IMPLEMENTASI PENATALAKSANAAN PERSALINAN PASIEN PESERTA BADAN PENYELENGGARA JAMINAN SOSIAL (BPJS) KESEHATAN DI PUSKESMAS PERAWATAN KOTA BENGKULU

EDI PRIANTO, Prof. dr. Mohammad Hakimi, Sp OG (K), Ph.D;Dr. dr. Mubasysyir Hasanbasri, MA

2015 | Tesis |

Latar Latar Belakang: Pada era BPJS sekarang ini persalinan normal diutamakan dilakukan di fasilitas kesehatan tingkat pertama, penjaminan persalinan normal di fasilitas kesehatan tingkat lanjutan hanya dapat dilakukan dalam kondisi darurat. Berdasarkan laporan Dinkes Kota Bengkulu tahun 2013 jumlah kematian ibu saat persalinan sebanyak 9 kasus, dan diketahui bahwa sebagian besar justru terjadi pada mereka yang dirujuk oleh puskesmas, hal ini mengindikasikan bahwa proses penatalaksanaan persalinan di puskesmas belum berjalan dengan baik. Bidan atau dokter puskesmas sebagai tenaga kesehatan harus mempunyai kesiapan untuk merujuk ibu dan bayi ke fasilitas kesehatan rujukan secara optimal dan tepat waktu, apabila menghadapi kesulitan dalam pelaksanaan persalinan di fasilitas kesehatan tingkat pertama. Tujuan: Mengetahui implementasi penatalaksanaan persalinan pasien peserta BPJS kesehatan di puskesmas perawatan Kota Bengkulu. Metode Penelitian: Jenis penelitian ini adalah penelitian kualitatif dengan rancangan studi kasus. Penelitian ini dilakukan di 3 puskesmas perawatan Kota Bengkulu. Informan penelitian ini berjumlah 18 0rang yang terdiri dari 3 orang kepala puskesmas, 3 dokter, 3 bidan, 3 perawat dan 6 pasien persalinan peserta BPJS di puskesmas perawatan Kota Bengkulu. Hasil Penelitian: Besar tarif persalinan pervagina dengan tindakan emergensi dianggap kurang mencukupi, dimana persalinan tersebut memerlukan pelayanan tambahan yang menambah beban kerja tenaga kesehatan khususnya bidan. Pemeriksaan USG dan operasi tidak dapat dilakukan di puskesmas perawatan. Dalam melakukan penatalaksanaan persalinan puskesmas perawatan menghadapi hambatan antara lain ketersediaan alat medis, ketersediaan obat dan iur biaya yang masih ada untuk pasien. Untuk kasus penatalaksanaan persalinan, masih ditemukan ibu yang meninggal saat persalinan sebanyak 7 persalinan. Kesimpulan: Biaya persalinan dengan tindakan emergensi masih sangat kurang dan pembayaran jasa pelayanan mendapatkan potongan yang menyebabkan ketidak sesuaian dengan beban kerja. Adanya beberapa anggota dari tim PONED yang sudah pindah tugas menjadikan pelayanaan tidak maksimal. USG dan tindakan operasi tidak dapat dilakukan di puskesmas. Terdapat hambatan-hambatan dalam penatalaksanaan persalinan yaitu pemanfaatan alat medis, kekosongan obat dan iur biaya.

Background: In this era BPJS are now give normally birth priority will be done in health care facilities first level, give normally birth in health care facilities advance can only be done in a state of emergency. According to a report in Bengkulu City in 2013 of maternal mortality at the time of birth as much as 9 cases , and it is known that most exactly happened to them that are referredby primary health care, this indicates that the assessment delivery in the primary health care has not run well. Primary health care doctor, midwives, and health workers must have a readiness to refer mother and child health facility reference optimally and on time, when facing difficulties in the implementation giving birth in health care facilities first level. The purpose: To know implementation of birth managements for BPJS participants health care primary health care in Bengkulu City. Method : This kind of this research is qualitative research with design case studies. This research will be done in 3 primary health care Bengkulu City. Informant or was 18 persons that consist of 3 persons the head of the primary health care, 3 doctors, 3 midwives, 3 nurses and 6 patients delivery in the primary health care participants BPJS in Bengkulu City. Results of Research: The cost normally births rate with emergency measures are considered less sufficient, where delivery requires additional services which fuelled work load health workers particularly midwives. USG examination and operations could not be done in the primary health care for treatment. In doing birth managements in primary health care facing obstacles among others availability medical instrument, availability and drug andfees that there are still for patients. For the case birth assessment, was still found mother who died at the time of birth as much as 7 births. Conclusion: The cost of birth on the emergency actionsis still very short and payment services to get broken pieces that cause of compliance with work load. The presence of some members of the team PONED who had already moved tasks made services not maximum. And the actions USG operation is not can be done in the primary health care. There are obstacles in curing delivery that is using medical instrument, drugs lessand cost. Key words : Managements of delivery, Kapitasi System, BPJS.

Kata Kunci : Managements of delivery, Kapitasi System, BPJS