PENGELOLAANDANAKAPITASI PUSKESMAS PROGRAM JAMINAN KESEHATAN NASIONAL DI KABUPATEN BALANGANPENGELOLAANDANAKAPITASI PUSKESMAS PROGRAM JAMINAN KESEHATAN NASIONAL DI KABUPATEN BALANGAN

Agus Syarkani, Dr. drg. Julita Hendrartini, M.Kes, AAK.; Dr.drg. Dibyo Pramono, SU.,MDSc.

2016 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang : Pelaksanaan program Jaminan Kesehatan Nasional yang telah dilaksanakan sejak tanggal 1 Januari 2014 membawa perubahan mendasar dalam sistem pembayaran pada Fasilitas Kesehatan Tingkat Pertama/Puskesmas. Sebagian puskesmas yang selama ini mendapat pembayaran langsung/out of pocket dari pasien yang dilayani, sejak era JKN mendapat pembayaran dengan pola prospective payment system, dengan model Kapitasi. Pemanfaatan dana kapitasi puskemas menurut Peraturan Presiden Nomor 12 tahun 2014 tentang pemanfaatan dana kapitasi pada FKTP milik Pemerintah Daerah serta Peraturan Menteri Kesehatan Nomor 59 Tahun 2014 tentang Pemanfaatan Dana Kapitasi Puskesmas, bahwa dana kapitasi puskesmas di alokasikan untuk jasa pelayanan dan dukungan biaya opersional pelayanan kesehatan. Pemanfaatan dana kapitasi puskesmas untuk jasa pelayanan di Kabupaten Balangan terealisasi secara penuh. Tetapi realisasi dana kapitasi untuk dukungan biaya operasional pelayanan kesehatan masih sangat rendah. Tujuan : Penelitian ini bertujuan untuk mendiskripsikan pemanfaatan dan pengelolaan dana kapitasi puskesmas untuk dukungan biaya operasional pelayanan kesehatan di Kabupaten Balangan Metode : Jenis penelitian ini adalah kualitatif dengan rancangan study kasus, penelitian dilakukan di Kabupaten Balangan dengan informan para stakeholder yang bersentuhan langsung dengan pengelolaan dana kapitasi puskesmas. Responden dalam penelitian ini berjumlah 18 orang, 4 orang kepala Puskesmas, 4 orang bendahara JKN puskesmas, 4 orang tenaga puskesmas yaitu perawat/bidan/tenaga kesehatan yang lain, kepala Dinas Kesehatan, kabid Promosi Kesehatan, Kasi/staf yang menangani jaminan kesehatan, Kasubbag Program Pelaporan, Anggota DPRD Kabupaten Balangan dan LSM. Hasil : Pemanfaatan dan pengelolaan dana kapitasi puskesmas belum terealisasi sesuai dengan peraturan dan peruntukannya, terutama pemanfaatan untuk dukungan biaya operasional pelayanan kesehatan. Faktor-faktor yang menyebabkan rendahnya serapan dana kapitasi dukungan biaya operasional pelayanan kesehatan adalah rendahnya tingkat sosialisasi, keterlambatan perencanaan, petunjuk teknis yang kurang lengkap dan tidak rinci, pertanggungjawaban yang dianggap sulit, dan kompetensi yang tidak memadai.

Background: The implementation of the National Health Insurance program which has been started since January 1, 2014 brought a fundamental change on the payment system in Primary Health Care facilities/PHC. Most health centers which have received direct payments/out of pocket from patients, since the era of JKN receive payment with prospective payment system, using capitation models. The use of capitation funds clinics organized by Presidential Decree No. 12 of 2014 on the use of capitation funds on FKTP belonging to the Local Government and the Minister of Health Regulation No. 59 of 2014 concerning the utilization of primary health center capitation funds, which stated that primary health centers capitation funds are allocated for services and support operational cost of health care. The realization of capitation funds to support operating costs of health services in Balangan district is still very low. Objective: To describe the management and utilization of capitation funds in primary health center. Methods: The study is a qualitative descriptive with case study design, research conducted in Balangan with stakeholders who personally come in contact with capitation fund management as informant. Respondents in this study were 18 people, 4 heads of primary health centers, 4 capitation treasurers of primary health centers, 4 staffs the clinic, head of the Department of Health, head of Health Promotion Department, Kasi/staff who deal with health insurance, Head of Reporting Program Department, Member of Balangan District Parliament and NGOs. Results: Management and utilization of primary health centers capitation funding has not been realized according to the rules and allocation, so that its utilization to support operational cost are still very low. Factors that led to low uptake of capitation funds in operational support is the low level of socialization, organizational management, treasurer competency, unspecified regulations, and stakeholderinadequate awareness about capitation. Conclusion: Utilization of capitation funds for operational support in health services is still very low due to several factors, such as lack of socialization, delays on activities planning and technical, weak managerial as well as accountability restraints.

Kata Kunci : Management, Utilization, Capitation Fund, National Health Insurance, Competence.