PEMENUHAN HAK PASIEN ASKES DENGAN TINDAKAN BEDAH DI UNIT RAWAT INAP RSUD SLEMAN

Elli Yuliani, Prof. dr. Adi Utarini, MSc., MPH., PhD.

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Peningkatan mutu pelayanan kesehatan menjadi isu utama dalam pembangunan kesehatan baik dalam lingkup nasional maupun global. Pemenuhan hak pasien menjadi hal mutlak yang harus diperhatikan dalam tatalaksana pelayanan kesehatan yang berkualitas. Per 01 Juni 2011 RSUD Sleman dan PT Askes Cabang Yogyakarta telah sepakat untuk meningkatkan mutu layanan pasien Askes dengan peningkatan tarif kerja sama dan peniadaan iur biaya. Dengan angka BOR >90%, menarik untuk dipelajari apakah hak pasien Askes terhadap hak kelas perawatan, hak bebas iur biaya serta hak informasi tetap dapat terpenuhi. Analisis atas pemenuhan hak ini penting dilakukan, mengingat semakin kritisnya pasien dalam memilih dan menilai kinerja provider kesehatan. Tujuan: Mengukur tingkat pemenuhan hak serta mengetahui pengaruh karakterisitik pasien dan penyakit terhadap pemenuhan hak pasien bedah Askes, sekaligus mengidentifikasi kendala yang dihadapi RSUD Sleman dalam pemenuhan hak layanan pasien bedah Askes. Metode: Penelitian menggunakan Mixed Method Sequential Explanator yang menggabungkan antara metode kuantitatif dan kualitatif. Studi deskriptif kuantitatif dilakukan untuk mendapatkan gambaran tingkat pemenuhan hak pasien rawat inap Askes dengan tindakan bedah di RSUD Sleman periode 01 Agustus - 30 September 2012. Hasil penelitian dikembangkan menggunakan studi kualitatif dengan wawancara mendalam guna mengidentifikasi kendala yang dihadapi RSUD Sleman dalam pemenuhan hak pasien bedah Askes. Responden terdiri dari pasien bedah Askes, petugas Askes Center, kepala ruangan, dokter dan pihak manajemen rumah sakit. Hasil dan Pembahasan: Tingkat pemenuhan hak kelas perawatan sebesar 51,43%, kesesuaian hak bebas iur biaya kamar sebesar 58,57% dan kesesuaian hak bebas iur obat sebesar 1,43%. Sementara kelengkapan Informed Consent bedah mencapai 8,57% dan Informed Consent anestesi mencapai 85,71%. Karakteristik pasien dan penyakit tidak memiliki pengaruh terhadap tingkat pemenuhan hak. Pemahaman pasien Askes atas pemenuhan haknya sudah cukup baik namun penjelasan informasi masih kurang memadai. Faktor yang menjadi kendala pemenuhan hak antara lain keterbatasan kapasitas ruang perawatan, kurangnya sosialisasi hak layanan kepada pasien Askes dan kurangnya monitoring ketersediaan obat DPHO. Upaya yang telah dilakukan antara lain penambahan ruang rawat dan pertemuan rutin antara pihak rumah sakit dan Askes. Kesimpulan dan Saran: Upaya pemenuhan hak pasien Askes belum optimal. RSUD Sleman dan PT. Askes harus meningkatkan sosialisasi hak kepada pasien Askes, mengupayakan suatu sistim layanan yang dapat memberikan kepastian besaran iur biaya kamar/obat di luar jaminan Askes, pemantauan ketersediaan obat DPHO serta meningkatkan performa petugas front liner dengan memberikan pendidikan dan pelatihan mengenai pelayanan prima.

Background: Improving quality of health care is a major issue in national and global health development. Fulfillment of patient's rights is absolutely to be critical in the management of quality health care. As of June 1, 2011 Sleman District Hospital and PT. Askes Branch Yogyakarta have agreed to improve the quality of services through increased tariff within the colaboration and no cost sharing policy. With BOR rate > 90%, interesting to be learned whether the right patient for the right class Askes care, freedom and the right cost sharing information can still be met. Analysis of the fulfillment of this right is important, given the critical patients in selecting and assessing the performance of health care providers. Objective: Measure the level of fulfillment of Askes inpatients with surgical at Sleman District Hospital, and knowing the influence between characteristic of patient and disease with fulfillment of patient right and identify factors which become obstacles in the fulfillment of Askes surgical patient’s right. Methods: This study used Mixed Method Sequential Explanatory design. Quantitative descriptive study was conducted to measure the level of fulfillment of inpatients undergoing surgery at Sleman District Hospital, for the period of 2 months. Qualitative data collection with in-depth interviews was carried out to identify constraints faced by hospitals in fulfilling of Askes surgical patients. Respondents consisted of surgical patients covered by Askes, officers at Askes Center, chief of ward, doctors and hospital management representative. Results and Discussion: The fulfillment of appropriate class was 51.43%, with no room cost sharing was 58.57% and no medication cost sharing was 1.43%. Completeness of surgical informed consent only reached 8.57%, unlike anesthesia informed consent which was 85.71%. There is no influence between the characteristic of patient and disease with fulfillment of patient right. Factors that hinders fulfillment of patient rights include lack of bed capacity, lack of dissemination about patient rights and lack of monitoring drug availability. Efforts that have been made included physical expansion of inpatient and regular meetings between hospital and Askes Centre. Conclusions and Recommendations: Fulfillment of Askes patient’s right is not yet optimal. Sleman District Hospital and PT. Askes should jointly promote dissemination of rights to patients, striving for a system service that can provide information the amount of cost sharing, room avaibility and drugs not covered by Askes, monitoring DPHO drugs avaibility and improve the performance of front liners by providing education and training on excellent service.

Kata Kunci : Pasien Bedah Askes, Pemenuhan Hak, Mixed Method