ANALISIS EQUITY JAMINAN KESEHATAN RAKYAT ACEH

M. YANI, DR. M.KES., PKK, Prof.dr. laksono Trisnantoro, MSc., Ph.D; Dr. Drg. Julita Hendrartini, MKes

2016 | Disertasi | S3 Ilmu Kedokteran

Latar belakang: Pemerintah Aceh sejak tahun 2010 melaksanakan program asuransi kesehatan sosial dengan nama Jaminan Kesehatan Aceh (JKA) yang sejak tahun 2014 diintegrasikan ke BPJS. Mengingat kondisi geografis dan penyebaran fasilitas serta tenaga kesehatan di Aceh, masalah ketidak adilan (inequity) menjadi tantangan untuk pencapaian Universal Health Coverage di Aceh pada tahun 2019. Tujuan: penelitian ini mendapatkan hasil analisis tentang gambaran equity program JKA berdasarkan utilisasinya dari status demografik peserta, gambaran peta penyakit, pengaruh jarak, ketersediaan asuransi serta perubahan tenaga kesehatan terutama dokter spesialis dan fasilitas kesehatan (tempat tidur) di 23 kabupaten/kota di Aceh. Metode: Penelitian ini adalah studi kasus dengan data bersumber dari peserta BPJS yang dianalisis secara time series berbasis geografis. Hasil: Terdapat in-equity yang semakin meningkat antar kepesertaan didalam pemanfaatan pelayanan rumah sakit. Dijumpai in-equity antarkabupaten/kota, dan antar regional. Jarak tempat tinggal berpengaruh terhadap pemanfaatan pelayanan. Peserta JKA (PBI-APBD) lebih besar menggunakan fasilitas pelayanan dibandingkan dengan peserta lainnya. Peserta Bukan Pekerja lebih banyak menderita penyakit non infeksi dan menghabiskan biaya tertinggi walaupun persentase jumlah kasus penyakit lebih kecil. Respon pemerintah Aceh dalam pemenuhan dokter spesialis dan distrubusi fasilitas kesehatan belum maksimal. Respon positif penambahan dokter dan fasilitas kesehatan bukan disebabkan oleh peran pemerintah Aceh melainkan oleh program BRR tahun 2006. Kesimpulan: Pelaksanaan kebijakan Jaminan Kesehatan Aceh dikhawatirkan tidak mencapai UHC pada tahun 2019 dan belum sesuai dengan amanah UU SJSN (2004) tentang keadilan sosial. Peran pemerintah Aceh, pemerintah daerah dalam penyediaan dan mendistribusikan tenaga dokter spesialis dan sarana kesehatan pada terutama kabupaten terlihat masih lemah. Saran Kebijakan: Untuk meningkatkan keadilan, distribusi tenaga kesehatan dan rumahsakit perlu diseimbangkan antar daerah dengan dana APBD dan APBN. Subsidi kepada kelompok peserta Jamkesmas (PBI-APBN) perlu dipertahankan dan ditambahkan dengan penyediaan rumah singgah. Kebijakan pemerintah Aceh dalam membayar premi kepada kelompok PBI-APBD sebagai local wisdom perlu batas waktu. Perlu ada pembatasan manfaat pelayanan medik untuk peserta BPJS dari kelompok mampu (bukan PBI).

Background: The Government of Aceh since 2010 has been embarking and implementing a policy to improve access to equitable healthcare protection for the community by carrying out a public health insurance program called Aceh Health Insurance (JKA). The JKA Program became a breakthrough as an effort to achieve the concept of universal health coverage along with the Healthcare and Social Security Agency (BPJS). Although in existence from 2010, there has been no research on equity for the implementation of universal health coverage until these days that analyzes the supply side based district/regional. Objectives: The aim of this study was to obtain the results of the analysis of the equity overview of JKA program through utilization levels based on demographic status of participants, mapping of disease, the impact of distance, availability of insurance (JKA) also the changing of availability of health workers especially specialists and health facility (bed) in 23 districts/cities in Aceh. Methods: This research is a case study on the topic of equity in implementation of Aceh Health Insurance that the data has been analyzed in time series. Results: Analysis result showed there is inequity amongst the participant in the utilization of hospital services. ASKES membership utilized the preponderant services compared to other membership. The inequity encountered between district/city, inter-regional. The district/city, the regional that has good resources and with condition not in remote and economically privilege area used the service higher. The distance of domicile were affecting on service utilization. There is inequity amongst JKA membership after integration, membership non workers more suffered the non-infectious diseases and spending a high cost though the percentage of number of disease case lower compared to membership of PBIAPBN whom higher suffered the infectious diseases. There were the addition of specialists and beds after the implementation of JKA health insurance. Positive response was not caused by the Government of Aceh but by BRR intervention program in 2006. Conclusion of the implementation of health coverage in Aceh is not yet accordance with the mandate of Law Number 40 on SJSN, there are still areas that have not been competent to utilize the health insurance because there is still roadblock in fulfillment of resources. Recommendations: The role of the Government of Aceh, the local government in provision and distribution specialists and health facility especially in district need xx to carry out immediately. The subsidy to the membership group of Jamkesmas (PBI-National Budget) should be maintained and added by provision of boarding house in order the equity in implementation of JKA can be achieved.

Kata Kunci : Aceh Health Coverage, Equity, Regional, Health workforces, Health Facility