Analisis Pembiayaan Kesehatan bersumber Pemerintah dengan Pendekatan District Helath Account (DHA) di Kabupaten Bulungan Provinsi Kalimantan Utara

SRI WARDANI, Dr. Fahmi Radhy, MBA, Dr. drg. Julita Hendrartini, M.Kes

2015 | Tesis | S2 Ilmu Kesehatan Masyarakat

INTISARI Latar belakang :Pembiayaan kesehatan di Indonesia masih menjadi permasalahan, isu kurangnya alokasi anggaran, missaloccation, dan inefisiensi pembiayaan kesehatan masih terjadi di Kabupaten Bulungan yang berdampak pada kinerja pelekasanaan program guna mencapai target MDGs dan SPM bidang kesehatan. DHA digunakan untuk menggambarkan aliran pembiayaan kesehatan di Kabupaten Bulungan yang dapat memberikan informasi secara rinci dan lengkap dalam proses perencanaan dan penganganggaran yang lebih efisiensi dan berbasis kinerja. Tujuan penelitian : Mendeskripsikan pembiayaan kesehatan bersumber pemerintah berdasarkanketersediaan, pengalokasian dan pemanfaatan biaya kesehatan serta mengidentifikasi efisiensi alokatif pembiayaan kesehatan bersumber pemerintah. Metode penelitian : Penelitian ini adalah penelitian deskriptif menggunakan pendekatan penelitian kuantitatif. Instrumen penelitian yang digunakan untuk analisis data adalah pivot table dan DEA frontier. Hasil Penelitian : Proporsi ketersediaan pembiayaan kesehatan bersumber pemerintah di Kabupaten Bulungan sebagian besar dibiayai melalui APBD Kabupaten (96,90%). Dinas Kesehatan sebagai agen pembiayaan kesehatan paling dominan (35,20%) dan RSUD (25,51%). Sebagai agen pembiayaan institusi tersebut juga sebagai provider dengan alokasi biaya kesehatan untuk Dinas Kesehatan (40,25%). Biaya kesehatan sangat tinggi untuk kegiatan tidak langsung (71,69%), sedangkan kegiatan kesehatan masyarakat dan kesehatan individu alokasinya sangat kecil masing masing 20,20% dan 8,02%. Program kegiatan penunjang juga mendominasi biaya kesehatan (74,39%) untuk kegiatan administrasi dan manajemen. Sebagian besar biaya kesehatan untuk operasional (54,32%) dan biaya investasi (44,55%). Jenjang kegiatan pelaksanaan biaya kesehatan di kabupaten(77,90%). Distribusi penerima manfaat biaya kesehatan untuk semua umur (70,27%) dan usia produktif (28,80%). Efisiensi alokatif pembiayaan kesehatan bersumber pemerintah ditemukan 4 program yang selalu efisien yaitu diare, demam berdarah, kesehatan remaja dan pengobatan umum dari 21 programyang efisien secara skala. Kesimpulan :

Background: Health funding in Indonesia remains a significant problem. Issues related to the lack of budget allocation, misallocation, and inefficiency of health funding still occurs at Bulungan Regency which affects program impelementation performance in achieving MDGs and SPM targets at health sector. DHA was applied to describe health funding flow at Bulungan Regency which facilitates details and complete information delivery in efficient and performance-based planning and budgeting process. Objective : To identify government-based health funding by source of funding, budget administrator, service provider, types of activities, types of program, level of activities and beneficiaries, and to identify the allocation efficiency of government-based health funding. Method: This is a descriptive research with quantitative approach. Instrument of research applied for data analysis was pivot table and DEA frontier. Result: The proportion of government-based health funding at Bulungan Regency was mostly funded by APBD or Local Government Budget (96.90%). The health budget administrator is mostly dominated by the Health Office (35.20%) and then followed by RSUD or Regional Public Hospital (25.51%). Aside from being budget administrator, these offices also works as service providers with health budget allocation for the health office (40.25%). The health budget is significantly high for indirect activities (71.69%), meanwhile the allocation of public health activities and individual health is fairly low, 20.20% and 8.02% respectively. Supporting activities program also dominates health budget (74.39%) in terms of administration and management. Most of the health budget was allocated for operational affairs (54.32%) and investment cost (44.55%). Levels of implementation program of health budget at the regency (77.90%). Beneficiary distribution of health budget for all ages (70.27%) and productive age group (28.80%). There were 4 consistently efficient program related to the allocaton efficiency of government-based funding, namely diarrhea, denguehemorrhagicfever, youthhealth, and individualhealthpromotionprogram out of 21 scale-based efficient programs. Conclusion: Health funding is still inefficient in terms of allocation as it's mostly dominated by indirect activities, which in turn adversely affects the accomplishment of health programs. Key words: Health funding, District Health Accounts (DHA), allocation efficiency.

Kata Kunci : Health funding, District Health Accounts (DHA), allocation efficiency.