana, obat-obatan dan BHP, akomodasi dan overhead. Besaran unit cost yang diperoleh di Puskesmas sebesar Rp.259.341 sedangkan BPS Rp.210.346, yang menunjukkan bahwa unit cost puskesmas lebih tinggi. Besaran tarif yang diusulkan tetap Rp.500.000 baik di puskesmas maupun BPS dengan kebijakan memperbaiki pelayanan puskesmas. Efektifitas program JKJ merupakan per~manberbagai pihak baik itu pemerintah daerah sebagai pengambil kebijakan dalam penetapan subsidi, bapel jamsosda dapat mengupayakan tarif berdasarkan unit cost serta upaya-upaya PPK untuk memberikan pelayanan yang baik dan melakukan efisiensi biaya., Pemerintah daerah Kabupaten Jembrana mengalokasikan anggaran dalam upaya perbaikan pelayanan puskesmas sehingga meningkatkan utilisasi puskesmas atau mempertimbangkan lagi pemanfaatan persalinan normal di puskesmas.
Background: One objective of the fifth Millennium Development Goals is to improve maternal health. Jembrana is a district at the Province of Bali that has serious attention to maternal health through the program of Jembrana Health Insurance (JHI). This scheme covers health service for mothers that comprises normal delivery, antenatal care and family planning. The service that had increasing claims every year is normal delivery service. Limited budget demands efficiency of resources, thus it is necessary to study unit cost, identify the cost needed particularly normal delivery service. Objective: To identify the difference in resources used to produce normal delivery service, calculate unit cost with Activity Based Costing (ABC) method, specify the amount of tariff and descriptive the perception of stakeholders about tariff of normal delivery JHI. Method: The study used a case study design. Analysis unit are private practice midwives and community health centers. Selection criteria of private practice midwives based on the utilization of normal delivery and community health centers based on category of health center, i.e. inpatient/primary health center. Subject of the study were midwives, head of health centers, director JHI management council and head of medical service department of Jembrana District of Health Office. Result: Differing activities in normal delivery affected the amount of cost that had to be paid. Difference in the use of drugs, usable medical materials and medical devices at the community health center was 143,868, at private practice midwives was 147,136 whereas based on the standard of normal delivery was 136,983. The difference was caused by activities outside the standard, i.e. activities of multiple palpation and use of drugs. Elimination of non value added activity would save 9.8% from direct tracing. The amount of cost directly involved and overhead would affect unit cost and amount of tariff. Conclusion and Suggestion: Activitydifferences will affect the resources used such as medical personnel, drugs, usable medical materials, accommodation and overhead. Unit cost at the community health center 259.341 and private practice midwives 210.346, which indicated that the higher unit cost in community health center. Tariff proposition was still 500.000 both in community health center and private practice midwives with the policy of improving the community health center services. JHI program effectiveness is the role of various parties, both the local government as policy makers in setting the of subsidy, JHI Management Council to seek tariffs on basis of unit cost and health provider to provide good service and cost efficiency. G9vernment allocated a budget to improve community health center services that increase the utilization or reconsider use of normal deliveries in community health centers.
Kata Kunci : Tarif, unit cost, persepsi stakeholder
