2024-03-29T07:48:44Z
https://journal.ugm.ac.id/index/oai
oai:jurnal.ugm.ac.id:article/2473
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
dc
PROSPEK PENGEMBANGAN PELAYANAN HOME CARE RUMAH SAKIT PRIMA MEDIKA DENPASAR
Suarjana, Ketut
Background: Demographic and epidemiologic transitions
cause population structure and changes in disease pattern
into degenerative and chronic disease. Hospitals in Indonesia
have not developed chronic care service. Prima Medika hospital
home care (HC) has not been developed, without assessing
the prospect of HC service development as a revenue
center.
Methods: Qualitative research using methods of participation
observation; in-depth interview with patients, personnel
of HC unit, and management; close observation with checklist.
Data were analyzed qualitatively using thematic content analysis
Results: Based on concept of strategic management, the
following opportunities and potentials of HC exist: patient satisfaction,
payment ability, and benefit perception, dependences
of cancer patients and elders. The hospital has the following
strengths: personnel readiness, presence of personnel motivator,
personnel commitment to work, facility and hospital equipment,
commitment from directors. However, their weaknesses
and barriers are: limited human resources, marketing, and tariff
calculation. Challenges and expectations of patients are:
diversification of service types, use of tools, visit frequencies,
and personnel qualification.
Conclusion: The prospect of HC service development was
high. Alternatives strategy proposed are: specific administration
for HC selection and offer to patients, HC tariff making
according to unit cost, provision or coordination of personnel,
rental and sales of tools, and focus for cancer patients and
elders.
Keywords: home care, prospect, strategy
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2473
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2474
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121118 2012 eng "
1410-6515
dc
INISIASI MENYUSU DINI PADA SEKSIO SESAREA: STUDI MIXED METHODS PADA DUA RUMAH SAKIT SWASTA SAYANG IBU DAN ANAK DI JAKARTA DAN BEKASI
Izwar, Dian
Background: Early initiation of breastfeeding (EIB) for all
babies is recommended globally and nationally as a part of
Baby Friendly Hospital Initiatives. Caesarean section (C-section)
has been identified as an obstacle to EIB implementation
Objectives: (1) To measure the proportion of EIB among
babies born by C-section, and (2) To explore the barriers of
EIB in C-section.
Methods: This study used a mixed-methods study, in which
the qualitative study embedded to the quantitative study. A
cross sectional design was applied to measure the proportion
of EIB in all babies born by C-section in two baby friendly
hospitals during two months of observation. In-depth
interviews were conducted among two pediatricians, two
anesthesiologist, two obstetricians, two nurses and two
managers. Qualitative data was analyzed by content analysis.
Result: Of 68 babies born by C-section, none were performed
for adequate EIB. Variations of knowledge on EIB procedure,
lack of cooperation among SC team, lack of infrastructure and
policy, as well as other obstacle from patients’ side were
among the barriers.
Conclusion: EIB is not adequately implemented in the two
baby friendly hospitals. Standards of EIB practice should be
established and disseminated to C-section team and patients
in the hospitals.
Keywords: early initiation of breastfeeding, caesarean
section, baby friendly hospital initiative, hospital practices
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2474
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2475
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121106 2012 eng "
1410-6515
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PERSIAPAN RUMAH SAKIT SWASTA DALAM MENERAPKAN TARIF PELAYANAN JAMINAN PERSALINAN: STUDI KASUS DI RUMAH SAKIT KHUSUS IBU DAN ANAK DI KOTAMADIA MALANG
Maharani, Asri Maharani
Background: High maternal death is mainly caused by limited
access to maternity services due to unaffordable cost of services.
Therefore, a special insurance scheme named Jaminan
Persalinan (Jampersal) was launched and it is expected to be
able to solve this problem.The Muhammadiyah Maternal and
Child Hospital in Malang is a private hospital that offers obstetric
and neonatal emergency service for those with Jampersal.
The Jampersal fee was already set similar to that of Jaminan
Kesehatan (Jamkesmas)scheme, using INA-CBG. Therefore,
it is important to elicit the possibility of Jampersal fees being
accomodated by private hospital.
Objective:This research aimed to compare between Jampersal
and hospital fees and analyse efforts of a private hospital in
accomodating the INA-CBG’s pricing scheme.
Methods:This study was carried out at Muhammadiyah Malang
Maternal and Child Hospital. Unit cost calculation and hospital
pricing were collected using the secondary data available from
the department of finance in the hospital, while Focus Group
Discussion (FGD) was held with the management level to understand
willingness and opportunity of hospital managersto collaborate
with the government in providing Jampersal services.
Results: The results showed that INA-CBG’s tariff was lower
than both unit cost and hospital pricing for normal delivery and
delivery with cesarean section.The unit costand tariff of normal
delivery were Rp1.633.704,00 and Rp2.070.275,00, respectively.
Both of them were higher than the INA-CBG’s tariff
(i.e., Rp1.487.770,00).The INA-CBG’s tariff for cesarean section
(i.e. Rp2.712.943,00) was lower than both the unit cost
and hospital tariff of similar service (i.e. Rp4.782.072,00 and
Rp 5.110.500,-, respectively). From the FGD, it was found that
unlike for cesarean section, efforts to accommodate the Jampersal
pricing for patients with normal delivery are possible.
Conclusions: The findings indicate that Jampersal feesare
lower than both the Muhammadiyah Malang Maternal and Child
Hospital’s pricing and unit cost.Development of clinical
pathwaymay become a solution for the hospital to apply the
INA-CBG’s tariff.
Keywords: fees, Jampersal, private hospital
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2475
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2476
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
dc
KETERLEKATAN DOKTER SPESIALIS DI EKA HOSPITAL BSD-CITY DAN PEKANBARU
Tjung, Lipin
Background: Physicians engagement to the hospital is more
important due to the growth and development of hospital as
well as tighter competition. Eka Hospital management attempted
to change the strategy for designing remuneration system and
physician partnership patterns so that physicians as the main
actors in medical service have high engagement to the hospital.
Objective: To analyse the correlation between remuneration
system, physician partnership patterns and physicians engagement
at Eka Hospital, and to analyse other related factor
influencing physicians engagement to the Eka Hospital.
Method: This study used a cross-sectional survey, supplemented
by qualitative data collection. Data were analysed using
correlation between remuneration system, physician partnership
patterns and physicians engagement.The instruments
applied in this study were questionnaires concerning perceptions
of the remuneration system that have been tested for its
validity and reliability, adopted from the Utrecht Work Engagement
Scale.
Result and discussion: The study showed that only 30% of
physicians at Eka Hospital had strong engagement. Most physicians
with positive perception toward remuneration system
had strong engagement to Eka Hospital. While those with low
engagement also had negative perception toward the remuneration
system. Most physicians with strong engagement
were part-time specialists. Likewise, those with weak engagement
were also part-time specialists. Engagement was
not only related to material or income they received but also
other non-material forms of reward and recognition. There
was a correlation between physicians engagement with working
location. BSD-City physicians had stronger engagement
than Pekanbaru physicians. By specialization, non surgery
physicians had higher engagement than surgery physicians.
Another related factors to physician engagement were motivations
of working at Eka Hospital, such complete facility to
enable them to develop their skill and professionalism, and
similar vision and mission with Eka Hospitals.
Conclusion: There was no correlation between remuneration
system and part time or full time physician engagement.
Physician engagement was related to hospital perception support
like completeness of the facility and staff support, vision
and mission of the hospitals and prospect for development of
skills and professionalism.
Key words: physicians engagement, remuneration, private
hospital
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2476
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2477
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
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MONTE CARLO SIMULATION FOR ANALYZING OPERATING THEATRE UTILIZATION SIMULASI MONTE CARLO DALAM MENGANALISIS UTILISASI KAMAR OPERASI
Hasan Basri, Mursyid
Background: Previous researches in different countries studied
about operating theatre performance, but in Indonesia less
research has been conducted. Operating theatre performance
is measured by utilization rate, however the way utilization
measured in practice is different with the general terminology.
We conduct research in one referral hospital. It was declared
that although the utilization of operating theatre is not high,
many patients wait for the services. Therefore, the objectives
of this research are to validate the low utilization rate and to
identify causes of unutilized capacity of operating theatre.
Method: This research applied statistical description method
to analyze the utilization with general terminology, and the
Monte Carlo simulation is run to identify what factors that cause
unutilized capacity. Three scenarios are used in the simulation.
First scenario is simulation with no cancellation occurs,
the second is simulation with cancellation, and the third scenario
is simulation for determining unutilized capacity due to
waiting and idle time in operating theatre.
Results: This study has successfully revealed factors causing
unutilized capacity of operating theatre i.e. number of cancellation,
waiting for facilities, and idle capacity. Our study
shows that 1% of cancellation rate will reduce utilization about
1%. This study also indicates that unutilized capacity due to
waiting for facilities and idle capacity in these operating theatres
is fairly high.
Conclusion: It had confirmed that operating theatres in the
hospital are in low utilization and need for improvement. Determining
utilization rate with Monte Carlo simulation provides more
information to hospital manager for decision making process.
Keywords: operating theatre, utilization, monte carlo simulation,
healthcare services
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2477
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2478
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
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EVALUASI PERENCANAAN DAN PENGANGGARAN DINAS KESEHATAN KABUPATEN PESISIR SELATAN PROVINSI SUMATERA BARAT
Kani, Abdul
Background: Pesisir Selatan District Health Office faces complex
problems with limited budget available. The budget is determined
in accordance to Act No. 25/2004 about the National
Development Planning System, Act No. 32/2004 about the Regional
Government, and Act No. 33/2004 about the balance
between central and district government budget.
Objective: This study is aimed to evaluate factors influencing
the implementation of planning and budgeting at Pesisir Selatan
District Health Office.
Methods:This was a qualitative study adopting a case study
strategy. The unit of analysis was the district level and data
were gathered through in-depth interviews. Key persons were
chosed reflecting the management capacity of district health
office, the executive role (Regional Government Budgeting
Team/RGBT), and the legislative role (Assembly at Regional
Level) at Pesisir Selatan District. Triangulation was conducted
by documents analysis and observation to enhance data quality.
Analysis was carried out through coding and categorization.
Results: The role of management was still weak in financial
planning and budgeting. This was due to lack of training on
budgeting and inaccurate data about the health problems. Coordination
in planning management was still weak because
the health centers were not involved, causing overlaps between
the programs. The resulted plan and budget made by
the district health office was revised by RGBT because they
were not convinced with the budget and the regional expenditures
and revenues budget was limited. The local parliament
was also not able to increase budget for the health sector.
Budget expenditure in years 2006, 2007, and 2008 were still
low.
Conclusion: planning and budgeting capacity of health office
management remain weak, which affect deficiency of health
budget. In the other hand local parliament could not be able to
increase health budget.
Keywords: planning and budgeting, health office, decentralization
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2478
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2479
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
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LAMA WAKTU OPERASI, LUAS DAERAH OPERASI, BANYAKNYA LARUTAN IRIGASI DAN JENIS ANESTESI DENGAN KOMPLIKASI YANG TERJADI PASCAODONTEKTOMI
Heryono, Andi
Background: There have been changes in clinical performance
management paradigm. Previously, clinical management
focused on the outcome occurred. Nowadays, the improvement
of health care processes becomes the main focus. Impacted-
tooth case is a frequentdental problem and a major
cause of patient complaints.Common complications during
odontectomy are oedema, trismus, paresthesia and dry socket.
Objective: This research aims to measure the relations between
operating time, operating area, amount of irrigation and
type of anaesthesia used with post odontectomy complications,
and to measure factors affecting odontectomy complications.
Methods: This study applied a cross-sectional study design.
Data were collected prospectively at Cipto Mangunkusumo
Central Hospital, consisting of subjective and objective clinical
examinations. Patient complaints post odontectomy, length of
surgery, operations area, amount of irrigations and type of
anaesthesia used were collected.The data obtained were
analyzed by using multiple logistic regression methods.
Results: There were 57 patients aged 18-55 years. Co-morbidity
was significantly associated with higher odontectomy
complications (p=0.026). Oedema, trismus, and paresthesia
increased with increasing length of surgery. However, length
of operation, operations area, amount of irrigations and type
of anaesthesia used were not statistically associated to odontectomy
complications.
Conclusions:Co-morbidity is associated with higher postoperative
morbidity. In revising and implementing clinical protocol,
co-morbidity should be considered as an important factor.
Keywords: clinical performance, complications, odontectomy,
teaching hospital
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2479
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2480
2024-03-29T07:48:44Z
jmpk:ART
nmb a2200000Iu 4500
"121110 2012 eng "
1410-6515
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PENGALAMAN PASIEN DIRAWAT INAP SEBAGAI UPAYA PERENCANAAN BAURAN PEMASARAN (STUDI FENOMENOLOGI DI RUMAH SAKIT X KABUPATEN MALANG, JAWA TIMUR)
Juhariah, Siti
Background: A good exploration of patient’s behavior in
choosing hospital and patient’s experience will build an
opportunity for hospital, especially on how hospital could make
a customer oriented product. Suitability of hospital product and
patient’s need can assure that the marketing process is driven
by the patients. Hospital mixed marketing as a marketing tool
can be used by hospital in order to get a right positioning at
target market, it was influenced the patients to chose hospital
as well.
Methods:It is a qualitative study with phenomenology approach
to descriptively know about patient’s experience during
hospitalization at Hospital X, District Malang. The baseline
phenomenon was consistently high visiting patients at Hospital
X among hospital competition in District Malang. We purposively
take six patients to include this study.
Results: We got some assessment regarding patient’s services,
hospital environment, and patient’s reason in choosing
Hospital X. Patient feel comfort during hospitalized, They reported
as: they were served by ‘friendly doctors’, ‘caring and
efficient nurses’ and ‘diligent cleaning services’. They enjoy
hospital environment such as: fresh air, no unpleasant odor,
clean room and toilet, a good clean maintenance, even at a
quite a big building hospital. A fast response time also was felt
by patients, with no class differentiation. Patient and relatives
can know well about hospital rule and direction, they feel well
informed. Patient feel happy with hospital payment, because it
was charged after all service finished. The reasons on how
patients chose this hospital X were components of: distance
(place), price, doctors (people), fast response time (process),
hospital environment (physical evidence). All these reasons
called mixed marketing components. Other reason out of mixed
marketing component is prestige.
Conclusion: By phenomenological approach, a good exploring
patient’s experience can use as marketing planning by
Hospital. A good marketing planning and strategy made hospital
be better during massive competition era.
Key words: patient’s behavior, experience, phenomenology,
mixed marketing
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
application/pdf
https://journal.ugm.ac.id/jmpk/article/view/2480
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
eng
Copyright (c)
oai:jurnal.ugm.ac.id:article/2481
2024-03-29T07:48:44Z
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nmb a2200000Iu 4500
"121110 2012 eng "
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EDITORIAL
Adi Utarini, Yodi Mahendradhata
Over 1700 participants from over 100 countries
attended the Second Global Symposium on Health
System Research in Beijing from October 31 to
November 3, 2012. The Symposium discussed stateof-
the art health system research and strategies for
strengthening health systems research through keynotes,
plenaries, concurrent sessions, satellites,
posters, films, informal discussions and debates.
One of the symposium sessions presented a
conceptual framework for health system research
which encompasses systems at macro-, meso- and
micro- levels. Health service research was depicted
at the meso- and macro- level of the systems, and
management research was noted as part of the
health service research domain. Thus, health service
management was viewed as a part of the overall
health system research domain.
The panelists highlighted that there are important
differences between research to support policymaking
at macro-level and research to support management
decision making. They first emphasized
that the nature of the evidence required would differ,
depending much on whom the evidence is supporting,
e.g. goverment official, hospital manager, health
professional, citizens. Second, they noted that it
would also be different depending on whether we are
supporting them: (1) to select which programs, services
and drugs to fund; or (2) to strengthen governance,
financial and delivery arrangements within
systems.
They further argued that decisions about services
and programmes are typically a single decision
made at a single point in time by a clearly defined
decision-maker as part of routine decision
making. In contrast, policy making decisions are
typically consisted of a number of heterogenous
decisions, made over a long period of time, by a
broad range of different decision makers, with little
or no routinization. They also highlighted that the
benefits, harms and costs of programs, services and
drugs are less context dependent, while the pros
and cons of policies at macro-level is much more
context dependent. Hence, in health policy research,
local tacit knowledge, views and experiences matter
much more.
The debate described above represents an effort
to clarify the boundaries of health system research,
health policy research and health service
research. There are however critical issues which
needs to be examined further, particularly in the interest
of health services management research.
Firstly, it is rather misleading to portray health service
management decision as typically technical,
routine and clear cut. The health service management
decision spectrum arguably spans from complete
certainty in one end to absolute ambiguity on
the other end, and many in between. There can be
political dimensions to these decisions, eventhough
they are at the organization or sub-organization level,
as they often entail allocation of scarce resources.
Thus, there are considerable rooms for local tacit
knowledge, views and experience as well within
health service management research. Secondly,
many management interventions are also context
specific. A management decision to adopt clinical
pathway may lead to significantly better clinical outcomes
in one hospital, but may result in minute
improvement of clinical outcomes in another
hospital.Thus, it is too risky to emphasize that health
service managementdecisions are not so much influenced
by context. Health service management
researchers who fail to discuss contextual matters,
may risk having their results haphazzardly generalized
or replicated. These points suggest that important
characteristics of health service management
research have not been adequately considered in
the symposium discourse above.
The relative neglect of health service management
research in the current discourse reflects the
lack of active contribution from health service management
researchers, and perhaps also reflects the
nature of a field which has not been much well developed
scientifically. This calls for efforts to strengthen
health service management research as a scientific
field. Drawing from efforts to strengthen health system
research as a field, we can think of several possible
ways to do this. First, we need to establish a
common language by developing authoritative textbooks,
journals and courses in health service management
research. Secondly, we need to promote
cross-disciplinary learnings as heallth service management
research is typically multidisciplinary. Third,
we need a society for health service management
research at national and international level. Fourth,
we need more professors, authoritative scientific leaders,
in health service management research.
98 Jurnal Manajemen Pelayanan Kesehatan, Vol. 15, No. 3 September 2012
Yodi Mahendradhata & Adi Utarini: What do we mean by health service ...
JMPK, the Indonesian Journal of Health Service
Management, remains committed to contribute
toward strengthening health service management
research by providing an accessible common peerreviewed
platform for state-of-the art health service
management researches since more than a decade
ago. We have attempted to make JMPK as accessible
as possible by providing online access to published
content. We will soon expand further by providing
possibility for online submission as well.
However, we are still left with the absence of
authoritative textbooks and society of health service
management research community in the country, in
contrast to what we have in epidemiology or clinical
research for instance.In the field of epidemiology,
there is the International Epidemiological Association
which publishes the International Journal of Epidemiology
and organizes the World Congress of
Epidemiology. At the national level, we also have
the National Epidemiology Network (JEN). The field
of epidemiology also benefits from authoritative textbooks,
such as those written by Kenneth J Rothman.
For clinical research, there is the International Clinical
epidemiology network and the field benefits from
authoritative textbooks such as those written by David
Sackett or Robert Fletcher. At the national level, the
Indonesian Clinical Epidemology and Evidence
Based Medicine Network has also been established.
We are looking forward to work with the health
service management research community to move
forward with strengthening health service management
research as a scientific endeavour.
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 16:09:48
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 03 (2012)
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oai:jurnal.ugm.ac.id:article/2497
2024-03-29T07:48:44Z
jmpk:ART
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"120519 2012 eng "
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Utarini, Adi
Jurnal Manajemen Pelayanan Kesehatan
(JMPK) telah mencapai tahun ke 15 penerbitannya
dan merupakan satu-satunya jurnal di Indonesia yang
mendedikasikan isinya untuk pengembangan kebijakan
dan manajemen pelayanan kesehatan. Berawal
dari naskah-naskah yang disusun oleh penulis
dari kalangan internal Fakultas Kedokteran UGM
(termasuk kontribusi dari peserta yang sedang menempuh
pendidikan berbagai program), selama
beberapa tahun terakhir kontribusi naskah telah
berasal dari berbagai penjuru dan institusi di Indonesia.
Dalam setiap penerbitan, separoh halaman
jurnal diperuntukkan bagi penulis di luar Fakultas
Kedokteran UGM. Hal ini menunjukkan bahwa
eksistensi JMPK telah diterima dan dibutuhkan
secara nasional.
Sejak tahun 1998, Prof Laksono Trisnantoro sebagai
pemimpin redaksi JMPK telah menginisiasi,
mengembangkan, meningkatkan profil dan kualitas
jurnal yang dibuktikan melalui status akreditasi
bersama tim editor: Prof. dr. Adi Utarini, M.Sc.,
MPH.,Ph.D., Prof.dr. Hari Kusnanto, SU., Dr.PH.,
Dr. Dra. Sri Suryawati, Apt., drg. Yulita Hendrartini,
M.Kes., dr. Mubasysyir Hasanbasri, MA., dan dr.
Yodi Mahendradhata, M.Sc, Ph. D.
Sejumlah 483 artikel telah diterbitkan di JMPK
sejak dimulainya penerbitan jurnal ini. Kami mengucapkan
terima kasih atas dedikasi tim editor selama
ini untuk JMPK, dan tetap mengharapkan kontribusinya
sebagai mitra bestari dalam perjalanan panjang
jurnal ini selanjutnya. Semoga jurnal baru yang akan
dirintis, yaitu Jurnal Kebijakan Kesehatan, akan segera
hadir di Indonesia untuk mendorong pengembangan
ilmu dan implementasi kebijakan kesehatan.
Dengan rencana penerbitan jurnal baru tersebut,
maka sesuai dengan namanya, JMPK akan memfokuskan
misinya untuk menyebarluaskan dan mendiskusikan
berbagai tulisan ilmiah mengenai manajemen
pelayanan kesehatan. Isi jurnal berupa artikel
hasil penelitian yang berkaitan dengan manajemen
rumah sakit, manajemen pelayanan kesehatan, manajemen
pelayanan klinis, asuransi kesehatan, dan
masalah yang relevan dengan manajemen pelayanan
kesehatan. Rubrik makalah kebijakan menjadi
ditiadakan. Mulai edisi Juni 2012, naskah-naskah
yang lebih mengarah pada kebijakan kesehatan akan
dikirim ke Jurnal Kebijakan Kesehatan dan terdapat
revisi petunjuk bagi penulis. Selain naskah berupa
hasil penelitian, kami tetap mengharapkan kontribusi
aktif para penulis/pembaca untuk resensi buku-buku
baru yang terbit dua tahun terakhir dan korespondensi.
Saran-saran terhadap pengembangan JMPK
secara umum juga sangat diharapkan.
Bagaimana pengembangan jurnal ini ke depan?
Beberapa pemikiran untuk pengembangan pada
gelombang JMPK selanjutnya akan berfokus pada
upaya untuk: (1) Mendorong sistem yang mempermudah
komunikasi antara pengelola jurnal, mitra bestari
dan penulis sehingga penulis dapat mengetahui
status review naskahnya, yaitu melalui sistem
online-submission; (2) Membuat call for paper untuk
topik-topik khusus dalam manajemen pelayanan
kesehatan secara periodik; (3) Meningkatkan kerja
sama dengan pihak lain untuk penerbitan edisi
khusus; (4) Meningkatkan kualitas artikel yang terbit
di JMPK melalui proses review yang berkesinambungan
dan edukatif untuk mendukung para penulis.
Keempat pengembangan tersebut diharapkan dapat
kami kembangkan bersama tim editor JMPK yang
baru, dengan meningkatkan keterlibatan perguruan
tinggi di luar UGM. Terima kasih kepada, dr, Ari
Probandari MPH, PhD (Universitas Sebelas Maret
Surakarta), dr. Vierra Wardhani M.Kes (Universitas
Brawijaya), akan kesediaannya untuk bergabung
dalam tim editorial JMPK serta kepada dr. Yodi
Mahendradhata MSc, PhD (Universitas Gadjah
Mada), Prof.dr. Hari Kusnanto, SU., Dr. PH (Universitas
Gadjah Mada) yang tetap bergabung dalam
tim. Kami percaya bahwa pengalaman tim editor
serta pengembangan riset manajemen pelayanan
kesehatan yang semakin kuat akan membawa energi
baru untuk menghasilkan sinergi yang kuat dalam
mempertahankan kelangsungan JMPK.
Akhir kata, edisi Desember 2012 akan mengangkat
tema manajemen pelayanan kesehatan dan
keselamatan pasien. Untuk itu, kami mendorong para
penulis dari berbagai institusi pendidikan, penelitian,
organisasi pelayanan kesehatan (rumah sakit,
Puskesmas dan lainnya), Kementerian Kesehatan,
Dinas Kesehatan, lembaga asuransi kesehatan serta
asosiasi profesi untuk mengirimkan naskahnya yang
sesuai dengan tema tersebut.
Jurnal Manajemen Pelayanan Kesehatan
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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Purnamanita, Purnamanita
Background: The Community Eye Medical Clinic (CEMC) as a
specialized eye hospital has been using the service performance
indicators for outpatient visits and financial indicators.
However, non-financial performance indicators were not yet
assessed.
Objectives: To analyze performance of CEMC with the Balanced
Scorecard (BSC) perspectives (customer’s perspective,
internal process perspective, learning and growth perspective
and financial perspective), and its interrelation among
each perspective, to identify the potentials and the development
plans of CEMC in Makassar
Methods: This was an explanatory research employing a
qualitative approach. Samples were selected using a purposive
sampling tehnique to include 100 respondents for the
customer performance and 43 respondents for employee performance.
The data were analysed descriptively.
Results: Applying BSC, performance of CEMC is 51.00% and
this belongs to the category of less healthy. The interrelation
of each pespective starts with training to improve staff capacity.
Along with use of information technology and financial
perspective, this will improve staff productivity in the learning
and growth perspectives. Staff satisfaction will improve the
technical quality related to the internal standard. This will lead
to increased number of visits and number of surgeries. Staff
commitment and capacity, increased of service velocity and
development of customer capital are potential to be improved.
The development plan includes making the performance based
on the reward system, the value creation process for customers
and the development of the customer capital. The development
plans focuses on increased staff commitment and capacity
(learning and growth perspective), improvement process
through reengineering and development of customer capital
through service attributes, relationship and image building.
Conclusion: Using BSC, we found a mismatch between high
customer satisfaction with low internal satisfaction. The management
should improve the reward based on remuneration
system, transparency on training opportunities to staff, and
develop integrated planning.
Keywords: balanced scorecard, performance achievement,
the community eye medical clinics
Jurnal Manajemen Pelayanan Kesehatan
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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"120619 2012 eng "
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Juanita, Juanita
Background: There has been increasing trends of tobacco
consumption among the poor families in the midst of government
effort to improve population health through health subsidy
programs for the poor.
Objective: To analyse the effect of policy on health subsidy
provisions to the poor with cigarette expenditures and utilization
of health service facilities.
Method: This study consists of two parts. Part one of the
study was a cross-sectional study using the Susenas data
year 2001 and 2004. The sample involved 69,166 households
(2001) and 60,832 households (2004) in all provinces in
Indonesia. Univariate and bivariate analysis with Chi Square
test were used in the statistical analysis. The second part of
the study was a documentary study on Indonesian tobacco
control policy.
Result: A significant increase in the proportion of smoking in
the household who receive subsidized health care was found
in 2004 (p <0.001). Smoking habits at home among those health
care subsidy recipients, increased 35.06 percent in 2004
compared to 2001, and this was significant (p 0.002). Outpatient
utilization significantly increased by 28.86% (p <0.001).
Frequency of hospitalization was decreased significantly in
2004 compared with 2001, amounting to 36.62% (p 0.020).
Tobacco control policy was stated in government regulation
No. 38/2000 which was then revised in No. 19/2003. These
were weaker than government regulation No. 81/1999.
Conclusion: The provision of health care subsidies has an
impact on the prevalence of smoking among the head of the
poorest households. Cigarette expenditures on households
receiving health subsidies are greater than expenditures on
education and health.
Keywords: health subsidy, smoking, utilization of health
services, and the poorest households.
Jurnal Manajemen Pelayanan Kesehatan
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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Sutomo, Retno
Background: Implementation of the expanded program on immunization
(EPI) has been excellent in Yogyakarta Province.
Since September 2007 this province has piloted the introduction
of inactivated polio vaccine (IPV), instead of oral polio vaccine
(OPV). The shifting policy raised concern on the possibility that
the new program would compromise the performance of the
existing EPI. This study was a part of evaluation study on IPV
pilot project in this province 2.5 years after its implementation. It
was aimed to assess the impact of IPV introduction on coverage
and timeliness of immunizations within EPI.
Method: We conducted a cross sectional study using WHO
standard 30-by-7 cluster sampling to evaluate the EPI program
in Yogyakarta Province, both in urban and rural areas. The
subjects included children aged 12-23 months old and their
parents. A questionnaire was used to get information from
parents/caregivers on demographic and socioeconomic characteristics.
Along with data on status and date of IPV vaccination,
we included those of other EPI. The impact of IPV implementation
was evaluated by determining the coverage and
timeliness of all immunizations within EPI. We compared the
current data with those in period before introduction of IPV.
We used Epi InfoTM 2003 software for data entry and analysis.
Result: Coverage of vaccinations within EPI is in overall ranged
from 92-100%. The coverage is similar between urban and
rural areas for all vaccines and doses. There is no difference
in EPI coverage before and after the introduction of the IPV.
Approximately 89% children have received complete immunization.
Average age of immunization for each vaccine was
very close to the recommended schedule. However, only 69%
children received the immunization timely.
Conclusion: The EPI coverage in Yogyakarta Province is excellent
and not compromised by the introduction of IPV. The
proportion of children received timely immunization is relatively
low. We suggest including timeliness, beside the coverage,
when evaluating the performance of immunization program.
Key words: immunization, EPI, IPV, coverage, timeliness
Jurnal Manajemen Pelayanan Kesehatan
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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Amalia, Hestyn
Background: Organizational value is the foundation to create
organizational culture. Hospital is an organization with distinctive
character due to its multiple professionals, technologies,
and problems. Wava Husada private hospital builds three
organizational values, namely dedication to serve, professionalism
and teamwork.
Objective: The objective of this study is to measure the effect
of organizational value on employee performance.
Method: This was a descriptive cross-sectional study using
primary and secondary data. All managerial staff (30 respondents)
and 50 nurses selected randomly were chosen to fill in
a questionnaire. Descriptive analysis of dependent and independent
variables and multilinier regression were applied to
show the effect of organizational value on employee performance.
Result: The findings show that overall, organizational value
influences the performance of managerial and nurse staff.
Partially, dedication to serve organizational value has a significant
effect on the managerial staff and nurse performance.
Conclusion: Professionalism doesnot influence the performance
of managerial staff and nurses, while teamwork has
significant effect on nurse performance. Among the three organizational
values, dedication to serve is the most dominant
value in both groups.
Keywords: organizational value, work performance, private
hospital
Jurnal Manajemen Pelayanan Kesehatan
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Alhamda, Syukra
Background: The Implementation of Health Promotion Program
at the hospital is an effort to manpower workers and
other community hospitals in maintain, enhance and protect
their health, through increased knowledge, willingness and
ability to healthy life style in the hospital.
Objective: This study aimed to explore information concerning
health promotion resources in the hospital, with respect to
human resources, fuunding and infrastructure
Method: This study was conducted to explore the implementation
of health promotion programs in the hospital with a systems
approach. This study used qualitative methods in-depth
interviews with the Director of Regional General Hospital Solok
City, Head of Section Officer, Health Promotion Coordinator at
the Hospital, Section Chief of Service, Head Room, Chief Officer
Installation and Polyclinic to represent all programs that
integrate health promotion in hospital, and conduct document
review of the implementation process.
Result: The results showed that the implementation of health
promotion programs have not been gone well, the programs
were not accordance with the instructions in the manual implementation
of health promotion in hospitals issued by the Ministry
of Health. There was a lack of infrastructure facilities required
for the implementation of health promotion as well as
lack of guidelines and procedures. Most officers do not have
the same understanding about the human resource for conducted
health promotion.
Conclutions: The conclusion of this research is the management
and decision-makers to put the manpower in accordance
with the educational background of health promotion with an
interest and talent in health promotion in hospitals, and not
least the importance of providing training for existing staff. For
the management of Regional General Hospital Solok City and
coordinator of Health Promotion in Hospitals (PKRS) in order to
create an integrated health promotion planning with other programs
at the hospital, so the goal of health promotion in hospitals
can be achieved.
Keywords: resource requirements, health promotion, human
resources
Jurnal Manajemen Pelayanan Kesehatan
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https://journal.ugm.ac.id/jmpk/article/view/2503
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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Raziansyah, Raziansyah
Background: Optimum care for chronic diseases should be
given a major attention. Hospitals have strategic roles in
providing health services, particularly for patients with chronic
diseases who require hemodialysis that is only available at the
hospital. In this unit, interpersonal relationship between the
patient and nursesis critical for the success of this long-term
therapy. The patient-nurse interaction will then shape
patients’experiences and hopes.
Objective: This study aimed to explore experiences and
expectations of patients undergoing hemodyalisis care at the
Hemodialysis Unit of Ratu Zalecha Hospital.
Method: The research employed a qualitative study. Data
were obtained from in-depth interviews with eight patients,
supported by an open observation, and the respondents were
selected purposively. The following criteria were used to select
the patients: age, sex, duration of hemodialysis treatment and
source of payment. Data were first transcribed and then
analyzed using open coding.
Result: Patients’ experiences during hemodialysis treatment
were divided into physiological, clinical, psychological, social
and spiritual experiences. These experiences shaped patient’s
hopes, consisted of individual, information, daily living and
nursing care expectations. Information played a central role to
continue hemodyalisis care and there was a major reliance on
care providers to give adequate information to support the
patients.
Conclusion:This study identified patient experiences and
hopes that should be taken account to improve hemodyalisis
care. In the future, it is recommended for hospitals to initiate
implementation of a chronic care model at a microsystem level
in order to integrate patient experiences and hopes into current
services.
Keywords:patient experience, hope, hemodialysis, qualitative
study
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 08:44:19
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Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 02 (2012)
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Ramdan, Iwan Muhamad
Population and labor force growth in the urban impact on
various social issues, environment and employment. Due to the
limited abilityof the formal sector to absorb labor, then comes
the work of the informal sector which is considered as a safety
valve in employment. Until now the occupational health and
safety (OHS) conditions of the informal sector is very poor.
The problems of OHS in informal sectors are: lack of understanding
of OHS, have no health insurance, not officially registered,
and no compensation due to occupational accidents and
occupational related diseases. The government has launched
a program of protection and health services to the poor and
near poor (Jamkesmas), however this effort is still being felt
not quite successful and has not touched the health and safety
aspects of the informal sector. Large companies are already
implementing health and safety management systems work
through the CSR program is one of the most strategic
alternatives in improving the occupational health and safety
condition of informal sector.
Keywords: occupational health and safety in informal sector,
corporate social responsibility
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 13:06:00
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https://journal.ugm.ac.id/jmpk/article/view/2505
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 01 (2012)
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Budi, Iwan Stia
Background: This research aims to analyze the contribution
of coordination to find tuberculosis (TB) suspects in Madiun
Regency.
Method: This is observational study, unit of analysis is Public
Health Center (PHC). Number of sample was 9 PHC where a
respondent of this research is Polindes Midwives, Nurse Pustu,
BP Personels and TB Coordinator.
Result: Spearman correlation test results showed there is
contribution between knowledge contribution about the coordination
and the type of coordination to communication and
supervision. There is a contribution on the role of supervisory
control to supervision, communication and work procedures.
There is a coordination mechanisms contribution (supervision,
communication and working procedures) to the coverage of
the findings TB suspected.
Conclusion: Coordination contributes to finding of TB suspects.
Keywords: contribution, coordination, coverage of findings
TB suspect
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 13:06:00
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https://journal.ugm.ac.id/jmpk/article/view/2506
Jurnal Manajemen Pelayanan Kesehatan; Vol 15, No 01 (2012)
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Sutomo, Retno
Background: Yogyakarta Province is the only province in
Indonesia that piloted IPV immunization since September 2007.
Therefore, it is essential to evaluate the implementation of this
new program. This study was aimed to determine the coverage
and timeliness of the IPV immunization after 2.5 years of
its introduction.
Method: A cross sectional study was carried out using the
WHO standard cluster sampling to estimate the immunization
coverage in urban Yogyakarta City and the remaining rural
districts in Yogyakarta Province. The subjects consisted of
children aged 12-23 months old and their parents. A questionnaire
was used to acquire information from parents/caregivers
on demographic, socioeconomic, and IPV immunization status,
dates, location, and access of immunization. Epi InfoTM 2003
software was used for data entry and analysis.
Result: Overall, 426 children were involved in the study (215
in urban and 211 in rural areas). The coverage for IPV1 through
IPV4 was 100%, 99.8%, 99.3%, and 96.7%, respectively. There
was no difference in coverage by urban/rural location, parents’
education level, number of siblings, and distance to health
service. The coverage is very similar to that of survey in 2004
when this province still used oral polio vaccine. The mean
ages of IPV administration were 2.3, 3.5, 4.8, and 9.4 and no
significant difference among urban and rural areas was found.
More than 95% children received IPV immunization at appropriate
age.
Conclusion: The IPV pilot project in Yogyakarta Province has
been implemented well with high coverage and appropriate
timeliness.
Keywords: immunization, polio eradication, IPV, coverage, timeliness
Jurnal Manajemen Pelayanan Kesehatan
2013-12-10 13:06:00
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Ardianto, Shofan
Hasanbasri, Mubasysyir
Tudiono, A
Background: Community participation can be based on a spirit
of mutual trust and mutual assistance. Health services in rural
and remote areas may survive if they are based on social
networks and become part of community life. Conversely, poor
access to services happen if he only relies on the efforts of
the parties in reaching out to community health facilities. Cooperation
between the public and management of health facilities
could build a community that is the key to the success of
community based health services. Motorcycle can also serve
as an alternative income. Although the fund concerned, the
practice is voluntary and not burdensome. An important factor
of community health services is openness between primary
health care facilities with community organizations.This study
aims to assess the referral on a motorcycle as a social networking
community in the health services.
Method: This study is a case study that tries to show a
pattern of social networks in community based health services.
The subjects of this study is the Nipah Pustu officers,
officials of polindes Setangi and Malaka, motorcycles and the
people who use taxi services in the referral. The collection of
data were carried out with in-depth interviews and observation.
Result: This study shows that informal motorbike ambulance
which grows in the community can help increase visits to health
facilities. Acceptance of the motorcycle by the public and
health professionals make an impact on the economic conditions
of transportation service providers. Wide availability
throughout the hamlet, 24-hour service, low cost, helps in
taking care of patients’ health card are the unique features for
which many people use motorcycle service. Also important
is that motorcycles are also used by the clinic staff for delivery
of examination materials and referral of patients.
Conclusion: Motorcycle ambulance is an important community-
based resources that facilitate access to health care facility
in villages in remote areas.
Keywords: two-wheeled bicycle ambulance, community participation,
community based health services in remote.
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Trisnantoro, Laksono
Data terbaru menunjukkan bahwa sebagian
besar kematian ibu dan bayi di Jawa berada di rumah
sakit dan sistem rujukan. Di Nusa Tenggara Timur
(NTT) sedang terjadi proses perpindahan tempat
kematian dari rumah ke fasilitas, dan bergerak ke
rumah sakit. Keadaan ini menjadikan sebuah tantangan
baru bagi dokter SpOG dan dokter SpA untuk
mempercepat penurunan kematian ibu. Pada konteks
penurunan kematian ibu, mutlak diperlukan peran
dokter SpOG dan dokter SpA dan kepemimpinannya.
Hal ini wajar karena secara teknis kesehatan
ibu dan kesehatan anak, dokter SpOG dan dokter
SpA menjadi pemimpin di lapangan (playing-captain)
untuk penurunan kematian ibu. Tim kesehatan yang
dipimpin termasuk dokter spesialis lain yang terkait
KIA (misal anastesi dan penyakit dalam), dokter
umum di rumah sakit, bidan di rumah sakit, dan
perawat rumah sakit.
Salah satu tugas penting dari para spesialis
adalah memimpin tim teknis pelayanan kesehatan
ibu dan anak di rumah sakit PONEK 24 jam dan
sistem rujukannya. Kepemimpinan teknis medik ini
sangat penting karena evidence di berbagai negara
menunjukkan tanpa mutu pelayanan klinik dan
rujukan yang baik, penurunan kematian ibu dan anak
akan sulit tercapat. Pertanyaan penting adalah
bagaimana situasi kepemimpinan spesialis untuk
MDG4 dan MDG5 dan apakah kepemimpinan
spesialis sudah diajarkan di pendidikan residensi.
Gambaran mengenai pendidikan kepemimpinan
di program residensi saat ini memang masih belum
ditangani secara sistematis. Di dalam pendidikan
residen kebidanan dan kandungan, topik kepemimpinan
memang satu dari sekian banyak kompetensi
yang harus dimiliki residen. Kepemimpinan termasuk
soft competency sehingga kadang-kadang tidak
diformalkan. Topik ini diberikan saat ada penugasan
keluar daerah yang merupakan cara untuk memantau
kemampuan soft competency.
Di dalam pendidikan kesehatan anak, topik kepemimpinan
sudah termasuk ke dalam modul spesialis
anak. Hal ini terwujud dalam stase dari pendidikan
spesialis anak, yaitu pada saat menjadi chief
di masing-masing bangsal. Namun leadership ini
masih terbatas pada peran dokter spesialis anak
pada kasus yang ditangani. Kepemimpinan dokter
spesialis anak dalam cakupan yang lebih luas belum
dituangkan secara langsung dalam modul pendidikan.
Di dalam pelatihan setelah menjadi spesialis
memang belum banyak yang dikerjakan di kesehatan
ibu dan anak.Topik kepemimpinan belum menjadi
isu penting dalam pendidikan profesi berkelanjutan.
Apabila dilihat ke agenda-agenda pertemuan kesehatan
ibu dan anak oleh ikatan profesi, belum banyak
materi yang mengarah ke kepemimpinan dalam
usaha mencapai MDG4 dan MDG5.
Dapat disimpulkan bahwa pendidikan dan pelatihan
kepemimpinan untuk SpOG dan SpA merupakan
kebutuhan dan salahsatu prasyarat untuk
percepatan pencapaian MDG. Beranjak dari situasi
ini kolegium perlu diperkenalkan lebih dulu mengenai
leadership pada saat pertemuan ilmiah tahunan
POGI atau IDAI dan kongres-kongresnya. Modul
pelatihan leadership untuk para spesialis perlu
segera dikembangkan karena modul pendidikan
spesialis baru mencakup leadership sebatas kasuskasus
yang ditangani. Oleh karena itu diperlukan
tindakan segera untuk melaksanakan.
Ada beberapa usulan untuk pengembangan modul:
Pertama adalah keterlibatan ikatan profesi. Oleh
karena itu, modul kepemimpinan yang disusun
sebaiknya melibatkan POGI dan IDAI. Keterlibatan
ikatan profesi ini menunjukkan komitmen untuk
pencapaian MDG4 dan MDG5. Kedua, dalam pelaksanaannya
sebaiknya modul pelatihan kepemimpinan
perlu berbasis pada web sehingga mudah
diakses. Kemudahan ini penting untuk menjangkau
hampir 500 kabupaten yang membutuhkan kepemimpinan
spesialis. Sebagai catatan, sasaran jangka
pendek untuk dokter SpOG dan dokter SpA yang
berada di rumah sakit - rumah sakit PONEK sebaiknya
dimulai tahun ini untuk mempercepat pencapaian
MDG4 dan MDG5. Ketiga, diperlukan banyak
instruktur yang menguasai leadership ini sehingga
perlu training of facilitator untuk mempelajari leadership.
Instruktur-instruktur ini merupakan tulang
punggung dalam usaha penyebaran kepemimpinan
di dokter SpOG dan SpA. Laksono Trisnantoro
(trisnantoro@yahoo.com)
Jurnal Manajemen Pelayanan Kesehatan
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Hafizurrachman, HM
Introduction: In the RSU Tangerang a benchmark of quality
care is the achievement of maximum performance hospital
workers with nurses as the tip of the spear. To ensure the
achievement of these achievements we need a policy that
ensures the implementation of it. Therefore we need research
that aims to produce a performance-based nursing policy
through the efforts of the suitability of job placement for nurses,
and efforts to provide protection against risks and hazards of
nursing jobs in RSU Tangerang.
Methods: This study applied a qualitative design confirmatory
interpretative through policy approaches Michael Hill. Data
were collected through 3 ways, with 29 people consisted of
key informants and informants. The basic question amounted
to 9 items with themes related to the study objective.Data
validation was ensured through triangulation of sources, approach
and time. Data is processed with Nvivo 7 for content
analysis to be presented on an analysis of policy and proceed
with the recommendations through the disclosure and presentation
of findings for policy.
Results: Analysis of policy shows the contents of the nursing
policy has a minimum requirement of nurse performance
regarding the ability of nurses, protection and regulation of
nursing workload, the job minimum environmental standards
and the availability of K3. While the policy of implementation
and policy outcomes as well as the policy environment is not
optimal. Thus the analysis for the policy recommended by the
availability of nursing policy on performance-based RSU
Tangerang which contains 9 chapters is needed. This requires
adequate resources and optimal socialization.
Conclusion: The implementation of this policy for nurses is
required to escort maximum performance, to achieve service
excellence in the RSU Tangerang.
Keywords: performance, nursing, regulation policy analysis
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Retnaningsih, Ekowati
Background: Social Health Insurance Program (Jamsoskes)
of South Sumatera is a system of health insurance for the
entire population of South Sumatera, who does not have health
insurance. The operational fund is shared between the province
and district. To determine the feasibility of the Public Service
Enterprise and other alternatives in the implementation of
Jamsoskes program.
Methods: The study was a qualitative method. The unit of
analysis is Jamsoskes program. Data were obtained through
in-depth interviews and focus group discussion using the
guidelines, and analyzed by content analysis and analysis for
policy.
Results: Based on the legal aspects, the implementation of
Jamsoskes in the form of Public Service Enterprise is not contrary
to the laws and regulations. In addition, based on the
results of judicial review by the Supreme Constitution in 2005,
the National Social Security System Act does not face the
opportunity for local government to establish and develop regional
provider of social security within the framework of national
social security system. Based on some aspects, there
are 3 alternatives for Jamsoskes Provider Agency in according
to the National Social Security System Law: 1) Maintaining
the management system of Jamsoskes by Health Department,
2) Determining an existing of a non-profit operating bodies, 3)
Administering into the Public Service Enterprise (BLU / BLUD)
Conclusion: Implementation of Jamsoskes in the form of Public
Service Enterprise is not contrary to the National Social
Security System Law. Recommendation for the South Sumatera
provincial government in order to consider the Public Service
Bodies as an Operating Bodies of Jamsoskes in the future
under the legal both national and regional level.
Keywords: public service bodies, health insurance, administering
bodies, laws, legal aspects, not for profit.
Jurnal Manajemen Pelayanan Kesehatan
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REVIEW KEBIJAKAN PADA INDIKATOR PENGEMBANGAN DESA SIAGA DI PROVINSI JAWA TIMUR
Sopacua, Evie
This article is a policy review that analyze the indicators in
developing alert villages which was build by Province Health
Office of East Java. Using normatif approach the core problem
and its characteristics was identified. Fulfilment of the indicators
in developing alert villages in East Java Province and estimating
the scores to rank the development of an alert village was the
core problem. Analyzing it’s consequencies, resistance and
trade-off was done using predictive approach.
Conclusion of the analysis is that using the indicators will
faced obstacles in deciding the development rank which was
reach by the alert villages. Suggestion of this analysis is to
use the main steps in developing alert villages which was
stated in Kepmenkes 564/2006 as indicators. Using
percentages in estimating indicators to fixed the rank of alert
villages was suggest also.
Keywords: indicator, alert villages development, policy review
Jurnal Manajemen Pelayanan Kesehatan
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Jurnal Manajemen Pelayanan Kesehatan; Vol 12, No 04 (2009)
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PENETAPAN PAKET PELAYANAN KESEHATAN DAN PERHITUNGAN PREMI PROGRAM PEMELIHARAAN KESEHATAN MAHASISWA UNIVERSITAS JENDERAL SOEDIRMAN TAHUN 2007
Intiasari, Arih Diyaning
Background: In an effort to provide health service access to
its students, University of Jenderal Soedirman develops a
scheme of health insurance in the program of student health
care assistance during academic year 2006/2007. During this
period there were some problems which caused the scheme
unable to cover all needs of students for health services. It is
expected that next time there is development in health service
package and premi calculation in order that the program of
student health care assistance can operate better.
Objective: To develop alternative health service package and
rational premi calculation for the implementation of student health
care assistance based on the coverage of participation at the
University of Jenderal Soedirman in the future.
Method: This case study used complementary qualitative and
quantitative approach. Major research design was quantitative.
Result: Service package of Soedirman Health Center for the
program of student health care assistance included primary
outpatient, continuing outpatient and inpatient health services
with particular limitation either on cost or length of stay. Unit
cost calculation of primary outpatient health service at Student
Health Center for Medication clinic was Rp24,423 and for Dental
Medication clinic was Rp96,387. Premi calculation was made
using actual utilization for Student Health Center as much as
Rp6.180/student/semester and for Purbalingga Community
Health Care Insurance was Rp67.062/student/semester.
Conclusion: The establishment of health service package
and rational premi calculation should enable the development
of health insurance program for students of the University of
Jenderal Soedirman and become an instrument for advocacy
for the policy makers in developing the program in the future.
Keywords: health service packages, premi calculation, unit
cost
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KEMAMPUAN SOFT SKILL SUMBER DAYA MANUSIA KESEHATAN DI KABUPATEN BOJONEGORO DAN MAGETAN PROVINSI JAWA TIMUR
Astuti, Wahyu Dwi
Background: The implementation of regional autonomy in
health care, Human Resources (HR) are required to have health
entrepreneurship ability, leadership and managerial. In fact,
until now information about the capabilities are not yet clearly
known.
Purpose: This study aims to know the capabilities soft skills
(entrepreneurship, managerial, leadership) of health workers
in the District of Bojonegoro and Magetan.
Method: Research design that is used is descriptive research
on the location of Health Dander, Baureno Health, and dr.
Sosodiro Hospital District of Bojonegoro. Health Candirejo,
Health Ngariboyo, Plaosan Health, Health Kawedanan Dr.
Sayidiman Hospital Magetan District. Research target is the
head office staff and health, and director of the hospital staff,
health staff and the head. Large target is 82 people. Variable
involved is the ability of soft skills aspects of entrepreneurship,
leadership, change management and conflict management.
Collecting data is done by giving a ranking scale with the content
of the medium on the aspects of konatif attitude. Data analysis
would be conducted descriptive.
Result: Result of research showed that entrepreneurial ability
is less 56.1%, 50.0% less in leadership and managerial 41.5%
less. Attributes such as entrepreneurial marketing 48.1% less,
self-confidence 57.3% less, task orientation and 58.5% poor
results. Courage risk taking 56.1% less; lobby and negotiate
47.5% less. Attributes such as leadership ability 36.6% less
directive, less supportive 82.9%, 48.8% less participative,
achievement orientation, and 52.5% less. While the ability to
manage changes to 13.4% less, manage conflict 74.3% less.
Conclusion: The situation above can be concluded that the
ability entrepreneurship aspects of soft skills, leadership and
managerial health still needs to be done so that less
improvement and development of these skills.
Keywords: soft skills, entrepreneurship, leadership,
managerial
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Jurnal Manajemen Pelayanan Kesehatan; Vol 12, No 04 (2009)
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PRAKTIK PERAWAT KELILING: STUDI KASUS TIGA PERAWAT DI KABUPATEN INDRAGIRI HULU PROVINSI RIAU
Afril, Zul
Hasanbasri, Mubasysyir
Trisnantoro, Laksono
Background: Professional service in isolated areas is very
limited because the policy on the placement of doctors tends
to put priority on urban areas. Nurses are health staff most
commonly available at isolated areas and utilized by the
community as medical staff in Indonesia for a long time. They
have been working on mobile basis from one village to another
because the community needs express and affordable
services. Legally, mobile nurses have infringed regulations
because they do not have permit for their practice and they
provide services beyond their expertise. Meanwhile, the
presence of mobile nurses greatly helps the government in
solving health problems in the community.
Objective: The study aimed to describe health services
provided by mobile nurses at District of Indragiri Hulu.
Method: This case study was carried out in February – April
2008. Data were obtained through participative observation
and in depth interview. The researcher followed the nurses
observed with open agreement from respondents and studied
the activities they carried out in their work.
Result: The result of the study showed that types of services
provided by mobile services at District of Indragiri Hulu were
relatively complete, comprising service of care to medication.
The service was accessible and inexpensive and payment
method was flexible. These nurses were willing to provide
health services as demanded by patients. They provided mobile
service because health staff available in marginal areas was
nurses. This caused high demand for health service provided
by nurses; however this mobile service was not protected by
regulations because so fan there was no regulation which
concerned with practicing nurses at District of Indragiri Hulu.
The only regulation that protected them was issued by national
association of nurses. Absence of regulation on nurses caused
control to practice of mobile nurses could not be enacted. The
control was needed to protect the community and the service
of mobile nurses itself.
Conclusion: The study proved that unavailability of doctors
had put nurses in a central position as medication providers in
isolated areas. Besides, proactive approaches made by the
nurses had become major factor of acceptance to their
presence in the community. Considering their control role, it
was suggested that the government issued administrative and
professional act on nurses order that control to quality of
nurses could ensured.
Keywords: availability of health staff, mobile nurses, social
motivation, isolated areas
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Jurnal Manajemen Pelayanan Kesehatan; Vol 12, No 04 (2009)
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EKSISTENSI UNIT PENGELOLA OBAT DI BEBERAPA KABUPATEN/KOTA SUATU ANALISIS PASKA DESENTRALISASI
Herman, Max Joseph
Background: Accessibility to essential drugs is a public right,
therefore it’s the government responsibility to make them
available. Previously before the era of regional autonomy, public
drug management in all districts/cities was performed by the
so-called District Pharmaceutical Warehouses (GFK). However,
nowadays the situation has changed because of the difference
in vision and perception of each regional government on the
former warehouses. Some public drug management units in
certain districts/cities are not functioning optimally. Inefficient
drug procurement regarding the number and kind of drugs as
well as timeliness results in gap between drug need and
procurement. Furthermore, loosening in drug supply procedure
makes essential drugs more unavailable to public.
On the other hand, decentralization policy in drug
management also undeniably brings advantages to the districts,
for example capacity building in drug procurement, increasing
capability in budget management and negotiation with district
decision makers as well as enhancing regional economic
activity. In revitalizing district pharmaceutical warehouses so
as to attain minimal health care standards in districts/cities,
baseline data in drug management and financing in several
districts/cities should make a valuable contribution.
Methods: A cross sectional descriptive study had been carried
out during July-December 2006 in 26 districts/cities out of 11
provinces. Samples were 26 district health offices (Dinas
Kesehatan Kabupaten/Kota) and 26 District Pharmaceutical
Warehouses (GFK) where as respondents were head of drug
section and head of warehousing respectively. Data were
collected by means of structured questionnaires and in-depth
interviews as well as the collection of secondary data of drug
logistics. Qualitative and quantitative analysis was performed.
Results: The study shows that: 1) although health budget in
general had risen, the average percentage of drug budget
allocation from 21 district health authorities was only 12.06%,
reflecting the low drug priority in district health policy because
drug expenditures may amount up to 40% of the total health
budget. 2) Public drug management was mostly performed by
the so-called regional technical provider unit (UPTD) with some
limitations concerning human resources and material in
achieving an effective and efficient drug management, and 3)
there was still lack of pharmacist assistants to manage drugs
in primary health care (Puskesmas) up to 20% and even more
piteously the lack of pharmacist in district drug management
unit (GF/UPOP Kabupaten/Kota, 12,5%).
Conclusions: Apart from the achievement of predetermined
indicators stated in minimal health care standards in districts/
cities, especially regarding essential and generic drugs, drug
management in general has been well performed concerning
planning and drug availability. More support and commitment
from the district government is a must considering that regional
development can not be separated from the health development
of the subject themselves.
Keywords: decentralization, District Pharmaceutical
Warehouse, public drugs, drug management
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Jurnal Manajemen Pelayanan Kesehatan; Vol 12, No 04 (2009)
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KAWASAN TANPA ROKOK SEBAGAI ALTERNATIF PENGENDALIAN TEMBAKAU STUDI EFEKTIVITAS PENERAPAN KEBIJAKAN KAMPUS BEBAS ROKOK TERHADAP PERILAKU DAN STATUS MEROKOK MAHASISWA DI FAKULTAS KEDOKTERAN UGM, YOGYAKARTA
Prabandari, Yayi Suryo
Background: In favor of the economic value of tobacco,
Indonesia has minimal anti-smoking policies and regulations.
Even though smoking is not permitted in the government offices,
health facilities, and schools, the regulation has not yet been
fully implemented, particularly in tertiary education institutions
such as universities. Faculty of medicine, as institution
educating future medical professional, should be role model in
implementing the tobacco free campus policy.
Objective: The present study examines the effectiveness of
tobacco free campus policy in the Faculty of Medicine,
University of Gadjah Mada (FM UGM) in Yogyakarta Province.
Method: Two cross-sectional surveys on medical student
smoking behaviors were conducted in 2003 (n=734) and 2007
(n=463), respectively. The prevalence of smoking and quitting
effort were measured in both surveys. Student’s opinion on
tobacco free campus policy was measured in 2007.
Result: The percentage of male non-smoker has increased
19.1%, while among female was 1.2%. While 11.9% students
stopped smoking when they were admitted in FM UGM, 6%
quitted smoking following the tobacco free campus
implementation and 7% reduced the number of cigarettes
smoked. Moreover, ninety percent of male and 94% of female
students at public schools supported the implementation of
tobacco free campus policy.
Conclusion: The implementation of tobacco free campus
policy has positive impact on reducing smoking behavior and
promoting quitting behavior among students in FM UGM. Both
male and female students unanimously support the tobacco
free area.
Keywords: smoke free area, smoking status, smoking behavior,
university student
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Trisnantoro, Laksono
Pada tanggal 30 Oktober 2009 diselenggarakan
Pertemuan Nasional untuk mencari masukan strategi
pembangunan kesehatan. Kabinet baru telah
mempunyai empat agenda pembangunan kesehatan
yang diharapkan diberi masukan oleh berbagai pihak.
Empat agenda tersebut adalah: (1) Isu peningkatan
pembiayaan kesehatan untuk memberikan jaminan
kesehatan masyarakat; (2) Isu peningkatan
kesehatan masyarakat untuk mempercepat
pencapaian target MDGs; (3) Isu pengendalian
penyakit dan penanggulangan masalah kesehatan
akibat bencana; dan (4) Isu peningkatan
ketersediaan, pemerataan dan kualitas tenaga
kesehatan terutama di daerah terpencil, tertinggal,
perbatasan dan kepulauan (DTPK).
Untuk mendukung upaya peningkatan isu-isu
pokok di atas, perlu diperhatikan kegiatan-kegiatan
yang mempunyai dampak cepat dan kegiatan yang
mempunyai dampak lama namun sebaiknya
dilakukan. Kedua jenis kegiatan tersebut perlu
dimasukkan sebagai agenda nyata pembangunan
kesehatan.
Kegiatan-kegiatan yang mempunyai dampak
cepat, antara lain: (1) menghilangkan hambatan
(bottle-neck) seperti keterlambatan pencairan APBN
di daerah. Hambatan ini dapat dihilangkan dengan
perbaikan proses pengelolaan anggaran pemerintah
sehingga dapat direalisasikan pada awal tahun
anggaran. Bottle-neck – bottle-neck lain perlu
diidentifikasi misalnya penggunaan Dana Alokasi
Khusus yang kaku perlu dicari pemecahannya,
ataupun kurangnya data untuk perencanaan. (2)
Dalam konteks alokasi anggaran pemerintah pusat
diharapkan ada pelaksanaan Standar Pelayanan
Minimal (SPM) bidang kesehatan di kabupaten/kota.
Pemerintah provinsi dan kabupaten diharapkan
mendanai kegiatan kesehatan sesuai indikator SPM.
Dengan menggunakan SPM, dalam alokasi anggaran
ini diharapkan ada pemihakan dukungan
pengembangan kapasitas dan pembiayaan bagi
daerah yang kapasitas fiskalnya rendah dan tingkat
kemiskinannya tinggi. (3) Melakukan percepatan
kegiatan pembangunan kesehatan dengan
penggalian, pengalokasian dan pemanfaatan
berbagai sumber pembiayaan kesehatan dari
pemerintah maupun masyarakat termasuk swasta.
Kerja sama dengan pihak swasta perlu
dikembangkan untuk memperluas jangkauan
pelayanan kesehatan. Kerja sama ini termasuk
pemberian insentif pajak dan subsidi bagi lembaga
swasta yang melayani masyarakat miskin berdasar
program pemerintah; (4) Memperkuat sistem
penanggulangan bencana, sejak dari fase
preparedness, kesiapan untuk emergency dan
recovery, dengan standar prosedur yang jelas.
Kegiatan-kegiatan yang mempunyai dampak lebih
lama namun sebaiknya dilakukan, antara lain: (1)
Memperkuat berbagai infrastruktur sistem
kesehatan, antara lain: pengembangan sistem
surveilans-respons di daerah agar masalah kesehatan
lebih diperhatikan dan menjadi dasar untuk
Musrenbang tahunan dan limatahunan. Hal ini
menjadi isu strategis untuk alokasi anggaran di
daerah guna mendapatkan dana kesehatan tidak
hanya dari Dinas Kesehatan, namun juga dinas-dinas
lainnya, terutama untuk menangani Social-
Determinants of Health. Penataan sistem informasi
kesehatan termasuk pemetaan status kesehatan,
faktor risiko, fasilitas, dan berbagai hal lainnya untuk
keperluan monitoring, evaluasi, dan perencanaan;
(2) Penguatan Dinas Kesehatan sebagai pengawas
sistem pelayanan kesehatan, termasuk mutu
pelayanan klinik; (3) Penguatan Departemen
Kesehatan untuk menyusun berbagai standar
nasional sektor kesehatan, peraturan pemerintah,
dan kemampuan fasilitasi bagi pemerintah daerah.
Pengembangan penelitian kesehatan biomedik,
klinis, dan kesehatan masyarakat secara sistematis
dan terintegrasi (bersifat translasional). (4)
Pengembangan tehnical assistance (konsultan)
kesehatan secara terintegrasi dengan prinsip
mengatasi masalah dalam sistem kesehatan.
Hal lain yang diperlukan adalah memperkuat
penggunaan kebijakan desentralisasi di sektor
kesehatan, antara lain menyangkut pembagian urusan
antara pemerintah, pemerintah provinsi dan pemerintah
kabupaten/kota diberbagai aspek kesehatan (Laksono
Trisnantoro, trisnantoro@yahoo. com).
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Trisnantoro, Laksono
Di penghujung tahun 2009 ini, usia Undang –
Undang (UU) Jaminan Kesehatan Masyarakat
(Jamkesmas) telah lima tahun (UU No. 40/2004).
Selama lima tahun, praktis UU Sistem Jaminan Sosial
Nasional (SJSN) tidak berjalan. Salah satu
penyebabnya adalah bahwa UU SJSN ini
membutuhkan UU lain yaitu UU Badan Pengelola
Jaminan Sosial (BPJS) yang tidak kunjung selesai.
Pernyataan menarik adalah bahwa UU SJSN ini terlihat
tidak efektif untuk merubah masyarakat dan tentunya
pertanyaannya mengapa gagal? Salah satu
penjelasan adalah bahwa UU SJSN tidak
memperhatikan sejarah masyarakat yang akan diatur
oleh UU. Sebuah UU dapat gagal karena tidak berhasil
merubah tata kehidupan masyarakat. Artinya tata
kehidupan yang sudah berlangsung lama sejarahnya
tidak bisa diubah. Masyarakat secara sengaja atau
tidak sengaja menolak pelaksanaan UU.
Diskusi mengenai kebijakan dan history
merupakan hal menarik untuk diperdebatkan. Sebuah
kebijakan (misal UU) dapat bersifat ahistorik jika tidak
mempertimbangkan atau melihat sejarah. Namun
perlu dicatat bahwa kebijakan memang dapat
bertujuan membalikkan sejarah atau merubah sebuah
tradisi. Lee Kuan Yew dengan kebijakan keras
berpuluh tahun mampu merubah perilaku kebersihan
penduduk Singapura. Jadilah sekarang situasi
Singapura yang lebih bersih dibanding London
(sebagai benchmark Lee Kuan Yew). Situasi ini
berbeda dengan kebiasaan hidup tidak bersih dalam
sejarah masyarakat perantauan Chinese. Kebijakan
Singapura bersih tersebut berhasil membalikkan
peninggalan sejarah. Kebijakan Singapura memang
sangat keras karena melihat budaya kebersihan
dalam sejarah Singapura yang tidak baik. Jadi kalau
sebuah kebijakan tidak memperhatikan sejarah/tradisi
budaya, maka kebijakan ini mempunyai risiko tidak
berjalan. Hanya di atas kertas.
Undang-Undang (UU) SJSN merupakan hal
sangat berat karena harus mampu merubah berbagai
hal termasuk perubahan budaya masyarakat, dokter,
tenaga kesehatan lainnya, pimpinan dan staf
perusahaan asuransi kesehatan, pejabat dinas
kesehatan, sampai ke pejabat. Undang-Undang (UU)
SJSN bukan hanya merubah prosedur, tapi budaya
yang sudah menjadi tradisi, menjadi bagian dari
sejarah panjang sektor kesehatan Indonesia. Tradisi
dokter mendapat fee for service tidak hanya 10
tahunan. Sudah lama sekali.
Sejarah sangat penting untuk menjadi
pertimbangan kebijakan. Pada tahun 1948,
pemerintah Inggris dari Partai Buruh secara keras
menasionalisasi semua pelayanan kesehatan agar
terjadi pemerataan. Hal ini tidak terjadi di Amerika
Serikat. Dengan menasionalisasi RS swasta,
pemerintah Inggris dapat melakukan intervensi
dengan kuat. Patut dicatat bahwa sekitar tahun 1948
medico industrial compleks belum sekuat sekarang.
Dalam konteks perubahan di Inggris, kebijakan
menasionalisasi menjadi NHS dilakukan oleh PM
Partai Buruh saat itu, dalam suasana rekonstruksi
Inggris pasca Perang Dunia II. Kebijakan ini
menasionalisasi pelayanan kesehatan swasta,
kemanusiaan (termasuk keagamaan), pemerintah
lokal diinisiasi oleh kantor PM Inggris yang cenderung
lebih ke kiri (sosialis) yaitu Partai Buruh.
Kebijakan ini sangat memperhatikan tradisi
dalam sejarah, termasuk tradisi pendapatan tinggi
dokter yang sangat kuat. Para pengambil kebijakan
paham bahwa para dokter pasti menentang. Oleh
karena itu, Aneurin Bevan (Menteri Kesehatan Inggris
saat itu) menyatakan: “I stuffed their mouths with
gold”. Agar tidak ditentang dokter, kebijakan ini
sangat memperhatikan pendapatan para dokter
sehingga mau berubah.
Dari gambaran ini, kita dapat melihat betapa
rapuhnya UU SJSN. Terbukti selama lima tahun tidak
berjalan. Kerapuhan timbul dari berbagai sudut.
Pertama dari saat disahkannya. Undang-Undang
(UU) SJSN disahkan oleh Ibu Megawati di hari-hari
akhir periode kepresidenan. Undang-Undang (UU)
semacam ini sering disebut sebagai “Midnight Laws”.
Dapat dipahami bahwa periode kepresidenen
berikutnya tidak merasa memiliki (ownership) UU
SJSN. Sangat berbeda dengan NHS di Inggris yang
disiapkan bertahun-tahun sebelumnya sebagai
agenda Partai Buruh. Oleh karena itu, UU SJSN perlu
diamandemen dengan salah satu tujuan adalah
meningkatkan kepemilikan dan dukungan politis dari
pemerintah yang berkuasa.
Kerapuhan kedua, UU SJSN tidak bicara
banyak mengenai tradisi di sektor kesehatan,
termasuk peran para dokter yang sangat powerfull.
Masalah apakah para dokter akan kekurangan
income apabila menjalankan UU SJSN tidak dibahas.
Kenyataan memang sudah terjadi. Model UU SJSN
memberikan insentif rendah dibanding OOP. Undang-
Undang (UU) SJSN tidak bicara banyak mengenai
bagaimana meratakan pelayanan kesehatan ke
berbagai tempat, UU SJSN tidak bicara banyak
mengenai tradisi masyarakat Indonesia yang tidak
kenal risiko dan lain-lain. Banyak sekali hal
operasional tidak dibahas.
Kerapuhan ketiga, UU SJSN mencakup
kesehatan dan berbagai aspek welfare dalam
hubungan pengusaha dengan buruh. Aspek ini sangat
politis. Berbagai kepentingan dan ideologi yang
saling bertentangan dapat terjadi. Hal ini dapat dilihat
dari kecurigaan para industrialis terhadap UU SJSN
ini yang dianggap mengurangi daya kompetisi produk
Indonesia. Undang-Undang (UU) SJSN menjadi
sangat rapuh pada perdebatan ideologis. Akibatnya
masalah teknis yang banyak terdapat disektor
kesehatan menjadi terabaikan. Komponen
kesehatan bisa menjadi tidak terurus secara baik
dalam UU SJSN.
Oleh karena itu, diusulkan agar UU SJSN
diamandemen dan kalau bisa dipisahkan sendiri.
Dari titik ini kemudian disusun UU Asuransi
Kesehatan dan atau UU Jaminan Kesehatan
Nasional. Mengingat beratnya masalah yang sampai
mencakup tata kehidupan dan sejarah yang sudah
panjang, diharapkan jangan diletakkan bersamasama
dengan jaminan sosial lainnya (Laksono
Trisnantoro, trisnantoro@yahoo.com).
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Ayuningtyas, Dumilah
A wave into democratization and liberalization which influenced
the development of government politic had arisen. This wave
also provided space for public’s participation or any other
private sector on development privatization including public
service. Thus health sector is not an exception in this case.
Substantive definition of privatization is action of diminishing
the government’s participation (state control) and increasing
private’s partaking. Although the inclination for escalation of
privatization policy on health service seems promising, yet it
still need endeavor to ensure that the implementation of
privatization in Indonesia does not contradict with government’s
obligation and objective in giving broadened and attainable
health service with good quality.
Keywords: government political development, privatization’s
policy on health service
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Ernawati, Ernawati
Background: Community Health Center (CHC) is hoped to
give quality antenatal care. However, maternal and child health
coverage in Bekasi District has not achieved the targeted
standard yet. First visit of pregnant mothers in 2006 was 87.5%
and fourth visit coverage was 77.8%. There were 21 cases
of maternal mortality in 2005 and only four out of 34 CHCs
achieved the target of maternal and child coverage. These
show that maternal and child health care performance is not
optimal; therefore, improvement should be made. One of
performance measurements is balanced scorecard which
includes four perspectives, namely finance, costumers’
satisfaction, internal business, and learning and growth.
Objective: To evaluate antenatal care performance between
high coverage CHC and low coverage CHC using balanced
scorecard approach in Bekasi District.
Method: This was an observational study with cross sectional
study design. Qualitative data were used in this study. The
subjects were the head of CHCs, the midwives responsible
for the implementation of antenatal care in maternal and child
health room, and all pregnant mothers receiving forth visit care.
The study was performed in Mekarmukti and Cibarusah CHCs.
Study instruments were questionnaire, checklist, and interview
guide. Univariate analysis and bivariate analysis with chi-square
test and stratification were used.
Results: There was an association between providers’
education/training and antenatal coverage (χ² = 10.015; p =
0.002; PR = 4.026; CI 95% = 1.667-9.724), and patients’
satisfaction (χ2 = 4.607; p = 0.032; PR = 2.516; CI 95% = 1.080-
6.348), while standardized care was not related to antenatal
care coverage. Stratification analysis showed that antenatal
care coverage in Mekarmukti CHC was better than that in
Cibarusah CHC (χ2 = 5.662; p = 0.017; PR = 4.407; CI 95% =
1.082-18.789), patients’ satisfaction in Mekarmukti CHC was
better than that in Cibarusah CHC (χ2 = 6.935; p = 0.008; PR =
8; CI 95% = 1.256-84.624). Based on the qualitative data, there
was no difference in finance performance in both CHCs.
Conclusions: There is a difference between providers’
education/training and the level of patients’ satisfaction in
Mekarmukti and Cibarusah CHCs. There is no difference in
Mekarmukti and Cibarusah CHCs operational fund and standard
antenatal care.
Keywords: balanced scorecard, performance, antenatal
coverage
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Silaban, Gerry
Background: The high number of industrial accident is caused
by management dysfunction in term of occupational health
and safety. The implementation of occupational health and
management system (OHSMS) established by the Regulation
of The Minister of Manpower No. 05/1996, is a government
policy that has to be implemented by the enterprises in the
attempt to decrease industrial accident rate. The performance
of OHSMS implementation is assessed by OHSMS audit to
gather objective evidence from strength and weakness in the
implementation of occupational health and safety in work places.
Method: The type of this research is survey research.
Research sample was established based on the manpower
number criteria of at least 100 people in each enterprise. The
performance of OHSMS implementation based on 12 OHSMS
audit elements was known to be correlated with 5 OHSMS
implementation principles. One factor repeated observation
variance analysis was used to test the performance difference
of 12 OHSMS audit items and 5 OHSMS implementation principles.
Result: A number of 53 (96.36%) enterprises fulfilled 0-60%
criteria and 2 enterprises (3.64%) fulfilled 60-84% criteria from
166 OHSMS audit criteria. The mean criteria fulfillment number
(percentage) was highest achieved (scored 4) in 5th element
(purchasing) that is 4 out from 7 criteria (57.14%) in 5th element.
Mean score of 5th element was reached with the highest
percentage (74.87% from 5th element maximum score). F-test
result showed a significant difference (p < 0.01) in 12 OHSMS
audit elements performance and t-test showed variety between
each performance in 12 OHSMS audit elements. Mean criteria
fulfillment number (percentage) was highest achieved (scored
4) in 3rd principle that is 20 out of 67 criteria (29.85%) of 3rd
principle. Principle 3 means score was reached with the highest
percentage (55.40% from 3rd principle maximum score). F-test
result showed a significant difference (p < 0.01) in 5 principles
of OHSMS implementation performance and t-test resulted in
variety between each principle performance in 5 principles of
OHSMS implementation.
Conclusion: Management should have a commitment and
involve all workers in enhancing OHSMS implementation
performance to reduce industrial accident rate which lead to
productivity and work quality improvement.
Keywords: industrial accident, registered enterprises in the
employment accident benefit program, the implementation
performance of occupational health and management system
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Herkutanto, Herkutanto
Background : The accountability of the physicians serving in
health care is a crucial factor to establish the patient safety.
The credentialing system, a process to grant clinical privilege,
aims to ensure the accountability. Credentialing processes vary
in different Indonesian Institutions, and frequently are
inadequately performed. Information about obstacles and
expectations on current credentialing process is needed to
design a strategy to develop credentialing system.
Methods: A qualitative study using Focus Group Discussions
(FGD) were conducted in four hospitals in Indonesia with
different characteristics. Every FGD was attended by 10-20
participants, consisted of physicians and hospital management.
The results of the FGDs were analyzed with qualitative
approach.
Results: The obstacles of the establishment of ideal credential
system rooted in the inappropriate perception that credential is
the same as physicians recruitment as hospital employees.
The expectations of the participants are the needs of monitoring
process, sound relationship between credential team and
hospital management, standardization of policy and credential
instruments, existence of objective credential team, and good
relationships among colleagues.
Conclusions: Indonesia needs a credentialing system that is
able to establish the patient safety. The expectations of
participants are in line with the recommended credential
system, which is based on the concept of professionalism.
Keywords: physicians credentialing system, professionalism,
patient safety
Jurnal Manajemen Pelayanan Kesehatan
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Oktarina, Oktarina
Background: Iodine deficiency disorder is one of four
malnutrition problems in Indonesia. Initial surveys at Primary
School children in East Java reveal the goiter prevalence is
high, the Total Goiter Rate (TGR) 22,9%. The recent study at
Surabaya City, has 16,93% of severely iodine-deficiency
villages, higher than normative value (less than 5%). Since
Surabaya is regarded as the second largest city after Jakarta,
the iodine-deficiency disorder have been considered major
problem. This need to be examined and analysed the
implementing programmed after all.
Method: The purpose of this study was a descriptive type,
done cross sectionally a carried out from Mei to July 2005. The
study was conducted to examine the effect of iodine-deficiency
disorder in 7 district area at 10 villages in Surabaya; Tambak
Oso Wliangun, Romokalisari (Benowo), Sidotopo Wetan,
Tambak Wedi (Kenjeran), Manyar Sabrangan (Mulyorejo),
Kedung Cowek (Bulak), Perak Utara, Nyamplungan (P.Cantikan),
Bubutan, and Bangkingan (Lakarsantri).
Result: The result show many faktor, such as social economic
factors from the society, the lack of iodine-deficiencies discrder
knowledge, low health staff motivation to run the program etc.
The middle term and short programme of iodine-deficiency,
planning, organizing, actuating and coordination at the Primary
Health Center (Puskesmas) should be taken soon.
Conclusion: The recommendation as follow promotive,
preventive, curative and rehabilitative strategy, by socialization,
advocation salty iodine and knowledge of goiter disease to
related cross sectoral department, as well as health staffs,
Primary Health Center staff, the society in severely iodine-
deficiency, nutrition and food awareness area. Provide overall
health services for iodine-deficiency disorder problems; diet
counseling, medical treatment, integrated management planning,
organizing and actualization. Coordinating and evaluating the
programme, improve the quality and professionalism in managing
the iodine-deficiency disorder problem especially in Primary
Health Center in Surabaya City.
Keywords: iodine-deficiency disorder problem, society and
health staff factors, management and control
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Hamzah, Asiah
Backgrounds: The increasing of quality competition in service
of hospital health, driving management of Stella Maris Hospital
in Makassar to design business strategy which can be cost
effective and improve the earnings. Strategy of target marketing
is one of the accurate alternatives because hospital will get
some benefit namely: 1) more efficient resource allocation 2)
can chosen the more interesting target, 3) more comprehending
of requirement and market desire 4) progressively narrow the
scope market served, and 5) progressively understand the
hospital to its market behavior.
Objectives: The aim of this research is to find out the hospital
market segment based on: the consumer characteristics, the
interest of market segment, and the profile of Stella Maris
Hospital in Makassar.
Methods: The research was carried out in the inpatient unit
of Stella Maris Hospital in Makassar. The data were obtained
by survey and questionnaire to 115 patients or patients’ family
in the inpatient unit of Stella Maris Hospital in Makassar from
April 15 to May 15, 2008.
Results: The result shows that based on customers’
characteristics, there were three market segments namely
segment I consisting of 30 people (26.09%); segment II
consisting of 25 people (21.74%); and segment III consisting
of 60 people (52.17%). Based on the interest of market segment,
segment III is determined as the target market by Stella Maris
Hospital in Makassar and labeled as health care maximize.
Based on the profile of Stella Maris Hospital in Makassar which
is viewed from potential market size, market compartment, the
number of closest competitors, substitution attendance,
geographical accessibility, and relationship between segment
with partner companies or insurance, segment III is determined
as the target market by Stella Maris Hospital in Makassar, and
labeled as health care maximize.
Conclusions: Viewed from the segment interest and the
profile of Stella Maris Hospital in Makassar, segment III which
labeled as health care maximize is determined as the target
market of Stella Maris Hospital in Makassar in 2008.
Keywords: target market, segmentation, hospital marketing
Jurnal Manajemen Pelayanan Kesehatan
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Nurliyasman, Nurliyasman
Background: Batam municipal government has implemented
the program of patient retribution cost exemption in all health
centers of Batam Municipality with no exception (includes the
haves and the have not) as long as they can show their
population identity card when they visit health canters.
Consequently health budget increases four times higher than
the previous fiscal year. This is interesting to study further in
order to find out the effectiveness or ineffectiveness of the
program implementation.
Objective: The study aimed to analyze the policy of retribution
exemption and increased drug expenditure budget.
Method: The study was retrospective observational using
both quantitative and qualitative data, analytical survey method
and cross sectional design. Quantitative data were obtained
with cluster sampling from documents of health centers such
as monthly report, number of visits of the patients, prescription
within three years (2005 – 2007) of samples of each year
were taken three months during peak visits to health centers
(June, July and August). Data obtained were tabulated and
analyzed using paired t-test at significance level 95%.
Qualitative data were obtained from in-depth interview with
related stakeholders.
Result: Retribution exemption program led to sharp increase
of visits to health centers to twice. There was no difference in
disease pattern before and after retribution exemption. The
result of paired t-test to prescription pattern showed difference
before and after retribution exemption. The Health Institution of
Batam succeeded to maintain good prescription pattern.
Conclusion : Caused sharp increase of drug budget after
retribution exemption in health centers was over anticipate of
drug procurement to forecast of visits health centre. The over
procurement can be anticipated by planning of drug
procurement the next years.
Keywords: health centers, retribution exemption, drug budget
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Trisnantoro, Laksono
Perkembangan Rumah Sakit (RS) swasta di
Indonesia tidak terlepas dari peranan dokter
spesialis. Secara historis peranan dokter spesialis
sangat besar, terutama pendirian RS swasta pasca
kemerdekaan. Dokter-dokter spesialis ternama ada
yang berkesempatan menjadi pemilik RS dan
mendirikannya. Fenomena ini menarik karena terlihat
ada rasa tidak puas, rasa tidak nyaman, tidak
mempercayai sistem di RS induk, ataupun tidak
cocok dengan RS induknya. Yang menarik walaupun
mendirikan RS sendiri, para dokter spesialis pemilik
RS swasta tidak keluar dari RS induknya.
Salah satu motivasi lainnya adalah sebagian
dokter spesialis yang mempunyai RS sendiri, tidak
ingin hanya sebagai “karyawan” atau lebih jauh lagi
sebagai “buruh” sebuah RS. Istilah “buruh” dapat
diartikan sebagai suatu keterpaksaan dokter untuk
bekerja di RS. Ini berarti tidak ada kesesuaian antara
nilai-nilai yang dianut pribadi dokter dengan nilai-nilai
RS-nya.
Pertanyaan-pertanyaan yang muncul adalah:
Apakah dokter spesialis cenderung berkeinginan
mempunyai RS sendiri. Lebih spesifik lagi: apakah
dokter spesialis tidak mempercayai sistem
manajemen RS induknya sehingga tidak terjadi
sinergi. Jika memang "ya" jawabannya apakah
ketidakpercayaan pada sistem manajemennya
merupakan hal yang tepat? Bagaimana hubungan
dokter spesialis dengan RS? Apakah berposisi
sebagai Pemilik, Karyawan, Mitra, atau Buruh? Apa
masalahnya? Bagaimana skenario di masa depan
untuk hubungan dokter spesialis dan RS swasta?
Tajuk ini mencoba untuk membahas pertanyaan
terakhir dalam konteks pertanyaan-pertanyaan
lainnya. Ada beberapa skenario RS swasta yang
mungkin terjadi.
Skenario 1: Perkembangan didominasi oleh RS
bertipe Boutique (layanan sempit) milik dokter
spesialis. Dokter spesialis merangkap sebagai
wirausaha untuk RS dengan layanan yang tidak luas.
Sistem manajemen dipegang sendiri oleh dokter.
Rumah Sakit (RS) tipe ini dapat dilihat dari
penampakan RSIA, RS khusus mata, atau RS
khusus bedah diberbagai kota.
Skenario 2: Perkembangan didominasi oleh RS
umum milik dokter spesialis dalam bentuk
perusahaan. Jangkauan pelayanan mengalami
perkembangan dari RS layanan sempit menjadi RS
Umum layanan luas yang berasal dari kepemilikan
dokter spesialis dan berkembang menjadi sebuah
korporasi besar. Rumah Sakit (RS) besar milik dokter
spesialis ini (bisa sendiri atau berkelompok)
menggunakan filosofi dimana dokter spesialis
lainnya yang bukan pemilik merasa cocok dengan
RS-nya. Skenario ini menggambarkan situasi
dimana para spesialis senang bekerja di RS yang
tidak dimilikinya.
Skenario 3: Perkembangan ddidominasi RS
swasta bukan milik dokter spesialis, layanan luas
dengan mengikuti filosofi partnership dengan dokter
spesialis. Pemiliknya dapat berupa lembaga
keagamaan, perusahaan, ataupun perorangan.
Model pelayanan klinik dan sistem manajemennya
menempatkan dokter sebagai partner.
Skenario 4: Perkembangan didominasi RS
swasta besar bukan milik dokter, dengan layanan
luas. Rumah Sakit (RS) swasta ini bukan milik para
dokter. Pemiliknya dapat berupa lembaga
keagamaan, perusahaan, ataupun perorangan.
Model manajemennya adalah birokrasi. Dokter
spesialis merasa menjadi karyawan atau buruh di
RS. Akibatnya dokter spesialis bebas bekerja di RS
swasta lain bahkan menjadi pemilik RS swasta lain.
Skenario mana yang paling mungkin terjadi?
Pengamatan saat ini menunjukkan bahwa terjadi
suatu interaksi kompleks antara sistem manajemen,
khususnya sistem pembayaran untuk dokter dengan
keinginan pribadi dokter spesialis, kesempatan
untuk pengembangan karir, kecocokkan bekerja dan
berbagai hal lainnya. Faktor penting lainnya adalah
aturan perijinan RS. Apabila aturan perijinan longgar,
dapat terjadi suatu perkembangan yang mengarah
ke skenario 1 dimana banyak RS berbentuk tipe
butik. Namun apabila ada peraturan bahwa dokter
spesialis dilarang untuk menjadi pemilik RS agar
tidak terjadi conflict of interest, ada kemungkinan
skenario 3 atau 4 yang akan terjadi. Faktor lain yang
perlu diperhitungkan adalah kepekaan masyarakat
dalam hukum. Jika terjadi semakin banyak tuntutan
hukum, maka dokter spesialis yang merangkap
sebagai pemilik sekaligus sebagai dokter
mempunyai risiko dituntut rangkap, sebagai pemilik
dan sebagai operator pelayanan klinik. (Laksono
Trisnantoro, trisnantoro@yahoo.com)
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Wirawan, I Made Ady
A series of aircraft accidents in the past three years exposed
serious safety problems in Indonesian civil aviation. Latest
aviation accident investigations reported that flight crews were
mainly responsible for two major accidents happened in 2007.
This indicates that occupational health and safety (OHS) is an
integral part of civil aviation. Improvement in OHS system would
then contribute to the development in Indonesian civil aviation
safety in general. This paper seeks to present applicable OHS
designs in Indonesian civil aviation by carefully considering
local situations, current problems and their determinants.
Furthermore, ideal designs based on literature reviews and
good practices in some developed countries were examined
to show the main principles and components needed in
designing a civil aviation OHS system.
Keywords: OHS system, civil aviation, Indonesia
ABSTRAK
Serangkaian kecelakaan pesawat udara dalam tiga tahun
terakhir telah menunjukkan masalah keselamatan yang serius
di dunia penerbangan sipil Indonesia. Dari hasil investigasi
terbaru, kru penerbang dilaporkan bertanggung jawab terhadap
dua kecelakaan maut yang terjadi tahun 2007. Hal ini
mengindikasikan bahwa kesehatan dan keselamatan kerja (K3)
merupakan bagian yang sangat penting dalam penerbangan
sipil. Perbaikan dalam sistem K3 akan memberikan kontribusi
dalam peningkatan keselamatan penerbangan sipil di Indonesia
secara umum. Tulisan ini menunjukkan desain K3 yang bisa
diterapkan di penerbangan sipil Indonesia dengan
mempertimbangkan situasi lokal, permasalahan saat ini dan
faktor-faktor penentunya. Lebih jauh, desain yang ideal
berdasarkan studi kepustakaan dan praktik-praktik yang baik
di beberapa negara maju dianalisis untuk menunjukkan prinsipprinsip
dan komponen-komponen utama yang diperlukan dalam
merancang sebuah sistem K3 penerbangan sipil.
Kata Kunci: sistem K3, penerbangan sipil, Indonesia
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Sulaeman, Endang Sutisna
Background:This research is grounded on the fact that the
target of the health service performance of UPTD Puskesmas
DTP has not been reached as shown on the result of the
evaluation in 2004. Based on the study at theories, there are a
couple at sub-problems which influence the effective
leadership and the optimal staff’s performance.
Methods: The objective of this research is to look for an
alternative solution to promote the staff’s performance through
realizing the effective leadership.
This research use descriptive analytical method with crosssectional
survey design. The independent variables at the
research are the leadership style and the leadership situation,
while the dependent variable is the staff’s performance. The
research measuring instrument use questioners disseminated
to 42 respondents in 6 UPTD Puskesmas DTP throughout
Kuningan Regency. The data analysis uses the method at path
analysis and multiple regressions.
Result and conclusion: The research findings that leadership
style applied by Heads UPTD Puskesmas DTP are mixed one’s
which consist of directive style, supportive style, delegative
style, and participative style (multicratic leadership style).
Leadership situation covering quality dimension of leader-staff’s
relationship, degree of task structure, amount of power
position, ability of leader, and staff’s maturity is at good category.
The staff’s performance of UPTD Puskesmas DTP covering
work ability (knowledge and skills), initiative, communication,
cooperation, planning and organizing, work productivity, work
satisfaction, and rewards is good category.
It is suggested that in the effort to promote the staff’s
performance of UPTD Puskesmas DTP, leadership style shall
to be applied by Heads of UPTD Puskesmas DTP use style
leadership of mixture among directive leadership style,
supportive leadership style, delegative leadership style, and
participative leadership style, and with interest using many
participative leadership style and should be adjusted with the
situation, the level at the staff’s maturity, the gaining of
information for problem solving, the time available, and
supported by the management resource and good
communication.
Keywords: leadership style, leadership situation, personal
characters of the leaders, staff’s performance
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Surjandari, Isti
Background : The increasing competition in healthcare
industry has caused the delivery of service quality to patients
become essential. Every hospital competes to deliver the best
service to its patients. As a result, it is necessary to analyze
hospitalized patient satisfaction. This study discusses service
quality improvement in healthcare industry by analyzing inpatient
satisfaction using Multivariate Analysis and Quality
Function Deployment (QFD).
Objectives: The objectives of this study are to identify patients’
characteristics which are significantly affect their satisfaction
level, to identify service attributes and dimensions which are
critical to patients, and subsequently improve those attributes.
Method: The identification of characteristics and service
dimensions which are significantly affect patients’ satisfaction
level is accomplished using Multivariate Analysis. While the
critical service attributes identification is completed using
Importance-Performance Analysis. Afterward, using House
of Quality (HOQ), as the basis of QFD, those critical service
attributes are developed into service elements.
Result: Using Discriminant Analysis, the result of this study
shows that patients’ characteristics which significantly affect
their satisfaction level are sex and occupation. The male and
unemployed patients are more satisfied than the female and
employed patients. Afterward, Factor Analysis brings about
five new factors (service dimensions), which are the linear
combinations of the original 42 service attributes. Based on
the Importance-Performance Analysis, there are four service
attributes which are critical to be improved which have high
importance level, but low performance level. Then, using the
Quality Function Deployment (QFD), the four critical service
attributes are developed into service elements. The service
elements with high priorities are training program, recruitment
of experts, standard of information flow, online administration
system, and computer as provider of information.
Conclusion: Service quality improvement in healthcare
industry can be analyzed more comprehensive by integrating
Multivariate Method and Quality Function Deployment (QFD).
The result of this study may provide contributions to hospitals
in general in enhancing its service performance to achieve its
patients’ satisfaction.
Keywords: customer satisfaction, healthcare industry,
multivariate analysis, quality function deployment
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Badi’ah, Atik
Background: Hospital was an organization that is found
because of the society demands which are more complex and
they have realized that health is very important. It makes the
hospital must gives the optimal services for the society. Nursing
services in the hospital are the main factor to decide the service
quality and the image hospital on the society, because the
greater society need of the good services the higher nurses’
working motivation will be needed in order to improve their
performance optimally. The purpose of the study is to find out
the relation between nurses’ motivation and performance in
Hospital Ward in Panembahan Senopati Bantul.
Method: This was a survey analytical research using crosssectional
approach to find out the relation between nurses’
motivation and performance at the same time. The instrument
was questioners that consist of the nurse characteristics and
questions on nurses’ motivation and performance.
Results: The finding analysis using product moment correlation
with significance score is 5 % (p < 0.005) showing there was
a significance relation between internal motivation and external
motivation factors (p = 0,000) with nurses’ performance. There
was a relation between the sub-variable responsible
(p=0,001), acknowledgment (p=0,000), achievement (p=0,000),
development (p=0,000), task (p=0,033), supervise (p=0,001),
work condition (p=0,000), organization policy (p=0,000), salary
(p=0,000) and nurses’ performance. However, there is no
significance relation between colleagues and nurses’
performance. The result of double regression analysis shows
the relation between internal and external motivation factor
(p=0,000) and nurses’ performance. While the sub-variable
achievement (p=0,005), development (p=0,003), work condition
(p=0,004), and organization policy (p=0,000) have a not
significance relation with nurses’ performance, but the others
(responsible (p=0,734), acknowledgment (p=0,320), task
(p=0,145), supervise (p=0,268), colleagues (p=0,773) and
salary (p=0,118).
Conclusion: This research showed that the internal and
external motivation factors were good, so it must be maintained
to keep the effect on nurses’ motivation. According to the
research findings, it also needs to increase the nurses’
motivation so that it can increase the nurses’ performance in
order to get the hospital goal. It can be done by developing the
nurses’ resource by doing workshop or getting higher
education.
Keywords: motivation, performance, nurse
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Wilopo, Siswanto Agus
Background: Two rotavirus vaccines have been available
for use. The objectives of the study to examine disease burden
of diare rotavirus and the cost and effectiveness of a rotavirus
vaccination program in Indonesia.
Material and Methods: Data on direct and indirect costs of
children with rotavirus diarrhea were established in Purworejo
District and Yogyakarta city. It was extrapolated to national
estimates on the basis of the projected birth cohort in 2007
and diarrhea morbiditity rate at national level. The main outcome
measures were economic burden and cost-effectiveness ratio
(Rupiah per DALY averted).
Results: The disease burden is equivalent to an economic
burden of an estimated Rp390.4 billion in medical direct costs,
Rp 67.3 bilion in nonmedical direct costs, and 70.4 billion rupiah
in indirect costs. From the health care system and community
perspectives, universal vaccination of infants at a cost of less
than US $12,7 for a vaccine dose would be a cost-effective of
public health intervention.
Conclusions and Recommendation: In Indonesia, rotavirus
vaccination would reduce the morbidity burden of rotavirus
infection, but would not be cost-effective unless the price of
vaccine decreased considerably. At the current price of
vaccine, universal vaccination program for rotavirus would
not be recommended.
Keywords: burden of disease, rotavirus diarrhea vaccine,
cost-effectiveness
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Hutapea, Tahan P.
Background: Individual need for hospital services is directly
influenced by psychologic variables: taste, sick-health
perception, expectation, assessment of provider and individual
characteristic such as: age, sex, education and job.
Objectives: The study covered people who had hospitalization.
The goal of this research is to identify and analyze factors that
influence the public demand to select hospital class and examine
bed composition which suitable with consumer needs and
consumer characteristics. The consumer’s characteristics are:
sex, education, job and ability, availability, acceptability,
accessibility and willingness.
Method: The samples are inpatients from Dr.Soetomo Hospital,
Dr.Ramelan Hospital and Darmo Hospital. Total sample is 296,
which consist of 98 from Dr.Soetomo Hospital, 98 from
Dr.Ramelan Hospital and 100 from Darmo Hospital. Samples
are collected by proportional stratified random sampling.
The method in this study is cross sectional study and analysis
with logistic regression analysis (significants < 0.05).
Result and conclusion: Result this experiment show that 3
factors (ability, availability and willingness) have correlation in
choosing the hospital class. Suitable Bed composition with
consumer need are: VIP:1st Class:2nd Class:3rd Class =
6%:15,6%:28,4%:50%.
Keywords: demand, consumer characteristics, hospital class
selection, bed composition
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Suryawati, Sri
Background: Medicine is an integral part of health services.
Several actions have been conducted by the government in
order to ensure the availability and affordability of medicines,
among others is close monitoring of medicine prices so that
they are affordable by the community. Previous studies in
Indonesia in 1996 and 2002 revealed that medicine prices,
both generic and branded, were quite high.
Objective: To evaluate selling price of generic medicine in
pharmacies in Kendari municipalities.
Methods: This is a non-experimental study applying a cross
sectional survey design, targeted to selling price of generic
and branded medicines in 27 pharmacies in Kendari municipality.
Data on prices was collected retrospectively from the
prescription sheet and pharmacy price lists, and in-depth
interviews were paid to uncover underlying factors on decision
to set the medicine prices.
Result: The study showed that in general, the average selling
price of generics was 2.72 times higher (range 0.70 – 15.38)
than the Ministry of Health Price Standard (HJA Menkes - Harga
Jual Apotek Menteri Kesehatan Tahun 2006). The average
selling price of branded medicines was approximately 14.53
times higher (range 1.24 – 76.33) than HJA Menkes. The selling
price of the most frequently prescribed generic medicines,
i.e., amoxicillin tablet 500 mg, were 3 times higher than HJA
Menkes 2006. Generic medicines which priced >5 times higher
than HJA Menkes 2006 included chlorfeniramine maleate,
ciprofloxacine, ambroxol, glibenclamide, metoclopramide, and
dexamethazone. A month treatment cost for hypertension with
captopril and furosemide ranged from Rp 8,300 to Rp 125,680
or in term of minimum daily wages (MDW) for Kendari which
was Rp 24,500, ranged from 0.3 to 5 MDW. Treatment cost for
pneumonia with amoxycillin ranged from Rp 7,972 to Rp 39,094
or 0.3 to 1.6 MDW. The prices of HJA Menkes 2006 were on
average 1.04 times (or equal) compared to the MSH
International Price Index 2006.
Conclusion: HJA Menkes 2006 equals to MSH international
price index 2006. The average selling prices of generics and
branded medicines in private pharmacies in Kendari municipality
were 2.72 times and 14.53 times, respectively, as compared
to HJA Menkes 2006. However, cheaper alternatives were
available, and treatment costs were affordable if patients
purchased cheaper products.
Keywords : medicine prices, pharmacy selling price, HJA
Menkes 2006, MSH International Price Index
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Trisnantoro, Laksono
Sistem ekonomi di Indonesia memberikan
kesempatan kepada lembaga pelayanan kesehatan
swasta untuk bekerja, dan pihak masyarakat diberi
kesempatan pula untuk memberikan sumber
dayanya bagi pelayanan kesehatan. Keadaan ini
sudah ada sejak jaman kolonial Belanda.
Konsekuensinya, sektor kesehatan di Indonesia
saat ini sudah berkembang menjadi industri dengan
dasar hukum pasar.
Selama 10 tahun terakhir pertumbuhan Rumah
Sakit (RS) Swasta di Indonesia lebih besar (2,91%
rata-rata per tahun) dari RS pemerintah (1,25% ratarata
per tahun). Pada tahun 1998, jumlah RS
Pemerintah (589) lebih banyak dari RS Swasta (491)
dengan selisih 98 buah. Sejalan dengan pesatnya
perkembangan RS Swasta, pada tahun 2008 jumlah
RS swasta meningkat menjadi 653 buah dan sakit
pemerintah menjadi 667 Buah. Dengan demikian,
selisih semakin mengecil yaitu 14 buah.
Dalam waktu lima tahun terakhir, RS swasta
berbentuk perseroan terbatas naik dua kali lipat
menjadi 85. Pertambahan terutama di daerah-daerah
dengan ekonomi kuat. Rumah Sakit (RS) Yayasan
mengalami pertumbuhan antara tahun 1998 sampai
dengan 2002. Setelah itu, jumlah RS yayasan tidak
bertambah secara signifikan. Rumah Sakit (RS)
Perkumpulan sedikit bertambah pada tahun
2001.Selama 10 tahun terjadi perpindahan bentuk
(migrasi) RS Swasta. Ada 26 RS Yayasan berubah
menjadi RS PT. Sebaliknya 5 RS PT berubah
menjadi RS Yayasan. Sebagian besar RS yang
melakukan migrasi berada di kota-kota besar.
Data ini menggambarkan dinamika kuat dalam
sektor RS di Indonesia. Dinamika ini terpengaruh
oleh kekuatan pasar yang besar di Indonesia.
Sebagaimana suatu sektor yang dipengaruhi oleh
pasar, akan terjadi variasi dalam mutu pelayanan.
Pertanyaan pentingnya adalah bagaimana mutu
pelayanan RS Swasta di Indonesia. Apakah sama
mutunya atau bervariasi dari mutu baik sampai mutu
buruk. Pertanyaan yang sama juga dapat diberikan
ke RS Pemerintah. Sayang pertanyaan ini sulit
dijawab karena memang belum ada sistem
pencatatan mutu RS yang dapat diandalkan.
Mengapa hal ini terjadi?
Sampai saat ini belum ada sistem yang
memisahkan antara regulator dan operator di sektor
kesehatan. Tanpa adanya regulator yang tepat maka
monitoring mutu pelayanan bukan hal yang mudah
untuk dilakukan. Hal ini berbeda dengan sektor
penerbangan yang sudah tegas memposisikan
Departemen Perhubungan sebagai regulator
sementara berbagai perusahaan transportasi
(termasuk Garuda) berfungsi sebagai operator.
Departemen Perhubungan tentunya mempunyai
catatan tentang mutu pelayanan penerbangan
termasuk angka kecelakaan. Perbandingan dengan
sektor perhubungan merupakan hal penting karena
sektor kesehatan dan sektor transportasi
menempatkan keselamatan (safety) sebagai isu
penting.
Departemen Kesehatan sendiri saat ini, masih
rancu dalam memposisikan diri apakah sebagai
regulator ataukah operator sistem pelayanan
kesehatan. Sebagai gambaran Direktorat Jenderal
Bina Pelayanan Medik masih bersifat rangkap:
sebagai operator sekitar 40-an RS pemerintah pusat,
sekaligus sebagai regulator lebih dari seribu RS di
Indonesia. Keadaan ini diharapkan tidak berlangsung
lama lagi. Perlu ada kebijakan jelas untuk
memisahkan kedua fungsi tersebut di pemerintah.
Kebijakan hal ini tidak hanya menyangkut aspek
teknis kesehatan namun juga politis dimana pasti
banyak pihak yang akan diuntungkan oleh
perubahan ini, sementara itu juga ada banyak pihak
yang akan dirugikan. Namun, membiarkan Direktorat
Jenderal Pelayanan Medik Departemen Kesehatan
mempunyai fungsi rangkap, jelas merupakan hal
yang tidak baik untuk pembangunan kesehatan.
Laksono Trisnantoro, trisnantoro@yahoo.com
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Utomo, Tomi Suryo
Background: Access to affordable essential medicines is
critical for management of public health in Indonesia. This is
because the government budget for medications is limited.
Furthermore, Indonesian sale of generic drugs, which would
be an effective strategy of providing cheaper drugs to the
public, is only 10% of drug sales. This is lower than other
countries in Asia. Relating to HIV prevalence, there is a
significant increase number, particularly in some regions in
Indonesia. It is not impossible that it will increase at alarming
levels in the near future. Finally, the enforcement of
pharmaceuticals patent law in Indonesia has created a tension
between national needs and domestic developmental policy
and international patent standards. This tension has particularly
affected Indonesia, since the TRIPS Agreement was introduced
in 1994. The TRIPS Agreement’s protection of pharmaceutical
patent has had adverse consequences for the health needs
of Indonesia since many patients cannot afford expensive
patented drugs.
Objective: This paper will consider the options or alternatives
open to the Indonesian government to address the access to
essential medicine issues that confront Indonesia as a member
of the WTO. A number of questions will be considered. First,
what factors are major influences on access to essential
medicines, in Indonesia? Second, what strategies and policies
will be recommended to the Indonesian Government to manage
the problems of limited access to affordable essential medicines?
Result: Patent law is not the only factor reducing access to
essential medicines. Non-patent issues that affect access to
essential medicines include: rational selection and use of
medicines; sustainable adequate financing; affordable prices
and reliable health and supply systems are issues that must
be prioritized by the Indonesian Government. Several optional
strategies and policies also need to be considered such as
controlling drugs promotion, maximizing the use of generic
drugs, improving administrative competence, drug
procurement, distribution and storage. Finally, prescribing
practices by physicians, pharmacists and drug vendors should
be a priority. Meanwhile more complex long-term goals, such
as establishing an industry to produce raw materials for
pharmaceuticals, can be considered. This could reduce the
impact of international pharmaceutical patents on price and
availability of essential medicines.
Conclusion: This paper concludes that the Indonesian
government must assess a set of non-patent issues affecting
the use of available drugs, particularly generic drugs. The
recommended policies and strategies will require careful
consideration by a multi-disciplinary committee for selection
and use of essential medicines.
Keywords: patent law, distribution and availability of essential
medicines, access to essential medicines, public health
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Hulu, Oktavianus
Background: Malaria is a major health problem in Nias. In
recent, resistance to Choroquin has occurred in Nias. One of
the potential factors is provider behaviour in diagnosing and
treating malaria cases. In Nias district hospital, malaria is one
of the ten most frequent diseases. This hospital functions as
referral for 18 health centres in the area.
Objective: This study focused on malaria case management
and aimed to: (1) describe occurrence of diagnostic and
treatment errors; (2) describe occurrence of error of omission
and error of commission; (3) to explore provider behaviour in
managing the disease; and (4) identify predisposing,
enabling,and enforcing factors to medical errors.
Method: A combination of quantitative and qualitative research
was applied in this study. One hundred forty six (146) blood
slides available in May 2007 were re-examined in Universitas
Gadjah Mada (UGM) laboratory to measure diagnostic
agreement. In addition, all medical record of malaria cases
were used to identify diagnosis and treatment errors.
Interviews were carried out with general practitioners,
specialists, laboratory staff and nurses who dealt with malaria
case management.
Result: Kappa index was low (0.04). Among all patients
diagnosed or treated as malaria (n=92), the occurrence of
medical error was 1.87 per patient. Among these, this study
identified 98 diagnostic errors, consisting of 16 cases of error
of ommission (17.39%) and 82 cases of error of commission
(89.13%). Treatment errors occurred in 92 cases, i.e. 19 cases
of error of ommission (20.65%) and 73 cases of error of
commission (79.35%). Provider behaviour contributed to
medical errors. The behaviour was supported by lack of
training on malaria for the hospital staff, absence of standard
operational procedure in managing malaria cases, incompetent
laboratory staff and lack of reward for good performance.
Conclusion: The occurrence of medical error in case
management of malaria was high. Improvements in clinical
quality should be prioritized, taken into account the underlying
factors.
Keywords: medical errors, malaria case management, hospital,
Nias
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Pinzon, Rizaldy
Background: The stroke care pathway is a simple resource
that provides the user with a summary of the key aspects of
care that should be considered for people with stroke at any
stage in their care. There is very limited study about the use of
clinical pathway in Indonesia.
Aim: This study described the process of developing clinical
care pathway and the trial of pathway for 50 patients with
acute stroke.
Method: The method of this study is after-before analysis.
We compare the process and outcome of non haemorrhagic
stroke patients before and after the pilot implementation of the
pathway. The data was obtained randomly from the medical
record of stroke patients. The data was analyzed descriptively.
Result: The data from 50 non haemorrhagic stroke patients
after the pilot implementation of clinical pathway were compared
with the data from previous year. The analysis showed that
there are improvement in the tracing for stroke risk factors,
swallowing assessment, nutritional consultation, and functional
status measurement after the pathway implementation. There
are not significant reductions on the average length of stay
and mortality rate between the two periods.
Conclusion: Our study showed that clinical pathway is
improving the indicator of stroke care services. The further
study for evaluating the effectiveness of stroke care pathway
in longer period is warranted.
Keywords: clinical pathway, stroke, process of care, outcome
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Siswanto, Siswanto
The objective of this case study was to learn the policy
process of the Gerbangmas movement in Lumajang district
as an innovation within decentralized system. Using qualitative
approach, data was collected by in-depth interview of key
informants and review of documents, then analyzed
thematically. The study has revealed that the policy change of
Gerbangmas initiative is not a radical but incremental process
which takes around five years period. It started from
“conventional Posyandus” to be “Balai Posyandu Mandiri”,
then revived by the Bupati into Gerbangmas movement. Health
sector has successfully advocated the Bupati to create a
common vehicle for all sectors. The study has identified that
the essences of Gerbangmas movement were (i) neutral
vehicle, (ii) shared goals, (iii) all sectors could be passengers,
(iv) strong power of the referee, (v) government financial
stimulants, (vi) self management by community, and (vii) neutral
cadres as the implementer (PKK). Gerbangmas movement
has encouraged multi sectors to set programs for community
empowerment. The study recommended that in conducting
community empowerment for addressing social determinants
of health, it is of importance to set a neutral vehicle that can
accommodate multi sectors’ interests.
Keywords: community empowerment, Posyandu,
Gerbangmas, inter-sectoral action, social determinants of
health
Jurnal Manajemen Pelayanan Kesehatan
2013-12-11 09:23:13
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Januraga, Pande Putu
Background: Premium subsidy of Jaminan Kesehatan
Jembrana or Jembrana Health Insurance (JKJ) in Jembrana
District has a rising trend since it began and needs to
redistribute, it’s critical to apply the cost containment programs
by introducing capitation system to primary health care
providers and premium payment to the member of JKJ.
Purpose: To examine perceptions of policy makers toward
background of premium subsidy, capitation system and premium
payment of JKJ and perceptions of providers toward capitation
system.
Method: Research was using cross sectional design and
data was taken by qualitative method. The subject was policy
makers and primary health care providers of JKJ. Instrument
being use was deep interview guidance.
Result and Conclusion: Generally policy makers of JKJ had
misinterpretation about the concept of basic needs and equity
egaliter in health, that causing resistance on premium payment.
Generally policy makers and providers of JKJ had bad
perception about capitation system.
Keywords: health insurance, capitation, premium payment
Jurnal Manajemen Pelayanan Kesehatan
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Herkutanto, Herkutanto
Background: People awareness to patient safety issues is
recently raising a long with the increase of malpractice claims.
Unsafe medical practice plays an important role to the issues.
The occurrence of unsafe medical practice could be prevented
if the medical staff committe in hospitals implement the medical
professionalism by overseeing the medical practitioners in
hospitals. Up to now, there are no valid information regarding
teh performance of the medical staff conmmittee, particularly
credentialing, audit, and disciplinary mechanism in hospitals.
Objectives: This study will explore the profile of the medical
staff committee and their performance in terms of their
organizational structure, credentialing and clinical privileging,
continuing professional development and medical audit, and
disciplinary measures.
Method: A cross sectional study was conducted to examine
the performance of the medical staff committees through
structured questionaires. The responders were
representatives of hospital managements of 133 hospitals who
agreed to fill in the questionaires. The scoring forms were
applied to score the several main functions of the medical
staff committee, i.e., structure, credentialing and clinical
privileging, continuing professional development and medical
audit, disciplinary measures, and management involvement in
the clinical governance.
Results: 91 % of the participating hospitals were General
Hospitals and the medical staff committee of 15% of the total
participants were absent. This research revealed that the mean
of the total score of the medical staff committees performance
were 17,9 + 4,9.
Conclusion: The study revealed that their performance was
still below the expected outcome since the delineation of clinical
privilege was not properly conducted by the hospitals. The
existence of credentialing and clinical privileging, continuing
professional development and medical audit, and disciplinary
measures reflects a better performance of the medical staff
committees.
Keywords: patient safety, medical staff committee,
performance
Jurnal Manajemen Pelayanan Kesehatan
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Trisnantoro, Laksono
Di berbagai daerah jumlah absolut kematian ibu
meningkat tajam. Kematian bayi juga meningkat.
Peningkatan ini tentunya sasaran Millenium Development
Goals (MDG)4 dan MDG5 sulit tercapai.
Pada konteks ini, kesehatan ibu dan anak (KIA) telah
banyak dilakukan penelitian yang menghasilkan
doktor baru, tulisan di jurnal dan berbagai hal lain.
Namun dampak untuk penurunan kematian ibu tidak
signifikan, bahkan di berbagai daerah ada peningkatan.
Sebagai komplemen berbagai penelitian perlu
dilakukan rencana aksi di daerah dengan pendekatan
common-sense. Pendekatan ini mengacu pada
sifat luhur manusia yang mampu menggunakan akal
sehat dan naluri.
Pendekatan sense making menggunakan langkah
langkah sebagai berikut: 1) Menggunakan konsep-
konsep universal untuk memahami masalah
yang terjadi di KIA; 2) Mengidentifikasi fakta di
lapangan dalam level kabupaten; 3) Melakukan
pemahaman dan pemaknaan mengenai data dengan
perspektif konsep-konsep universal (sense making);
4) Melakukan usulan respons dalam kebijakan dan
manajemen program untuk mengatasi masalah yang
terjadi; (5) Usulan respons kebijakan dan manajemen
program tertuang dalam dokumen yang berisi
kebijakan dan manual manajemen yang komprehensif;
(6) melakukan aksi perubahan berbasis respons
di berbagai tempat secara sukarela dan dimonitor
proses dan evaluasi dampaknya; dan (7) melakukan
evaluasi terhadap aksi perubahan yang dilakukan
untuk perbaikan kebijakan. Berbagai langkah dapat
diuraikan lebih rinci agar dapat operasional. Langkah
1: Konsep-konsep universal yang dipergunakan.
Penanganan KIA memerlukan pendekatan sistem
kesehatan dengan komponen-komponen yang mencakup:
(1) pelayanan kesehatan dan tindakan masyarakat
di hulu dan hilir; (2) fungsi-fungsi dalam
sistem kesehatan misal pemberi pelayanan, regulasi,
pembiayaan, pembayaran Sumber Daya
Manusia (SDM), perubahan perilaku masyarakat;
dan (3) perlunya reformasi sistem pelayanan
kesehatan KIA. Prinsip-prinsip universal yang
digunakan mencakup: continuum of care, koordinasi
yang baik antar berbagai pihak, membedakan antara
daerah maju banyak fasilitas dan tenaga dengan
daerah yang kurang, mutu pelayanan dan
keselamatan ibu dan bayi, dan menggunakan
semaksimal mungkin pembiayaan negara untuk
mengurangi angka kematian.
Langkah 2: Mengidentifikasi fakta. Data mengenai
kematian ibu dan bayi perlu diindentifikasi. Selanjutnya
dilakukan langkah 3 dengan dilakukan pemahaman
dan pemaknaan data dalam perspektif
konsep universal dan situasi lokal. Pemahaman dan
pemaknaan data ini dilakukan dalam kerangka pertanyaan:
Reformasi kebijakan apa yang akan dilakukan
di level kabupaten? Penguatan manajemen apa yang
akan dilakukan?
Langkah 4. Usulan respons lokal mencakup
perlunya kebijakan KIA yang mencakup perbaikan di
hulu dan di hilir. Usulan kebijakan tersebut antara lain:
penggunaan kematian absolut sebagai indikator
kinerja sistem, perbaikan tata kelola sistem pelayanan
KIA, dan reformasi kebijakan yang tidak terbatas
pada Jampersal saja. Reformasi kebijakan mencakup
perbaikan aspek pembiayaan jaminan bagi ibu
yang bersalin, perbaikan mekanisme pembayaran
bagi lembaga dan tenaga kesehatan; perbaikan pengorganisasian
pelayanan kesehatan KIA yang
mencakup hulu, rujukan dan hilir; penguatan kebijakan
regulasi; dan peningkatan promosi kesehatan
untuk memperbaiki perilaku masyarakat. Secara
khusus dalam paket kebijakan ini ditekankan mengenai:
peningkatan kemampuan pre-emptive strike
dalam rujukan terencana sehingga mengurangi rujukan
emergency; perbaikan jalur rujukan; pengarahan
pembiayaan negara untuk ibu-ibu bermasalah; dan
perbaikan mutu pelayanan dan keterlibatan aktif para
spesialis dalam pengurangan kematian ibu dan anak.
Langkah 5 berupa penulisan draft kebijakan dan
manual manajemen. Mengapa menggunakan model
manual di kabupaten? Jawabannya adalah bahwa
program KIA sangat rumit yang melibatkan banyak
lembaga dan banyak profesi. Melalui cara manual
diharapkan masalah yang kompleks ini dapat dicari
solusinya dan dapat dilakukan pengembangan
secara sistematis. Lebih jauh lagi, dengan adanya
manual sistem pelayanan kesehatan ibu dan anak,
peranan tenaga pembantu teknis (konsultan) dalam
KIA akan lebih mudah dilakukan.
176 Jurnal Manajemen Pelayanan Kesehatan, Vol. 14, No. 4 Desember 2011
Laksono Trisnantoro: Strategi Luar Biasa untuk Penurunan Kematian Ibu dan Bayi
Diharapkan usulan ini dapat diuji di beberapa
daerah terpilih sebagai langkah 6 yaitu melakukan
action berbasis respons di berbagai tempat dan
dimonitor proses dan evaluasi dampaknya (Langkah
7). Langkah 7 ini sangat penting karena sebagai usulan
yang luar biasa tentunya harus dapat diukur hasil
perubahannya. Pengukuran ini dilakukan dengan
indikator jumlah kematian ibu dan bayi absolut di
sebuah kabupaten.
Pertanyaan yang akan terus berkembang dalam
penyusunan dan pelaksanaan perubahan kebijakan
dan manajemen program KIA di kabupaten adalah:
Apakah perubahan kebijakan dan manajemen KIA
ini logis dan masuk akal (making sense)? Apakah
mengandung pembaharuan yang luar biasa untuk
usaha pengurangan kematian ibu dan anak? Apanya
yang baru? Apakah usulan ini dapat berjalan ataukah
hanya di atas kertas saja? Apa bukti-bukti yang dapat
mendukung usulan ini? Sebagai catatan akhir, andaikata
usulan ini dianalisis tidak logis dan tidak dapat
diaplikasikan, apakah ada alternatif perubahan kebijakan
dan manajemen untuk mengurangi kematian
ibu dan anak di kabupaten? Laksono Trisnantoro
(trisnantoro@yahoo.com)
Jurnal Manajemen Pelayanan Kesehatan
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Oktarina, Oktarina
Findings on female circumcision in few areas in Indonesia show
that nearly 88.5% of the field by medical personnel, in Padang
Pariaman 67.5% also carried out by medical staff, while the
remaining non-medical personnel, while in Makassar and bone
almost 100% female circumcision is performed by non-power
health or dukun beranak if done by non medical personnel,
Kemenkes can not regulate. Female circumcision as a tradition
that must be respected, even if they basically do not agree to
such practices as viewed from the medical side, female circumcision
is an activity that is not known and is not recommended.
To protect the health of women and their infants to
further strengthen the decision then the health minister issued
regulations Permenkes No.1636/Menkes/Per/XI/2010 female
circumcision which issued November 2010. In the presence of
female circumcision Permenkes aims to protect women from
illegal life-threatening circumcision and reproductive system,
Health Minister also gave authority to certain medical workers
such as doctors, midwives and nurses to perform female circumcision
procedure.
Keywords: ministerial regulation, Female Genital Cutting, tradition
Jurnal Manajemen Pelayanan Kesehatan
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Tandrasari, Devi
Background: Quality health care is one of the requirements
needed by everyone, including service in the hospital. Clinical
indicators used as a quality tool that enables objective measurement
to assess whether it has provided excellent service
to customers or patients. Sardjito General Hospital has been
set and measure the performance of clinical services using
clinical indicators since 2000, but the indicators are not compiled
systematically by type of key services that can be given
by doctors in the department at the hospital.
Objective: To develop a clinical indicator for measuring the
performance of clinical services of a department in the hospital,
to trial the implementation of measures of clinical indicators,
and to evaluate the clinical indicators that have been
made.
Methods: Qualitative research using an action research study
design. The subject of this research is Obstetrics and Gynecology
Department at Sardjito General Hospital, Yogyakarta
and specialist doctors and doctors who follow education obstetrics
and gynecology specialization final semester. Data
collection is done by analysis of the results of the workshop,
the analysis results of questionnaires, analysis of interview
data availability, analysis of test results of clinical indicators of
measurement, and analysis of the results of the finalized workshop.
Results: Ten clinical indicators agreed to be measured in the
Obstetrics and Gynecology Department. Based on the results
of the questionnaire, the ten clinical indicators are approved
by most doctors. Of the ten clinical indicators, there is one
indicator that did not have the data, the numerator of the clinical
indicators for services normal partus /vaginal partus. The
agreements in the finalized workshop are to make changes
the operational definition, the value of the achievement standards
and the availability of existing data.
Conclusion: Obstetrics and Gynecology Department will perform
the measurement for the ten indicators that have been
set. Clinical indicators that do not have the availability of data
will still be measured by creating a special form. Changes and
improvements to the operational definitions and standards of
achievement values need further discussion.
Keywords: quality of service, clinical indicators, obstetrics
and gynecology
Jurnal Manajemen Pelayanan Kesehatan
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Emilia, Ova
Background: Provider attitudes about issues pertinent to
patient safety may be related to errors and adverse events.
Residents as the main health provider in teaching hospitals
play an important factors for assuring patient safety.
Objective: To assess the attitudes of residents towards patient
safety and compare the attituted to other health providers
nurse/midwive) in the Obstetrics Gynaecology Outpatient Clinic.
Methods: This was a survey conducted in a teaching hospital
at Yogyakarta. Safety Attitude Questionnare (SAQ)-A questionnaire
was adapted into Indonesian setting to assess attitudes
among residents and nurses at Obstetrics Gynaecology
outpatient clinic. All residents and health providers were invited
to participate in this survey.
Results: Total of 71 respondents involved in this survey (consisted
of 79% of total residents and 82% of total nurses). The
SAQ-A questionnaire which was used here had comparable
internal consistency with the previous study. In general attitudes
towards patient safety were higher among nurses/
midwive than residents. Significant differences revealed related
to perception to management and stress recognition.
Perception to management score was the lowest compared to
other scales (19,6% residents versus 33,3% nurses with
positive attitudes). There was no differences for other scales
but still with low attitude scores. Aspects related to “information
transfer between residents and consultant”, “clinic referral
system” and “care in test results management” were perceived
as poor by residents and nurses.
Conclusion: Residents have lower attitudes towards patient
safety compare to nurses/midwive. This study shows the
importance of providing orientation among residens before
their training program to improve patient safety attitude.
Key Words: attitude towards patient safety, safety attitudes
questionnaire, teaching hospital
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Kwang, Ridwan
Background: In the last decade there has been a dramatic
shift in the human resource management. Personal Balance
Scorecard (PBS) is a new concept with the approach “from
the inside out” that uses the individual employee as a starting
point.
objectives: To obtain information about the performance of
nurses in M.H. Thamrin Salemba Hospital based approach to
the PBS, also to analyze PBS as performance appraisal instrument.
Methods: The study was conducted in November 2010 to
January 2011 using an instrument Scorecard Personal Balance
(PBS). Analyses were conducted with quantitative and
qualitative approaches. Sample of quantitative research is the
entire population of nurses in the inpatient adult MH Thamrin
Salemba Hospital. Survey instruments used for quantitative
research are containing questions about the performance of
nurses from the perspective of PBS. The qualitative research,
conducted in-depth interviews of nurses who meet certain
criteria. Performance measurement results with PBS and then
compared with the desired target and then analyzed descriptively.
Results: This study found that the performance is good enough
in the financial perspective, but still lack of nurses performance
on the customer perspective, there are some sectors
which need to be improved in the internal business perspective,
also learning and development perspective, and there is a
unit of work teams with performance score less well than
other units, that unit is Burns Unit.
Conclusion: From the analysis it concluded that PBS in its
role to measuring the performance of nurses also can translate
the vision, mission and strategic goals of the nurses into
performance indicator and strategic planning. It also obtained
from this study that the result of performance measurement
using PBS was in conformity with the situation on the field and
not deviate with BSC of M.H. Thamrin Salemba Hospital. It
suggests that the concept of the PBS can be further developed
and used mainly on an ongoing basis.
Keywords: balanced scorecard, personal balanced
scorecard, performance measurement, system management
Jurnal Manajemen Pelayanan Kesehatan
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Simamora, Sarmalina
Introduction: Medication error in term is the incidence that
can be harmful to the patient due to human error in handling
hospitalized patient care that actually can be avoided. Medication
error can be classified as: dispensing errors, prescribing
errors and administration errors. Among of medication error
caused by less communication, loading work, distribution system
and a role of occupational health care was low enough.
Objective: The aim of this research was to evaluate the frequency
and type’s incidence of medication error by a role of
occupational pharmacy working at hospitalized room care.
Based on active participation they act to check the appropriate
of Medical notes, Recipe (R/), Nursing drug administration notes;
such as identity of patient, Medical record number, product
name, quantity, posology, strengthening, doses ,and direction
of doses.
Methods: This research was pre-experimental, which took
pre-post intervention approach. Data Collection were conducted
in three steps; pre-participation, being-participation and
post-partcipation. To indentify the incidence of medication error
of their active participant determined by Chi-Square statistically
performance.
Result. As the result of 94 samples patient there were the
influences of occupational pharmacy among inter variability in
which the odds ratio value was 4,055, p value 0,0001. Among
of medication error the higher performance were administration
phase 81,32%, prescribing phase 15,88 % and transcribing
phase 2,8%.
Conclusion: Increasing a role of occupational pharmacy in
the hospitalized health care can be lowering the incidence of
medication error due to their active participation.
Keywords: medication error, RK Charitas Hospital, occupational
pharmacy
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Duma, Krispinus
Background: Fatigue was allegedly the cause of accidents
in the Perusahaan Tambang Batubara (PTB) and the OHS management
company focused on the manpower to cope with recommends
getting enough sleep, exercise, balanced diet and
so forth. But fatigue is caused by various factors including,
work environment factors, lifestyle, health conditions and so
forth but it is not disclosed to the work force. Occupational
Health Safety (OHS) extension system with lectures held so
far one way communication from the management of PTB to
the workforce and look at labor as objects rather than as OHS
subjects.
Purpose: Towards a Better Health and Safety Module (MMSS)
as the OHS method and media effective counseling increased
knowledge, attitude and behavior of OHS and innovative labor
force in controlling fatigue in PTB.
Methods: This quasi-experimental type (quasi experimental)
with nonequivalent design (pretest and posttest) control group
design, consisting of treatment group (experimental) and control
groups. Treatment groups received MM-SS, while the control
group did not get the MMSS.
Result: Application Module Towards Good-Health as a method
and medium of OHS for one-year extension effective improve
the OHS knowledge and attitudes heavy equipment operator
significantly (p<0.05), but not yet effective increasing behavior
of heavy equipment operator (p> 0,05) in control of work
exhaustion in the PTB. Relationships of OHS knowledge and
attitude with the level of job burnout WR light, WR sound indicator,
and KAUPK2 significant (p <0.05) but not significant
OHS behavior (p> 0.05). The correlation coefficient of OHS
knowledge, attitude and behavior with the level of job burnout
WR light, WR sound indicator and KAUPK2 is 0.090 to 0.540.
Conclusion: Module OHS (MMSS) as extension methods and
media effective K3 K3 improve knowledge and attitudes, but
not yet effective increase K3 behavior PTB heavy equipment
operator. Knowledge and attitudes K3 significantly associated
with fatigue level heavy equipment operator work PTB, but the
relationship behavior of K3 with no significant level of job
burnout.
Keywords: modules, knowledge, attitude, behavior, fatigue
work
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Trisnantoro, Laksono
Saat ini ada keluhan mengenai siapa yang layak
menjadi Kepala Dinas Kesehatan Kabupaten. Beberapa
kabupaten mengalami hal menarik bahwa
Kepala Dinas Kesehatan mempunyai pendidikan
sarjana dan pascasarjana yang bukan dari pendidikan
kesehatan. Sementara itu Peraturan Menteri
Kesehatan sudah jelas bahwa pendidikan Kepala
Dinas Kesehatan harus di bidang kesehatan masyarakat.
Pertanyaannya apakah pendidikan Kepala
Dinas kesehatan yang bukan berasal dari bidang
kesehatan akan merugikan status kesehatan
masyarakat?
Salah satu argumen menarik di daerah mengenai
hal ini adalah agar Dinas Kesehatan jangan
sampai menjadi “kerajaannya” para dokter dan tenaga
kesehatan. Oleh karena itu, Dinas Kesehatan perlu
dibuka untuk dapat dipimpin oleh tenaga yang
mempunyai pendidikan S1 dan S2 di luar kesehatan.
Sebagai timbal-baliknya adalah tenaga kesehatan
dapat menjadi Kepala Unit yang lain misal Kepala
Bappeda, Asisten Sekretaris Daerah, bahkan Sekretaris
Daerah. Badan Pemerintah Daerah (Bappeda)
yang secara tradisional dijabat oleh para insinyur
sipil, arsitektur, saat ini semakin banyak dijabat oleh
profesional dari kesehatan. Dengan terbukanya jalur
ini maka karir seorang Kepala Dinas Kesehatan
dapat berkembang ke tempat lain, tidak hanya di
sektor kesehatan. Apakah hal ini tepat?
Sistem kesehatan di dunia saat ini berkembang
semakin kompleks. Terdapat dinamika dalam hubungan
antara peran pemerintah, pendanaan,
kebijakan desentralisasi kesehatan, pengaruh
sistem pasar dalam pelayanan kesehatan, berkembangnya
teknologi kedokteran, meningkatnya
penyakit-penyakit tidak menular dalam situasi
penyakit menular yang masih tinggi, tuntutan masyarakat
yang semakin besar, pengaruh internasional,
sampai ke reformasi kesehatan.
Perkembangan-perkembangan tersebut, tanpa
pengelolaan yang baik dapat mempunyai dampak
negatif terhadap status kesehatan masyarakat. Pada
era desentralisasi Dinas Kesehatan merupakan
lembaga strategis di daerah untuk menetapkan berbagai
kebijakan kesehatan dan pelayanan kesehatan
serta manajemen kesehatan untuk meningkatkan
status kesehatan masyarakat. Kepala Dinas Kesehatan
adalah pemimpin yang harus mengelola
lembaganya yang dalam desentralisasi menjadi lebih
terbuka dan sensitif terhadap perubahan politik di
daerah. Kepala Dinas Kesehatan diharapkan mampu
memahami dinamika perubahan di sektor kesehatan
dan berbagai kompetensi yang dibutuhkan dan
memahami proses penyusunan kebijakan dan berbagai
pilihan kebijakan termasuk adanya reformasi
kesehatan di dunia, Indonesia, dan daerahnya
sendiri.
Semakin rumitnya sektor kesehatan yang harus
mendalami aspek teknis medik, sebaiknya Kepala
Dinas Kesehatan Kabupaten Provinsi adalah tenaga
kesehatan yang mempunyai pendidikan S1 dan S2
dalam ilmu-ilmu kesehatan. Tanpa ada dasar
pendidikan ini, dikhawatirkan kompetensi Kepala
Dinas Kesehatan sulit tercapai.
Untuk meningkatkan kompetensi kepala Dinas
Kesehatan, Menteri kesehatan mengeluarkan
Permenkes No. 791/2009. Celakanya desentralisasi
juga melahirkan Gubernur/Bupati/walikota yang tidak
mengindahkan aturan dari Kementerian Teknis
seperti Kementerian Kesehatan. Akibatnya terjadi
pengangkatan Kepala Dinas Kesehatan yang tidak
sesuai dengan Permenkes. Di berbagai tempat
Kepala Dinas Kesehatan dijabat oleh sarjana bukan
dari ilmu-ilmu kesehatan.
Bagaimana ke depannya? Situasi ini tidak
mungkin diteruskan karena akan mengganggu pembangunan
sektor kesehatan. Pengangkatan Kepala
Dinas Kesehatan harus sesuai dengan kompetensi.
Diharapkan pula pengangkatan juga jauh dari pertimbangan
politik ataupun hutang budi Bupati atau
Walikota terpilih kepada seseorang yang telah
membantu dalam pilihan kepada daerah.
Dalam suasana desentralisasi yang seperti ini,
Permenkes seolah tidak dipandang oleh pemerintah
di daerah maka diharapkan ada peningkatan
kekuatan aturan tentang kompetensi dari Permenkes
menjadi Peraturan Pemerintah. Peningkatan ini
tentunya membutuhkan usaha yang besar. Laksono
Trisnantoro (trisnantoro@yahoo.com)
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Marchira, Carla R.
Carla R. Marchira
Bagian Jiwa, Fakultas Kedokteran,
Universitas Gadjah Mada, Yogyakarta
ABSTRACT
Developing countries often encounter difficulties integrating
mental health into community health care, and Indonesia is no
exception. With an estimated population of 240 million, but with
very limited human resources in health care, especially mental
health care, Indonesia struggles to maintain an effective mental
health program. This review describes the changing process
in Indonesian governmental policies concerning mental
health, the current status and challenges of mental health in
community health care, and suggestions toward minimizing
the problems. Suggestions include training health workers,
waging a national campaign against stigma, and develop the
mental health program accomodated with the need assessment
of the area.
Keywords: integration, mental health, community health care
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Yuniarti, Evi Yuniarti
Background: Badan Pengelola (Bapel) Jamkesos has made
efforts to control cost by implementing utilization review since
2006. Data obtained from the result of utilization review (UR)
have not been fully evaluated to assess the performance of
health service providers. This is essential because UR can be
used by Bapel to communicate with the contracted health
service providers.
Objective: To evaluation implementing utilization review at
Jamkesos of Yogyakarta with describe UR activities; identify
the performance of health service providers and average
amount of health service cost before and after the implementation
of UR by Bapel Jamkesos of Yogyakarta Special Territory.
Method: The study was a survey that used before and after
design and secondary data of claim records. Variables of the
study were average support examination, percentage of irrelevance
of support examination, percentage of non generic
drugs, average cost of support examination, average cost of
drugs, average cost of operation, average total cost. Data
analysis used descriptive analysis was made to get an overview
of average cost and t-test to find out the difference of
the performance of health service providers before and after
UR.
Result and Discussion: Utilization Review (UR) carried out
by Jamkesos had not evaluated and analyzed the data available.
There was no significant difference in average support
examination, percentage of irrelevance support examination,
percentage of non generic drugs, average cost of support
examination; and average total cost of DHF service before
and after UR.
Conclusion: UR activities at Jamkesos of Yogyakarta Special
Territory were not yet optimum. There was no difference
in the performance of health service providers before and
after UR and there was difference in average total cost of
DHF service before and after UR carried out by Jamkesos.
Keywords: utilization review, cost containment, cost of health
service
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Kusumarini1, Putu
Background: Since February 2009 hospital has been using
electronic prescribing at outpatient clinics to reduce the medicine
collection waiting time at outpatient pharmacy.
Objective: To describe the role of electronic prescribing in
minimizing the risk during prescribing and transcribing, identify
doctors’ acceptance and also to compare patients, medicine
collection waiting time with electronic prescribing to manual
prescribing.
Methods: A study on doctors’ acceptance was a descriptive
study by using quantitative analysis. Interview with doctors
regarding their experience in using electronic prescribing and
also interview with pharmacies getting information about the
role of electronic prescribing in minimizing the risk during prescribing
and transcribing was a quantitative analysis study. A
study on comparing patients’ medicine collection waiting time
with electronic prescribing to manual prescribing was using
quasi-experimental method.
Results and conclusions: Path analysis results showed
that perceived usefullness had bigger influence than perceived
ease of use in term of acceptance of electronic prescribing.
Most of doctors told that they have benefit of using electronic
prescribing. Electronic prescribing could minimize the risk during
prescribing and transcribing and also reduce the waiting
time.
Keywords: electronic prescribing, doctors’ acceptance, prescribing,
transcribing, medicine collection waiting time
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Surmiyati, Surmiyati
Background: Integreated-administration service program in
the hospital (PPATRS) has an important role for PT Askes
(Persero) in optimizing costumer satisfaction. Integreated-administration
service program in the hospital (PPATRS) is applied
in the hospital Askes Center. Based on a PPATRS survey
done in Askes Center in Dr. Suradji Tirtonegoro Hospital in
Klaten, it is known that the service is not in a good order, lack
of management, improper waiting room, and long and complicated
service.
Objectives: The objective of this research is to understand
the implementation of PPATRS in Dr. Suradji Tirtonegoro Hospital
Klaten.
Method: This is a descriptive qualitative research, done in
Askes Center of Dr. Suradji Tirtonegoro Klaten. The data was
collected by interviewing; the subject of the research was
Askes Center Coordinator, Hospital Control Team Leader, and
Askes Participants by using guided questions.
Result: The result of the research shows that the PPATRS
has been implementing in Dr. Suradji Tirtonegoro Klaten based
on Standard Operational Procedures as written down on The
Guideline of Health Service Administration Askes Sosial, but
there are some standard items that haven’t been implemented,
such as physical standard, human resources, service flow
mechanism, and control towards in-patients of Askes participants.
Conclusion: Integreated-administration service program in
the hospital (PPATRS) in Askes Center of Dr. Suradji Tirtonegoro
Klaten has been implemented but still below the existing standard
so that needed to be improved and re-managed especially
for physical standard, human resource, service flow
mechanism, and control towards in-patients of Askes participants.
Keywords: implementation, PPATRS, Askes Center
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Fitriati, Rachma
Background: Quality improvement in public service has become
a major concern in government institutions as an effort
to provide the maximum public service. It is also a major concern
for government hospitals in Bengkulu Province.
Objective: To analyzing the quality level of the service provided
by three government hospitals namely RSUD M. Yunus,
RS Jitra, and RS Dinas Kesehatan Tentara (DKT).
Method: The study uses quantitative-positivistic approach
with sampling techniques performed by non probability sample
through accidental sampling. This study uses analysis of the
service quality (Servqual) and the Importance-Performance
Analysis (IPA) through a survey of 300 respondents.
Result and Discussion: Results showed the dimensions of
the highest service priority level based on the ratings given by
respondents is the assurance. While at the lowest priority of
service quality is different, there are differences in all three
hospitals. If RSUD M. Yunus lowest on service quality of empathy,
while RS Jitra and RS DKT lowest on physical appearance.
Conclusion: The results of both analyzes using the Servqual
and IPA are mutually reinforcing. The highest performance at
RSUD M Yunus on the dimensions of assurance, RS Jitra on
the dimensions of reliability, and RS DKT on the dimensions of
tangible. Recommendations for subsequent research is to
complete a more in-depth analysis of this quantitative research,
with mengesplorasi qualitative aspects of the reality of the
quality of public services of government hospitals in Bengkulu
Province. Continued research in this area is needed to determine
the readiness of Bengkulu Province in implementing the
national social security system in health to be held in January
2014.
Keywords: public service, government hospital, service quality,
importance-performance analysis
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Sumihardi, Sumihardi
Background: Work accident in Indonesia was remaining high
due to less attention toward occupational health and safety.
There was an elevation number of work accident from 95,418
cases in 2005 to 95,624 cases in 2007 in Indonesia. In Padang,
West Sumatera there was decreasing of accident case. However,
the number of work accident in PT P & P Lembah Karet
was reported elevated from 9 cases in 2005 to 24 cases in
2007. Therefore, there is a need to apply work safety control.
Generally, there are two methods for controlling occupational
safety, i.e. mechanical and human intervention, but mechanical
treatment is expensive and need more expertise, while
human intervention is considerable. One of human intervention
that can be applied to control occupational safety is displaying
poster and disseminat of SOP. The objectives of this
study is to assess the influence of displaying safety poster
and disseminat of SOP through education and training toward
attitude and practice of safety among labour, as well as on the
number of work accident.
Method: This study was carried at PT P & P Lembah Karet
Padang. Design of this study was time series. This design
was chosen based on the advantage on multiple observations
before and after intervention. Participants of this study was
115 worker and taken from stratified random sampling. Safety
poster and SOP delivered through education and training study
intervention were. Study instruments were attitude scale, accident
log and check list of safety behavior. Data were analyzed
with repeated measures analysis of variance and paired
t test.
Result: Result showed there was a different on attitude scale
(t = 31,747, p< 0,001) before and after with gain score of
30,73%. Indeed, the mean score of practice was also significantly
different before and after (F = 99865,228, p < 0,001). T
test analysis showed that there was a different score of
practice before intervention and after the fourth observation (t
= 547,792, p < 0,001), and total number of occupational accident
significantly different before and after intervention (t =
4,371, p < 0,05) with decreasing point of 78,57%.
Conclusion: It can be concluded that safety poster and SOP
delivered through education and training increased attitude
30,73% and practice 88,79%. Moreover, total number of occupational
accident decreased of 78,57%. Based on this study,
it is recommend that monitoring of occupational safety periodically
through safety poster accompany with education and
training is needed, to increase attitude and practice of toward
occupational accident, so the number of work accident will
decrease into zero.
Keywords: safety poster, SOP, attitude, practice, work accident
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Trisnantoro, Laksono
Saat ini terdapat keluhan mengenai mutu
pendidikan dokter Indonesia, masalah
penyebarannya, serta biaya pendidikan. Keluhan ini
tidak terbatas pada pendidikan dokter umum, namun
juga pendidikan spesialis (residen di rumahsakit).
Dalam konteks ini memang dirasakan ada sesuatu
yang salah dalam pendidikan kedokteran Indonesia.
Oleh karena itu Komisi X DPR melakukan inisiatif
dengan mengajukan Rancangan Undang-Undang
(RUU) Pendidikan Kedokteran. Saat ini RUU tersebut
telah masuk ke pembahasan materi oleh
pemerintah. Diharapkan akhir bulan Juni 2011
pemerintah telah selesai menyusun tanggapannya
untuk kembali dibahas oleh DPR. Pertanyaan
penting yang sering timbul adalah apakah memang
perlu RUU tersebut. Apa masalah kebijakannya?
Dalam tulisan ini ada dua kebijakan yang disoroti
yaotu kebijakan pemerintah di pendidiakn dokter
umum dan kebijakan di pendidikan spesialis.
Berbagai kebijakan yang terkait dengan
pendidikan dokter umum berada dalam berbagai
konteks menarik. Pertama ada berbagai kesulitan
dalam memasukkan lulusan SMA dari daerah sulit
ke Fakultas Kedokteran (FK) negeri, dalam suasana
kebutuhan daerah akan dokter. Dalam situasi ini
eforia desentralisasi mendorong berbagai pemerintah
daerah mendirikan FK dengan modal keuangan dan
sumber daya manusia (SDM) yang terbatas.
Akibatnya mutu pendidikan kedokteran di berbagai
fakultas dipertanyakan. Kedua, kurikulum pendidikan
dokter di Indonesia terlihat berusaha mengejar
kemajuan teknologi sementara itu kesesuaian
dengan kebutuhan lokal terlihat kurang diperhatikan.
Ketiga. dalam suasana permintaan tinggi lulusan
SMA untuk menjadi peserta Pendidikan kedokteran
, berdampak pada situasi dimana fakultas
kedokteran menghasilkan pendapatan besar untuk
perguruan tinggi. Terjadi peningkatan tarif ataupun
sumbangan dari mahasiswa termasuk mahasiswa
asing. Terjadi fenomena buruk yang tidak dapat
dielakkan, fakultas kedokteran di berbagai universitas
negeri dan swasta menjadi penyumbang untuk
pendidikan di fakultas lain.
Di sisi pendidikan profesi selama bertahun-tahun
terjadi ketidak jelasan domain rs pendidikan apakah
berada di Kementerian Kesehatan atau pendidikan
dengan konsekuensi sumber anggarannya.
Kementerian Kesehatan merupakan pemilik
sebagian besar rumahsakit pendidikan yang tidak
mempunyai anggaran khusus untuk pendidikan
dokter umum. Akan tetapi kerjasama antara dua
kementerian ini belum jelas.
Kebijakan pemerintah di Dokter Spesialis
merupakan faktor kedua penting untuk menyusun
RUU ini. Jumlah lulusan dokter spesialis setiap tahun
sangat tidak signifikan jika dibandingkan dengan
kebutuhannya. Hal ini disebabkan karena pendidikan
kedokteran spesialis hanya ada di perguruan tinggi
negeri dan tidak ada dukungan pemerintah dalam
anggaran. Data menunjukkan fakta bahwa
pertumbuhan tenaga dokter spesialis sangat lambat
dibandingkan dengan kenaikan jumlah penduduk.
Oleh karena itu, perlu dirancang sistem pendidikan
spesialis dengan harapan, jumlah dan mutu spesialis
segera dapat memenuhi kebutuhan masyarakat Indonesia.
Di pendidikan spesialis dibutuhkan campur
tangan pemerintah, termasuk pendanaanya. Dengan
demikian biaya yang ditanggung oleh masyarakat
dapat berkurang. Salahsatu inovasi dalam pendidikan
spesialis adalah memberi kesempatan ke sistem
pendidikan yang berdasarkan rumah sakit (hospital
based) pemerintah dan swasta dalam lingkup sistem
perguruan tinggi, dengan ujian nasional untuk
standarisasi kompetensi mereka. Oleh karena itu
kebijakan terhadap peserta pendidikan dokter
spesialis perlu diubah. Peserta pendidikan (residen)
adalah bukan hanya peserta didik, namun juga
merupakan pemberi pelayanan di rumahsakit yang
mempunyai hak dan kewajiban, termasuk menerima
pendapatan dari kegiatannya di rumahsakit.
Kebijakan-kebijakan pemerintah di pendidikan
kedokteran ini perlu dilakukan dengan alat kebijakan
publik yang kuat, dalam bentuk Undang-Undang,
tidak cukup dengan Peraturan Pemerintah. Oleh
karena itu dibutuhkan RUU pendidikan kedokteran.
Ketika membahas RUU Pendidikan Kedokteran
maka perlu analisis dengan menggunakan
pendekatan reformasi dalam pendidikan kedokteran.
Dalam konteks sejarah, reform bisa berulang-ulang
sesuai kebutuhan jamannya. Reformasi pendidikan
kedokteran yang dituliskan oleh Frenk dkk (Lancet
2010) berfokus pada reform medical education di
abad 20 kemarin. Menurut Frenk ada tiga reform
pendidikan kedokteran di abad ke 2-0: (1) The first
generation, launched at the beginning of the 20th
century, instilled a science-based curriculum; (2)
Around mid-century, the second generation introduced
problem-based instructional innovations; dan
(3) A third generation is now needed that should be
systems based.
Dengan pendekatan pemikiran reformasi
pendidikan kedokteran terlihat bahwa RUU
Pendidikan kedokteran merupakan sebuah reformasi
di pendidikan kedokteran. RUU ini merupakan
kebijakan reformis dalam pendidikan kedokteran,
yang merupakan reformasi generasi ke tiga. Laksono
Trisnantoro (trisnantoro@yahoo.com)
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Suryawati, Sri
Narkotika lebih dikenal masyarakat karena masalah
penyalahgunaannya, padahal salah satu kelompok narkotika
yang digunakan dalam bidang medis adalah analgetika narkotika,
utamanya tablet morfin, yang merupakan obat esensial.
Penghitungan kebutuhan yang akurat untuk analgetika narkotika
sangat penting untuk memastikan ketersediaannya bagi
pelayanan kesehatan pasien. Saat ini data global menunjukkan
bahwa penggunaan morfin lebih terkonsentrasi di beberapa
negara di Eropa dan Amerika Utara saja, sedangkan di negaranegara
lain termasuk Indonesia, konsumsinya sangat minim.
Morfin bahkan tak tersedia di 70 negara dan teritori.
Penyebabnya bisa karena kurang akuratnya penghitungan
kebutuhan, kurang digunakan atau karena kebocoran distribusi.
Di lain pihak, ketidakakuratan penghitungan juga bisa
menyebabkan surplus persediaan yang bisa menyebabkan
kebocoran distribusi dan dapat mengarah ke penyalahgunaan.
Oleh karena itu, sangatlah penting untuk memilih metode
penghitungan kebutuhan morfin yang paling tepat, agar
kebutuhan medis terpenuhi secara optimal. Makalah ini
menyajikan sistem pengawasan internasional untuk penyediaan
narkotika bagi kebutuhan medis, dan langkah-langkah untuk
meningkatkan keakuratan penghitungan kebutuhan analgetika
narkotika, dengan tetap memperhatikan langkah-langkah
pengamanan distribusinya.
Kata Kunci: sistem pengawasan internasional, analgetika
narcotika, morfin, estimasi, metode kuantifikasi
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Nurrizka, Rahmah Hida
Background and Method: This research measured Society
Satisfaction Index (SSI) toward health service at Achmad
Mochtar Hospital West Sumatera. Society Satisfaction Index
(SSI) is one of indicators for measuring public service provided
by govermental institution for society. This is stipulated in the
decesion of Minister for Empowering State apporatus Number
No. 25/2004 on General Guide for Society Satisfaction Index
at Service Unit of Goverment Institution.
Result and Conclusion: The result of measuring SSI at
Achmad Mochtar Hospital showed; (1) in general, service given
to society has been good, except for aspects; officers discipline
in serving, the speed of service, the certanty of service cost
and service schedule, (2) from service side, service at inhospital
stay is better that service at out-hospital stay and
emergency service, (3) the difference in service occured
according to service unit and three best service based on SSI
were in the unit of modwifery, sex/skin and THT. Based on this
finding, goverment and hospital can improve health service.
Keywords: society satisfaction index, helath service, public
service
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Wiedyaningsih, Chairun
Backgrounds: Since objective information on medicine
advertisements are often scarce, medicine advertisements
may affect community’s perception and health. The Critical
Evaluation Medicine Advertisement by the community (CEMAcommunity)
was a strategy that may empower community in
evaluating medicine advertisements. It was developed based
on the previous study targeted to medical students with
modifications on the content and the inclusion of local regulation
on medicine promotion.
Objectives: To evaluate effectiveness of the CEMAcommunity
method in improving knowledge and skills of
participants.
Methods: The study utilized pre and post in time series with
control group design. The CEMA-community intervention method
consisted of two sessions; the first was a brief lecture and
the second was small group discussions using printed and
audiovisual medicine advertisements in problem-oriented
approach. Activity materials and methods were developed and
provided to the activity. Data on knowledge was obtained by
questionnaires. Data on skills was assessed by the number of
inappropriate claims they could identify the advertisements.
Effectiveness of approach was shown by the significance of
increasing level of knowledge and skills after intervention.
Results: Participants’ knowledge and skills in the CEMAcommunity
group improved significantly (Wilcoxon test, p< 0.05).
Score of knowledge in the CEMA-community group before-,
right-, and 2, 4 weeks-after intervention (means: 13.9±2.52;
18.0±2.72; 19.0±3.10; 18.3±3.74, respectively) improved
significantly (Mann-Whitney, p<0.05) as compared to control
group (means: 14.1± 2.84; 14.8±2.94; 14.8±2.85; 15.6±2.45,
respectively). At the same time points, scores of skills in the
CEMA-community group (means: 7.8±6.05; 16.5±10.01;
32.6±12.89; 32.2±13.06, respectively) also improved
significantly (Mann-Whitney, p<0.05) as compared to control
group (5.5±6.60; 4.7±4.91; 8.7±10.07; 9.5±10.15, respectively).
Conclusion: CEMA-community was effective in increasing
knowledge and skills to critically evaluate medicine
advertisements.
Keywords: community empowerment, medicine
advertisements, knowledge, skills, CEMA-community, problemoriented
approach
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Sopacua, Evie
Background: Washing hands with soap on right a time is an
effort to change bad attitudes which does not support the
expected health’s status. Washing hands with soap couldn’t
succeeded if there was not clean water access. This analysis
purposed to know the relation between clean water access
with washing hands with soap’s attitudes on household with
children under 5 years based on region’s type in Indonesia.
Method: This analysis used chi-square’s and log-regression’s
test with Riskesdas 2007 data as analysis units. It showed
that 243.396 children under 5 years on 104.109 urban’s
households and 139.287 rural’s households.
Result: The result showed that the clean water access 90%
either in urban or rural was good, but the attitude washing
hands with soap were still low, under 60%. Chi-square test
showed there was a relation between the clean water access
and the outcome level with washing hands with soap’s attitude.
Log-regression test showed that tended based on the outcome
level in avarege and poor households, and did not differs
between urban and rural.
Conclusion: There were relations between the clean water
access and outcome levels with washing hands with soap.
Washing hands with soap ‘s attitude with clean water or not
still on the low level, either on urban or rural. Household with
poor economic’s and avarege’s status tended to low washing
hands with soap’s attitude againts the wealthy one. This study
recommended to improve health’s education to all community,
to understand the importance of washing hands with soap
using clean water for all activities, especially before eating,
before preparing the food, after loosen the bowels/babies’
care, and after holding the animals.
Keywords: clean water access, washing hands with soap,
household with children under 5 years
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Suryanto, Suryanto
Background: Job satisfaction will improve the nurse
performance in hospital. This occurs when the nurses perceive
intrinsic rewards (e.g. feel something has achieved) and
extrinsic rewards (e.g. salary/incentives) which have been
received were fair and reasonable. The job satisfaction in
nurses will raise motivation in the workplace so that the numbers
of absence will be decreased. The job satisfaction can also
improve physical and mental health status that has impact on
physical fitness, high work morale and motivation so that the
nurse performance will be increased.
Objective: To identify relationship between job satisfaction
and nurses perceptions about leadership with the nurse
performance of post certification ISO 9001/2008 in PKU
Muhammadiyah Hospital Gombong.
Method: Explanatory quantitative research methods with
survey and cross-sectional approach. Data analysis was
performed with linear regression test. The independent
variables were job satisfaction and nurse perceptions about
leadership and dependent variable was the nurse performance.
Samples were 95 nurses who worked in PKU Muhammadiyah
Hospital Gombong. The research instruments use modified
Likert’s scale, questionnaires and interview guides. The data
sources are nurses, patients and several informants.
Result: The analysis result of ANOVA test was found F count
26.44, significance level of 0.000. With relationship value of
0.44. There was a significant positive relationship between
job satisfaction and nurse perceptions about leadership with
the nurse performance of post certification ISO 9001/2008 in
PKU Muhammadiyah Hospital Gombong. The closeness of
relationship is moderate category while R Square value
(determination coefficient) was 36.5%. This means that the
job satisfaction of nurses and nurse perceptions about
leadership is jointly affect the nurse performance about 36.5%
Conclusion: There was a significant positive relationship
between job satisfaction and nurse perception about leadership
with the nurse performance of post certification ISO 9001/
2008 in PKU Muhammadiyah Hospital Gombong. To improve
the nurse performance, nurses should make some innovations
in their work. The management of hospital should improve the
control function and the comfort of work environment in the
hospital.
Keywords: job satisfaction, leadership, performance
Jurnal Manajemen Pelayanan Kesehatan
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Maharani, Asri
Background: The willingness to pay of society for the
products of laboratory services as one of the health
precautions need to be improved. Ownership of health
insurance is one factor that wants to study its effect on
willingness to pay for laboratory services because health
insurance is expected to have a society can allocate funds for
preventive health
Objective: The purpose of this study is to determine the effect
of health insurance ownership of willingness to pay for
laboratory services.
Methods: A cross sectional study design using the 100
respondents who were taken proportionally from eight selected
districts in Banyuwangi. Variables that were examined include
the willingness to pay as measured by the method of contingent
valuation and ownership of health insurance. The data
collection tool is a questionnaire. Data were analyzed using
logistic regression.
Results: The results showed that the level of willingness to
pay of respondents for all types of laboratory examinations is
still low. Most respondents (76%) did not have health insurance.
Only about 50% of respondents who do not have health
insurance are willing to pay for laboratory examination.
Respondents who have health insurance tend to want to pay
for laboratory services. From 24 respondents who have health
insurance, more than 50% of respondents (15 respondents)
were willing to pay for laboratory services. The ownership of
health insurance of respondents did not significantly affect
the willingness to pay for laboratory examination product
(sig. = 0.287, B =- 0.511). This may be due to the Banyuwangi
Regency society has not so familiar with health insurance and
still less has it, so most of the out-of-pocket payments.
Conclusion: The ownership of health insurance respondents
did not significantly affect the willingness to pay for products
laboratory examination. It is need to introduce more products
laboratory services and health insurance benefits to the
Banyuwangi community.
Keywords: willingness to pay, laboratory services, ownership
of health insurance
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Santosa, Heru
Background: Public Health Center (“Puskesmas”/Pusat
Kesehatan Masyarakat) is a leading health service facility in
the development of community health in Indonesia and plays a
vital role to realize the vision of Healthy Indonesia 2010. The
objectives to evaluate the health service quality of Puskesmas;
The quality of Puskesmas services was evaluated using
Serqual method while the data was collected using quantitative
and qualitative methods.
Method and Result: The quantitative analysis indicated that
the mean score for quality was 3.79. In addition, the health
service quality of Puskesmas, on all dimensions, generally
shows the scores above 3. This means that the health service
quality of Puskesmas is at a relatively good level. Stratified by
the mean scores, the dimensions of responsiveness and
reliability have similar mean scores of 3.85; the dimension of
empathy has a mean score of 3.81; and the dimension of
assurance has a mean score of 3.79.
Conclusion: The dimension of tangible has the lowest mean
score of 3.64. The factors affecting the improvement of health
service quality in Puskesmas are the input factors, process
factors, and environmental factors for achieving the vision of
Healthy Indonesia 2010 through the implementation of the North
Sumatera Province Health Project-II.
Keywords: public health center, Puskesmas
Jurnal Manajemen Pelayanan Kesehatan
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Trisnantoro, Laksono
Di berbagai provinsi di Jawa dilaporkan angka
kematian ibu stagnan bahkan ada yang memburuk
dalam waktu empat tahun terakhir ini. Di provinsi
Indonesia timur, kematian bayi dilaporkan memburuk
sejak tahun 2000 ketika desentralisasi kesehatan
dijalankan. Mengapa hal ini terjadi? Apa saja faktorfaktor
yang mempengaruhinya?
Dalam tajuk ini, secara khusus dibahas
mengenai peranan tenaga kesehatan saat ini untuk
usaha penurunan MDG4 dan MDG5. Potret situasi
tenaga kesehatan saat ini adalah jumlah kurang,
distribusi tidak merata, kerja sama antar profesi
kurang, dan kompensasi yang tidak sesuai
harapan. Kekurangan tenaga kesehatan terjadi di
daerah maju seperti Jawa dan tentunya di daerah
sulit seperti Papua ataupun Nusa Tenggara Timur
(NTT). Di Jawa masih terjadi kekurangan dokter
spesialis obsgin, anastesi, serta anak di berbagai
kabupaten. Di daerah sulit seperti NTT dan Papua
terjadi kekurangan dokter spesialis, dokter, bidan,
dan perawat yang sangat besar. Kesenjangan
Sumber Daya Manusia (SDM) Kesehatan di 32
Kabupaten/Kota sangat mencolok. Di DKI Jakarta
ada sekitar 450-an dokter anak sementara di
Bengkulu kurang dari 10. Di Jakarta lebih dari 150
tenaga spesialis anastesi bekerja, sementara di NTT
tidak ada satupun spesialis yang bekerja penuh
waktu.
Dalam pelayanan kesehatan ibu dan anak,
terlihat bahwa kerja sama antar profesi kurang.
Kesehatan ibu dan anak seolah identik dengan bidan
dan dokter spesialis. Peranan dokter umum mengecil
dalam dekade ini. Dokter umum menjadi profesi
yang kurang terlatih dalam pelayanan kesehatan ibu
dan anak. Kurikulum pendidikan dokter cenderung
menempatkan dokter umum sebagai penonton dalam
emergensi kebidanan. Sementara itu, jumlah
spesialis obsgin sangat kurang. Sayangnya
perhimpunan spesialis dan kolegiumnya terkesan
tidak bersedia memberikan keahliannya ke dokter
umum di daerah yang tidak ada atau kekurangan
spesialis obsgin. Keadaan SDM ini diperparah
dengan sistem kompensasi yang tidak menarik untuk
melakukan pelayanan kesehatan ibu dan anak
khususnya yang melalui program jaminan
kesehatan.
Mengingat momen pencapaian target MDG4 dan
MDG5 di tahun 2015 sudah dekat, walaupun sudah
agak terlambat, faktor SDM perlu diangkat sebagai
isu strategis. Tanpa SDM yang baik maka upaya
mengurangi kematian ibu dan anak tidak akan
tercapai di tahun 2015, termasuk upaya mengurangi
gap antara provinsi timur dan barat.
Dalam hal SDM, ada beberapa isu stretegis yang
perlu dibahas. Isu strategis pertama adalah perlunya
tenaga kerja kesehatan bekerja bersama
menggunakan prinsip pencegahan primer sampai
sekunder/tertier dengan menggunakan pendekatan
perjalanan alamiah penyakit. Analisis kebijakan
menunjukkan bahwa kebijakan nasional tentang
kesehatan ibu dan anak banyak berada di masyarakat
dan puskesmas. Seiring dengan situasi ini, kebijakan
nasional tentang tenaga kerja di MDG 4 dan MDG 5
banyak membahas bidan, jarang untuk dokter dan
spesialis. Di samping itu, ada kecenderungan
kebijakan kesehatan ibu dan anak tidak membahas
pelayanan kuratif. Dalam penyusunan dan
pelaksanaan kebijakan terlihat ada pemisahan
kegiatan antara pelayanan primer dengan sekunder
dan tertier. Akibatnya rumah sakit dan tenaga kerjanya
dalam kondisi terabaikan dalam MDG4 dan MDG5,
padahal saat ini di Jawa kematian ibu banyak terjadi
di rumah sakit. Aksi strategis yang diperlukan dalam
isu ini adalah: (1) Meningkatkan pemahaman tentang
perlunya kerja sama pelayanan primer sampai
sekunder-tertier; dan (2) Meningkatkan jumlah dan
kerja sama antar profesi dalam MDG4 dan MDG5.
Dalam konteks aksi strategis ini patut dicatat
bahwa Kemenkes melakukan penggabungan
pembinaan pelayanan kesehatan primer dan
sekunder-tertier. Ada dua Ditjen dengan nama dan
tugas baru yaitu Ditjen Bina Upaya Kesehatan dan
Ditjen Bina Gizi dan KIA. Bersama dua Ditjen baru
ini diharapkan koordinasi pelayanan primer dengan
sekunder/tertier menjadi lebih baik di pelayanan
kesehatan ibu dan anak.
Isu strategis kedua adalah perlunya inovasi
dalam menambah jumlah dokter spesialis dan
kemampuan tenaga kesehatan di berbagai tempat.
Sebagai gambaran saat ini mutu sistem rujukan
masih buruk. Di daerah sulit, PONED dan PONEK
24 jam sulit berjalan karena kekurangan SDM.
Di banyak kabupaten di Jawa, pelaksanaan
PONEK sulit 24 jam karena terbatasnya jumlah SDM
dan sistem manajemen tidak memungkinkan. Apa
innovasi strategisnya? (1) perlu dilakukan inovasi
menambah jumlah tenaga melalui sistem kontrak
seperti yang dilakukan Program Sister Hospital NTT;
(2) perlu mendayagunakan residen. Residen saat ini
dapat dikembangkan sebagai tenaga yang tidak
hanya belajar tetapi juga bekerja. Residen dalam
proses pendidikannya ditempatkan di RS yang
kekurangan tenaga dan dibayar sesuai
kompetensinya; (3) perlu melakukan Task-Shifting.
Definisi Task-Shifting menurut WHO adalah: Task
shifting involves the rational redistribution of tasks
among health workforce teams. Specific tasks are
moved, where appropriate, from highly qualified
health workers to health workers with shorter training
and fewer qualifications in order to make more
efficient use of the available human resources for
health. Melalui adanya Task-Shifting ini kebutuhan
tenaga kesehatan secara sementara dapat diatasi,
namun perlu pendidikan tenaga kesehatan yang
sebenarnya; (4) perlu melakukan kontrak tenaga di
pelayanan kesehatan primer. Saat ini memang sudah
ada kontrak tenaga (dokter, bidan), namun kontrak
bersifat perorangan yang kurang efektif. Di daerah
sulit tenaga kontrak perorangan cenderung
berkumpul di kota kabupaten. Kontrak perlu
dilakukan secara kelompok dan menjamin aspek
keamanan serta logistik. Inovasi ini membutuhkan
kemitraan antara pemerintah dan swasta. Lembaga
Swadaya Masyakarat sebaiknya ada yang bisa
menjadi kontraktor untuk menyediakan tenaga
secara kelompok (dokter, bidan, perawat,
epidemiolog, dan lain-lain).
Isu strategis ketiga adalah memperhatikan
insentif bagi tenaga kesehatan. Sebagaimana
diketahui tenaga kesehatan sebagai makhluk
ekonomi mempunyai kepuasan hidup yang diukur
dengan: (1) tingkat pendapatan yang terdiri dari: gaji
dan insentif dari praktik; serta (2) waktu yang dapat
dipakai untuk rekreasi. Saat ini penetapan insentif
tenaga kesehatan masih berdasarkan asumsi.
Pemerintah belum pernah melakukan negosiasi
dengan ikatan profesi. Sementara itu, ikatan profesi
masih belum mempunyai standar pendapatan dan
insentif bagi anggotanya yang wajar. Sebagai
gambaran penetapan insentif dalam Jampersal,
ditolak oleh sebagian bidan karena tidak sesuai
dengan harapan. Insentif dokter dalam sistem
kapitasi puskesmas juga dirasakan sangat kurang
oleh para dokter.
Sebagai penutup dapat ditegaskan bahwa target
MDG 4 dan MDG 5 di tahun 2015 sulit tercapai tanpa
inovasi dalam kebijakan tenaga kerja kesehatan.
Dalam hal ini perlu ada keberanian untuk melakukan
aksi yang bertujuan mengurangi kematian ibu dan
anak dengan memperhatikan isu-isu strategis.
Laksono Trisnantoro (trisnantoro@ yahoo.com)
Jurnal Manajemen Pelayanan Kesehatan
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M. Ramdan, Iwan
So far, the approach used to assess the company’s achievement
of occupational health and safety (OHS) performance are more
retrosfective and based on statistics of occupational accident
and work related disease in the past, though this approach
contains a lot of weaknesses. Likewise, prevention and reduction
of occupational injuries and work related disease was not based
on behavioral approaches, whereas the main causes of
occupational injuries and work related disease is a behavioral
factor of labor. In fact, until now the performance of Indonesian
OHS has not been prideful yet.
The research proves that the determinant of labor
behavior (self-efficacy and perceptions of OHS) has been
significantly positively related to achievement of OHS
performance, and as a strong predictor for predicting
achievement of OHS performance. To improve achievement of
OHS performance in the future, the results of this study is
recommended for use because it has several advantages over
retrosfective approaches. This research also has made
measuring tool that has proven valid, reliable and fit to assess
self efficacy and perception of labor specific to the field of
OHS. This instrument can be used as additional tests in
the recruitment of new workers or for work rotation at the
company.
Keywords: achievement of OHS performance,
proactive approach, self-efficacy questioner and OHS
perceptions questione
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Supriyanti, Eri
Kristin, Erna
Djasri, Hanevi
Background: Pharmacy service is a high risk area in the
support of health service quality. PKU Muhammadiyah Hospital
is a hospital that respons to systematic movement in services
that focus on patient safety such as minimizing the incidence
of medication error that often happens. This condition requires
new design that can minimize risk for the incidence of medication
errorr by implementing Failure Mode and Effect Analysis (FMEA)
method as a systematic and proactive method that improves
quality of hospital service.
Objective: To design new service quality at PKU
Muhammadiyah Hospital Yogyakarta by identifying risk for
medication error in the process of drug use, factors that can
induce the incidence of medication error in the process drug
use and make new design that can minimize risk for medication
error of PKU Muhammadiyah Hospital Yogyakarta.
Method: This study used action research. This design was
chosen to involve subject of the study more actively in doing the
redesign of pharmacy service using FMEA method to minimize
risk for the incidence of medication error. Subject of the study
were all incidents of medication error in the process of drug use
including related health staff involved in the process of drug
use. Primary were data obtained from indepth interview, group
discussion, focuses group discussion, and workshop.
Result: Failure Mode and Effect Analysis (FMEA) method was
expected to minimize errors in drug use system at outpatient
pharmacy service at PKU Muhammadiyah Hospital Yogyakarta.
Through FMEA method it was identified that the highest Risk
Priority Number (RPN) was failure in confirmation with doctors
(294), failure in identifying drug name (216). In this study new
designs proposed as pilot project were change of layout of
drug identification color sticker according to therapy class; the
determination of standard operating procedure of
communication with doctors giving prescription, confirmation
with doctors for non cito prescription and procedure of
implementation of outpatient pharmacy service supervision.
Trial of layout of drug identification color sticker was carried
because it did not need high cost and was relatively easy to
socialize and do. The result of evaluation after new design
intervention was declining value of RPN for failure in
communication with doctors (from 294 to 196) and failure in
identifying drug name (from 216 to 144).
Conclusion: The new design implemented was relatively
effective in minimizing errors in identifying drug name and
minimizing failure in communication with doctors.
Keywords: medication error, failure mode and effect analysis,
redesign
Jurnal Manajemen Pelayanan Kesehatan
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Misnaniarti, Misnaniarti
Background: One strategy to achieve Healthy Indonesia is
alert village program as stipulated in Decree of the Minister of
Health number 564/Menkes/SK/VIII/2006. The observation
through document review of Ogan Ilir health profile in year
2007, environment-based morbidity is still high at 7.011 cases
of diarrhea, 30 cases of dengue fever, 68 cases of clinical
malaria and 11.637 cases of upper respiratory infections and
295 cases of pulmonary tuberculosis. It showed that there're
still health problems that need to be handled by both government
and society.
Objective: Objective of this research was to develop
recommendations of alert village development based on local
resources in Ogan Ilir district.
Methods: This was an observational study with quantitative
and qualitative approaches. The data was collected in Ogan
Ilir Health Office, all Health Centers in the working area of
Ogan Ilir, and 40 villages that have become the pilot of alert
village program in Ogan Ilir.
Results: Development of alert villages in Ogan Ilir still top
down, and the establishment of alert villages have not been
fully utilizing the potency of various community based health
activities.
Conclusion: The community empowerment still needs to be
improved so that local community can dig their own potential
resources. The local government and health centers only as
facilitators.
Keywords: alert village, community based health activities,
community empowerment.
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Paramastri, Ira
Background: The Child Sexual Abuse (CSA) is sexual activity
conducted by adult, elder people or a child to their peer. The
impact of sexual abuse could be of physical, psychological as
well as social traumas. The CSA data varies based on its
resources. The phenomenon was not always be reported, as
the child was lacking of courage/will to report, lacking of family
support to be brave to provide the reports to the police or
lacking of various parties for the child protection. To protect
child, it needs a prevention strategy to reduce the rate of the
cases. The teachers so far are seen as capable figures to be
the agent of change for their students.
Objectives: The objective of the research was to test the
appropriateness of the Elementary School Teachers as the
agent of change for the CSA prevention.
Method: The research used a quasi experiment with pretestposttest
control group design. The subject of the research
were the teachers of “NC elementary school” and “LP 1
elementary school” whom purposively taken and the chosen
of “NC elementary school” as the control group and the “LP1
elementary school” as the experiment group on random basis.
Each elementary school teacher was evaluated of their CSA
knowledge on pre and post intervention basis. The program
intervention was conducted by research team.
Results: The result shows that before the experiment was
conducted, the knowledge of the two groups on an equal
position therefore the precondition of an experiment was
fulfilled and the experiment was able to be conducted (p>0,05).
There were a raise of knowledge from = 29,32 to become
= 32,18, although this result was not statistically significant.
Unlike the experiment group, the control group showed a
knowledge differentiation on pre and post of the intervention
(p<0,05), It shows by = 28,29 to be = 29,52. Before the
intervention there were no differentiation between the two
groups (p>0,05), nevertheless the mean of the control group
is = 28,29 or lower than the mean of the experiment group
of = 29,32. As well as after the intervention, the two groups
did not show differentiation (p>0,05), however the mean of
control group is = 29,52 or lower than the experiment group
of = 32,18. The response of the teachers from the two
elementary schools toward the program was very good and
they committed to support and willing to widely share it to their
students. Furthermore, the teachers from the control group
suggested share it to the local district level.
Conclusion: Although statistically it did not show any
differentiation, but practically, the teachers could become the
agent of change for CSA prevention.
Keywords: teacher, agent of change, prevention, CSA
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Susilaningsih, Francisca Sri
Latar belakang: Penelitian tentang kolaborasi antara dokter
dan perawat dalam asuhan pasien pada model pelayanan
rawat inap terpadu (MPRIT) merupakan bagian dari action
research yang bertujuan untuk mengembangkan model asuhan
pasien sebagai basis integrasi antar profesi dalam pelayanan
kesehatan di rumah sakit pendidikan Hasan Sadikin. Model
pelayanan rawat inap terpadu (MPRIT) dikembangkan untuk
meningkatkan tata kelola pelayanan pasien di tatanan rawat
inap guna mengatasi fragmentasi pelayanan karena tumpang
tindihnya peran dan fungsi care provider dengan latar belakang
profesi yang berbeda. Diharapkan potensi kerawanan terhadap
berbagai kesalahan dapat diantisipasi dan diminimalisasi, serta
keutuhan dan kesinambungan pelayanan pasien dapat
diwujudkan. Tujuan penelitian ini adalah untuk mengidentifikasi
kerjasama dokter dan perawat secara kohesif dalam empat
komponen model yaitu alur proses pengelolaan pasien,
pengelolaan pasien secara tim, dokumentasi asuhan pasien
secara terpadu dan pemecahan masalah secara interdisiplin.
Metode: Penelitian ini menggunakan studi deskriptif untuk
mengidentifikasi perilaku afiliasi dan perilaku individu pada
kelompok dokter dan perawat yang menjalani proses kolaborasi
dalam pelayanan pasien di unit dengan MPRIT. Sejumlah 39
dokter dan 32 perawat berpartisipasi dalam penelitian ini.
Instrumen untuk mengukur perilaku afiliatif dan perilaku individu
dikembangkan berdasarkan konsep pelayanan interdisiplin dari
Sullivan. Kohesivitas dokter dan perawat dalam kolaborasi
asuhan diukur dengan uji beda rerata skor perilaku afiliasi dan
perilaku individu pada keempat komponen model.
Hasil: Rerata skor perilaku afiliatif secara signifikan lebih besar
dari perilaku individu pada tiga komponen model yaitu alur proses
pengelolaan pasien, pengelolaan pasien secara tim, dan
penyelesaian masalah secara interdisiplin. Temuan ini
mengindikasikan bahwa dalam proses kolaborasi, dokter dan
perawat cenderung menggunakan pendekatan share expertise
daripada personal autonomy. Hal ini merupakan ciri kohesivitas
kelompok. Baik pada kelompok dokter maupun perawat, rerata
skor perilaku afiliasi lebih besar dari perilaku individu. Pada uji
beda rerata skor perilaku individu antara dokter dan perawat,
tidak ada perbedaan yang bermakna pada alur proses
pengelolaan pasien dan dokumentasi asuhan terpadu. Adapun
pada pengelolaan pasien secara tim dan penyelesaian masalah
secara interdisiplin, rerata skor perilaku individu dokter secara
bermakna lebih besar dari perawat. Pada uji beda rerata skor
perilaku afiliasi antara kelompok dokter dan perawat, tidak ada
perbedaan yang signifikan di alur proses pengelolaan pasien
dan pengelolaan pasien secara tim. Adapun untuk dokumentasi
asuhan terpadu dan penyelesaian masalah secara interdisiplin,
secara signifikan rerata skor perilaku afiliasi dokter lebih besar
dari perawat.
Kesimpulan: Share expertise merupakan ciri penting perilaku
afiliasi yang diperlukan untuk mewujudkan kerja sama yang
kohesif antar pelaku pelayanan kesehatan. Penelitian ini
menyimpulkan bahwa dokter dan perawat bekerjasama secara
kohesif pada alur proses pengelolaan pasien dan pengelolaan
pasien secara tim.
Kata kunci: kolaborasi, dokter-perawat, interdisiplin, perilaku
afiliasi, perilaku individu
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Lisiana, Novi
Background and Objective: A retrospective descriptive study
of anti-tuberculosis drugs in patients with TB - HIV/AIDS who
were hospitalized Nusa Indah Sanglah Hospital 2009 aims to
determine suitability of the use of anti-tuberculosis (OAT) to
the National Treatment Guidelines 2008 which consists of types
of drugs, combination drug and dosage, also to identify drug
interactions that do occur based on the level of significance.
Results and Conclusions: The results showed that the use
of OAT category 1 has the largest percentage of 61.7% and
then use of a combination of streptomycin with ethambutol
which is 12%, then use of isoniasid and rifampin which has a
percentage of 6%. The percentage of the correct dose 60.9%,
8.7% is not appropriate, and not identified was 30.4%. Usage
of the appropriate OAT that is equal to 74% and 26% did not
deserve. Drug interactions occurred in 23 patients with a
significant percentage of drugs that interact with a percentage
of 11.1%, the importance of 2 namely 33.3%, the importance
of 3 namely 0%, significance 4 namely 16.7%, and the
significance was 5 of 55, 6%.
Keywords: tuberculosis, TB-HIV/AIDS, suitability
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Ayuningtyas, Dumilah
Background: It is crucial for hospitals to concentrate on what
is needed by service users, rather than what is provided at
the hospital. Customers will choose the health care provider
that offers maximum value. Creation and delivery of value to
customers is an effective marketing strategy for hospitals. So
that, hospitals need to know the position of its value in the
eyes of customers and compared with competitors.
Objective: To understand the overview of Customer Value in
Poly Oncology Dharmais Cancer Hospital compared with Poly
PPKT Y Hospital in 2010.
Methods: This study uses quantitative research methods by
interviewing 100 respondents in Poly Oncology Dharmais
Cancer Hospital and Poly PPKT Y Hospital to obtain primary
data.
Results: Results showed that customer value in Poly
Oncology lower than customer value in PPKT. However, in the
value map, customer value in Poly Oncology is in quadrant
expensive, which means having the opportunity to gain market
share greater than PPKT which value is in quadrant discount.
Conclusion: Attributes of service at Poli Oncology and PPKT
still needs to be improved by conduct training for nurses about
customer service, increase social activities in society, and
give more attention to health facilities.
Keywords: customer value, benefits, costs
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Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan (JMPK) bulan Juni 2010 ini merupakan edisi khusus yang membahas mengenai kebijakan untuk Universal Coverage. Mengapa dilakukan edisi khusus? Diharapkan edisi ini dapat merangsang para peneliti untuk menuliskan penelitian mengenai Universal Coverage, sekaligus mencoba menghadirkan JMPK ke para pengambil keputusan. Diharapkan JMPK menjadi salahsatu jembatan untuk menghubungkan antara dunia akademik dengan pengambilan keputusan yang selama ini kurang efektif. Pengalaman subyektif Pusat Manajemen Pelayanan Kesehatan-Fakultas Kedokteran Universitas Gadjah Mada (PMPK-FK UGM) sebagai lembaga peneliti dan kebijakan menyiratkan penelitian memang belum dipergunakan secara penuh dalam sejarah program jaminan kesehatan di Indonesia. Dalam pengalaman tersebut dapat dilihat bahwa perguruan tinggi berada dalam posisi yang tidak mantap. Dalam hubungan segitiga tersebut, ada pengalaman empirik bahwa pendapat dari perguruan tinggi diabaikan dan hubungan kerja yang berbasis pada kontrak jangka pendek tidak dilanjutkan. Dalam pengalaman program JPKM di Klaten (awal dekade 90-an) pada saat fase identifikasi masalah dan isu untuk kebijakan terjadi perbedaan pendapat antara perguruan tinggi dan penyandang dana mengenai berbagai hal prinsipil. Dalam perbedaan pendapat ini maka dalam proses kebijakan selanjutnya (perumusan kebijakan, pelaksanaan kebijakan, dan evaluasi kebijakan) terlihat bahwa pihak perguruan tinggi dan lembaga penelitian kurang mendapat peran. Akibatnya tidak ada ruang untuk melakukan evaluasi independen terhadap efektivitas kebijakan model JPKM. Sebagai bangsa, Indonesia membuang kesempatan dalam masa pembelajaran besar antara tahun 1990-an ke tahun 2004. Pengalaman lain, pada awal tahun 2005 ketika kebijakan askeskin dilakukan, usulan untuk mengembangkan suatu sistem jaminan kesehatan yang detil ditulis berdasarkan good governance yang perlu dicoba secara empirik dengan melibatkan berbagai stakeholder. Usulan PMPK- FK UGM ditulis dalam bentuk dokumen saran untuk penyusunan kebijakan kesehatan yang didanai GTZ. Intinya usulan ini menyatakan bahwa kebijakan pembiayaan kesehatan bukan hanya menyangkut kebijakan, namun menyangkut berbagai hal lain yang kompleks, antara lain: rujukan kesehatan, ideologi, budaya para dokter, sampai ke masalah kompensasi. Namun usulan ini ternyata tidak diperhatikan. Akibatnya dana kegiatan askeskin melalui PT Askes Indonesia berjalan tanpa ada persiapan mengenai sistem pembiayaan dan pelayanan kesehatan, dan tidak disertai dengan evaluasi kebijakan secara ilmiah. Perubahan di tahun 2008 ke Jamkesmas, adalah kebijakan yang berada di luar jangkauan manfaat ilmu pengetahuan karena kebijakan ditetapkan secara situasional. Kebijakan ini merupakan hasil negosiasi pragmatis terhadap situasi yang mendesak. Secara keseluruhan, dalam masa 20 tahun terakhir ini, terlihat bahwa Perguruan Tinggi atau Lembaga Penelitian tidak ada yang menjadi mitra atau think-tank khusus untuk asuransi kesehatan. Hal ini berbeda dengan Reformasi Kesehatan oleh Presiden Obama yang didasari oleh sekelompok peneliti dari Harvard University, atau skema di Thailand yang merupakan sebuah kelompok yang terdiri dari beberapa perguruan tinggi dan lembaga penelitian. Kegiatan yang terjadi lebih banyak pada hubungan antara pengambil kebijakan dan individuindividu di perguruan tinggi saja. Dalam konteks kekuatan tawar, tentunya hubungan ini menjadi lebih lemah dibanding dengan kalau ada hubungan organisasi antara pengambil kebijakan dan lembaga. Keahlian perorangan sebagai konsultan atau narasumber sangat rentan untuk tidak diteruskan. Dengan demikian secara jelas terlihat bahwa peran perguruan tinggi masih lemah. Apakah hal ini terkait dengan ketidakstabilan proses kebijakan, mulai dari perencanaan, penyusunan, sampai implementasi dan monitoring kebijakan jaminan kesehatan. Sebagai catatan: pembiayaan kesehatan adalah sebuah sistem yang riil yang dapat diukur keberhasilannya. Saat ini terlihat bahwa keberhasilan sistem jaminan kesehatan belum baik. Bagaimana dengan jaminan kesehatan yang ada di daerah. Dimana peran perguruan tinggi di daerah? Logikanya peran perguruan tinggi di kebijakan jaminan kesehatan di daerah akan lebih mudah karena skalanya yang lebih kecil dan akses ke pengambil kebijakan lebih muda. Akan tetapi data menunjukkan bahwa beberapa pemerintah daerah tidak menggunakan para dosen atau peneliti di daerah masing-masing. Sebagai penutup: dalam konteks sejarah di Indonesia, secara keseluruhan, peran Perguruan Tinggi belum berada dalam posisi yang baik. Dapat dikatakan bahwa perguruan tinggi atau lembaga penelitian belum pernah secara utuh berada dalam posisi sebagai pemberi masukan kebijakan dalam tahap penyusunan kebijakan, pelaksanaan kebijakan, sampai monitoring dan evaluasi kebijakan, terutama di level nasional. Dipandang dari Evidence Based Policy situasi saat ini untuk sistem jaminan kesehatan adalah situasi dimana kurang ada bukti ilmiah kuat yang dipergunakan sebagai dasar pengambilan keputusan. (Laksono Trisnantoro, trisnantoro@yahoo.com).
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Siswanto, Siswanto
The impact of regional autonomy Act has resulted in health
services system reform in Indonesia by central, province as
well as district/municipalities. The article is to analyze the “trade
of f” of Indonesian health services reform after the
implementation of regional autonomy Act by the use of normative
goals of health system, i.e equity, quality, and efficiency, as
assessment parameters. The analysis revealed that: (i) the
implication of regional autonomy Act has resulted in Indonesian
health services system reform which is partial and scattered,
(ii) part of health services system reformation has moved to
socialism, another part of the reformation has moved to
liberalism, with the implication of trade-off between equity,
quality and efficiency, (iii) the whole Indonesian health services
system remains in the position of liberalism (market system),
(iv) the choice toward socialism or liberalism is inherent with
the trade-off of advantages and disadvantages, so the
intervention of its negative impacts are important. The article
recommended that it is of importance to set in advance the end
goal of Indonesian health services system by all stakeholders,
whether choosing liberal (market) system or social system,
then setting up a clear road map completed with feasible
incremental programs to achieve the predetermined end goal.
Keywords: regional autonomy, liberalism, socialism, trade-off
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Triratnawati, Atik
Background: Traditional medicine is frequently perceived as
negative and even though many people still practice. It the use
of traditional medicine is mainly due cause to tradition. The
villager tends to use traditional medicine as primary healing.
This article tried to identify frequent diseases among Javanese
and economic capability to afford health cost.
Methods: Ethnography study using observation and in-depthinterview
among 48 informants and 6 key informant of peasant
community in Sleman, DIY and fisherman in Rembang, Central
Java, during 2007-2008. Phenomenology approach used during
data collection and analysis.
Result: Masuk angin (wind illness) is a disease which
frequently occur among the villager. Traditional medicine was
applied because it is inexpensive, easy, effective and suitable
with the cognitive related to the harmony (equilibrium). The
principle of coining was binary opposition such as: hot x cold;
loose x tight; angin masuk x angin keluar; better x awful and
the equilibrium is the basic rational of traditional medicine.
Recommendation: Traditional medicine must be recognized
by the government and should be in equal position to modern
medicine in order to reduce negative opinion, so the rational of
it is recognized by others.
Keywords: holistic, traditional, masuk angin, effective, cheap
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Ainy, Asmaripa
Background and objective: Universal Social Health Insurance
of South Sumatera (Jamsoskes) is an effort undertaken by the
Government of South Sumatera to improve the accessibility of
health services for the people in South Sumatera, held since
22 January 2009. The aim of this study was to analyze the
implementation of Jamsoskes policy in the community health
centers in Palembang during the year 2009.
Methods: This was a policy analysis research with qualitative
and quantitative approaches. Data were obtained in Health
Office of South Sumatera Province, Health Office of Palembang
City, 38 community health centers in Palembang and users of
Jamsoskes. Qualitative data were collected through: in-depth
interviews and FGDs, then quantitative data were collected
through review of documents related to Jamsoskes. Content
analysis was used to analyze qualitative data and quantitative
data were analyzed by univariate statistics.
Results: Results showed that: 1) Implementation of Jamsoskes
has been according to district regulation of South Sumatera
Province Number 2/2009 and Governor Regulation Number 23/
2009; 2) Source of funds were contribution from budget of
South Sumatera Province and Palembang City; 3) Organizing
consist of the provincial coordination team, the city coordination
team, the service managers team, and verification officers. 4)
The utilization of Jamsoskes in 38 community health centers
was 408.830 people and the total of referral 9.089 people. 5)
Several problems in implementation of Jamsoskes i.e. on aspect
of membership administration, services administration, and
financial administration. There were incomplete identities in
membership administration, in services administration aspect,
medical diagnosis’ or treatments sometimes were not appropriate,
whereas in the financial administration, the claims cost were
not in accordance with district regulation. During the year 2009
the difference between billing and approval of claims in 38
community health centers at total of Rp21.037.000,00
Conclusion: Health financing policy in Palembang City through
Jamsoskes program was not optimal, as seen from several
problems: membership, services, and financial administration.
Recommendation for Health Office of South Sumatera Province
to build membership database and not use Jamkesmas
verificator for Jamsoskes verificator in order to reduce work
overload. Health Office of Palembang City need to disseminate
routinely of data verification to community health centers and
also to verificators. Community health centers need to intensify
provisia of information to society about prerequirements to get
Jamsoskes service.
Keywords: healthcare financing, social health insurance,
community health centers
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Januraga, Pande Putu
Background: To conduct an analysis of the influence of the
Bali Mandara Health Insurance (JKBM) policy concerning the
existence of district level health insurance and its impact on
achieving universal coverage.
Method: Literature review to produce an analysis of JKBM
policy and to produce appropriate policy alternatives for
financing and health care issues which emerged from the
implementation of JKBM.
Results: The aim of Bali Mandara Health Insurance is to provide
health services which are fully subsidized by the Provincial
and Districts Government in Bali. JKBM is intended for peoples
who do not protected by health insurance programs. The
implementation of JKBM has forced Tabanan to stop the Askes
Mandiri program while Jembrana District decided not to take
part in JKBM. Unlike JKJ and Askes Mandiri, JKBM is still managed
by a coordination team under Bali Health Office Supervision.
Furthermore another fundamental difference is regarding on
how they finance the program. JKBM is fully financed from
sharing subsidies while JKJ and Askes Mandiri are financed
from member premium. Nevertheless JKBM policy is potential
to expand the efforts of achieving universal coverage, improve
equity in health financing and fulfil a non-profit principle of
social health insurance. Along with the positives impact, this
program also has several weaknesses. One of the
weaknesses is lack of consideration to the principles of social
solidarity and mutual cooperation. Communities’ participation in
health financing program which has been developed by JKJ
and Askes Mandiri is abandoned. In addition to these
weaknesses JKBM also less able to adopt the district health
insurance who have first evolved. JKJ case shows of JKBM
failure to apply the principle of portability and benef its
coordination of the services thereby potentially harming the
people of Bali.
Conclusion: Bali provincial government should immediately
develop Implementing Agency (Badan Pelaksana) of JKBM to
organize and develop the program. In addition to this, member
participation throughout premium payment could be established
gradually to ensure the sustainability of the program. JKJ and
JKBM should operate in harmony by considering role distribution
between member, Provincial Government of Bali, and
Government of Jembrana.
Keywords: health insurance and universal coverage
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Maharani, Asri
Background: The willingness to pay of society for the
products of laboratory services need to be improved.
Objective: The purpose of this study is to determine the effect
of health insurance police ownership on willingness to pay for
laboratory services.
Methods: A cross sectional study design using 100
respondents taken proportionally from eight selected districts
in Banyuwangi. Variables that were examined include the
willingness to pay as measured by the method of contingent
valuation and ownership of health insurance police. The data
collection tool is a questionnaire. Data were analyzed using
logistic regression.
Results: The results showed that the level of willingness to
pay of respondents for all types of laboratory examinations is
still low. Most respondents (76%) did not have health insurance.
Only about 50% of respondents who do not have health
insurance are willing to pay for laboratory examination.
Respondents who have health insurance tend to want to pay
for laboratory services. From 24 respondents who have health
insurance, more than 50% of respondents (15 respondents)
were willing to pay for laboratory services. The ownership of
health insurance of respondents did not significantly affect
the willingness to pay for laboratory examination product (sig.
= 0.287, B =- 0.511). This may be due to the fact that Banyuwangi
District society community so familiar with health insurance
and only few has it, so most are out-of-pocket payments.
Conclusion: The ownership of health insurance do not
significantly affect the willingness to pay for laboratory
examination.
Keywords: willingness to pay, laboratory services, ownership
of health insurance
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Gondodiputro, Sharon
Background: Apart from funding, the role of health care
providers on the health insurance scheme should be taken
into account, because they are one of the components of
health insurance scheme and could play as gate keepers.
They include private and public health providers. 92.14% of
the total primary health providers in Bandung District are private
health providers, consisted of 561 doctors, 392 midwives and
154 private clinics. The objective of the study was to assess
the involvement, mechanism of payment and willingness to
participate of the private health providers in the health insurance
scheme
Method: A survey with a simple random sampling was
conducted using questionnaire for 207 respondents (153
doctors and 54 clinics).
Result: Only 23% doctors and 21% clinics that already had
contracts with 14-20 third payers. The mechanisms of payment
from the third payer to the providers were capitation (43%
doctors, 50% clinics) and claims (39% doctors, 43% clinics).
Among private providers who had not yet contracts with third
payer, only 55% doctors and 56% clinics wanted to have
contract. Factors contributed to the refusal were human
resource and facilities, finance, administration and health care
delivery
Conclusion: Private health providers should be involved, as
part of the health insurance scheme in Bandung District with
developing efforts to gain trust between the providers and
third payers and considering a proper benefit for all.
Keywords: Private Health Providers (PPK I), gate keeper,
health insurance
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Kasim, Felix
Background: In the developed countries, the role of health insurance becomes more important because there is a great demand for health service. Health insurance is a kind of insurance product which is especially medical care for the member of health insurance if they are sick or get an accident. For that reasons, a research about The Analysis of the Management of the Health Service through the Health Insurance System in the Prof. Dr. WZ. Johannes Hospital Kupang 2009. Objective: The purpose of this research is to describe about the analysis of the management of the health service through the health insurance system also the enthusiasm of the participant of ASKES to health insurance services in the Prof.Dr. WZ. Johannes Hospital Kupang 2009.Method: The method used in this research was mixed of qualitative and quantitative methods, with grounded theory for the qualitative method and cross sectional for the quantitative method, descriptive observational design and survey instrument in a questionnaire form with 18 questions and depth interview to some informed. The subject of the research was the participants of ASKES outpatient and inpatient in the Prof. Dr. WZ. Johannes Hospital Kupang. The sampling method used was an accidental sampling made of 60 respondents. Result: The results of the research show that health insurance services system in Prof. Dr. WZ. Johannes Hospital Kupang ASKES administration section, infrastructure means, medic or non medics are good. Conclusion: There should be more research on service system in Prof. Dr. WZ. Johannes Hospital to ASKES members with analytical methods so that more things can be explained and described. Refers to the results of this study, it is necessary to have a Minimum Service Standards (MSS) that patterned tripartite relationship between the members, ASKES administrator and party health service providers who have contracted with health insurance provider with the managed care health insurance with service system by PPK network. On hospital’s principal of autonomy as organizers of activity, so that health status, income and education, consumer factor and PPK ability and acceptance of health service and sickness risk and environment will be develop to comprehensive responsible with overutilization decreasing and high inflation on health service, through the better financial management, more efficient and transparent. The other side of restructuring costs in hospital that global nature need cost unit which is one way for hospital to make efficiency because by that way will be known which service in hospital need to subsidized and which is profitable. By doing restructuring costs in hospital, we can use Strategic Cost Management. This strategy will help hospital to face competition. The implementation with Cost Leadership Strategy(CLS) or Low-Cost Strategy will do all it can to beat competitors by giving cheaper services from another hospital, but with same quality or better. General Hospital is the examples of hospital that may choose this strategy. Tools to reach this strategy are analysis cost hospital services better known as Unit Cost. This consideration will obtain recommendation rates, efficiency strategy and System Account Design overall in hospital.
Keywords: health insurance, health service system, high quality health
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Trisnantoro, Laksono
Indonesia diharapkan mengikuti Konvensi ILO
No 102/1952 yang mengatur (1) kecelakaan kerjapenyakit
jabatan, (2) sakit-persalinan, (3) cacat total
tetap termasuk karena hal lain, (4) pemutusan
hubungan kerja bagi yang bekerja, (5) sementara
belum bekerja (fresh graduate), (6) hari tua dan (7)
potensi kemiskinan (tunjangan keluarga). Undang-
Undang SJSN yang disahkan di tahun 2004 sebagai
kebijakan nasional mengenai jaminan sosial
diperlukan untuk mengatur berbagai hal tersebut.
Masalah kebijakan yang ada saat ini adalah UU
SJSN yang diharapkan banyak pihak akan efektif
untuk mengatur asuransi/jaminan kesehatan di
Indonesia ternyata gagal memenuhi harapan ini.
Undang-Undang SJSN sudah lebih dari 5 tahun tidak
efektif, dan mempunyai prospek yang sulit dijalankan
secara teknis. Mengapa hal ini terjadi? Dipandang
dari tujuannya, isi UU SJSN bersifat tanggung.
Apakah sebagai UU yang bertujuan mengatur
berbagai jaminan sosial seperti amanah Konvesi ILO
secara garis besar, ataukah bertujuan mengatur
sampai ke urusan operasional pelaksanaan.
Salahsatu ketidak jelasan UU SJSN sebagai
UU yang bertujuan untuk mengatur Social Security
adalah mengenai fungsi pemerintah. Di dalam UU
SJSN juga tidak jelas peran pemerintah propinsi dan
kabupaten. Hanya disebut sebagai Pemerintah.
Konotasi adalah pemerintah pusat (APBN).
Sementara itu de-facto saat ini, pemerintah propinsi
dan kabupaten mempunyai andil besar dalam jaminan
kesehatan. Ketidak jelasan ini memicu Yudicial
Review di MK dan sampai sekarang masih menjadi
kontroversi.
Apabila UU SJSN bertujuan mengatur hal
operasional untuk asuransi dan jaminan kesehatan,
terlihat bahwa hanya sedikit pasal yang mengaturnya
(10 Pasal, dari nomor 19 sampai 28). Pasal-pasal
tersebut tidak cukup karena asuransi/kesehatan dan
jaminan kesehatan sangat kompleks. Diperlukan
aturan dalam level UU yang mencakup posisi
jamkesda, perusahaan asuransi swasta, bagaimana
mutu pelayanan akan dijamin, apa peran Kemkes,
DinKes, RS, hubungan kontraktual, masalah
pemerataan pelayanan, dan lain sebagainya.
Khusus untuk pemerataan ada pasal dalam UU
SJSN yang menyulitkan operasionalnya misalnya
pasal 23 ayat 3.
Dalam hal di suatu daerah belum tersedia
fasilitas kesehatan yang memenuhi syarat guna
memenuhi kebutuhan medik sejumlah peserta, BP
Jaminan Sosial wajib memberikan kompensasi.
Pasal ini sungguh sangat sulit dijalankan karena
penyebaran tenaga dan fasilitas kesehatan di
Indonesia yang masih sangat timpang. Sebagai
gambaran di Propinsi NTT saat ini tidak ada dokter
anastesi bekerja penuh. Jika pasal ini dijalankan
maka BP Jaminan Sosial harus memberikan
kompensasi pada warga NTT yang membutuhkan
pelayanan anastesi. Apa bentuk kompensasinya?
Apakah harus memberikan dana transportasi ke
Denpasar bagi pasien dan keluarganya untuk
berobat? Pasal ini pelaksanaannya sulit didefinisikan.
Hal ini yang menyebabkan UU SJSN ini sulit dalam
pelaksanaan secara teknis.
Dalam konteks perbandingan isi, UU SJSN perlu
dibandingkan dengan Amerika Serikat yang besarnya
negara, sistem ekonomi, adanya pemerintah pusat
dan daerah, mirip dengan Indonesia. Di Amerika
Serikat, hal-hal dalam Konvensi ILO (tahun 1952)
disebut sebagai Social Security Act yang diterbitkan
lebih awal di tahun 1935 dengan berbagai amandemen
sesudahnya. Secara lengkap yang diatur adalah:
Federal Old-Age, Survivors, and Disability Insurance,
Unemployment benefits, Temporary Assistance for
Needy Families, Health Insurance for Aged and
Disabled (Medicare), Grants to States for Medical
Assistance Programs (Medicaid), State Children’s
Health Insurance Program (SCHIP), dan Supplemental
Security Income (SSI). Selanjutnya untuk hal-hal yang
lebih spesifik untuk asuransi kesehatan diatur oleh
berbagai UU, antara lain: The Health Insurance
Portability and Accountability Act of 1996 (HIPAA),
the Medicare Prescription Drug, Improvement, and
Modernization Act, dan tentunya yang terkait dengan
reformasi kesehatan Obama. Dengan demikian Social
Security Act yang disusun tahun 1935 ini tidak satusatunya
UU yang mengatur asuransi/jaminan
kesehatan di Amerika Serikat.
Di Indonesia ada beberapa pendapat yang
menyamakan UU SJSN dengan Reformasi
Kesehatan. Menurut hemat kami, UU SJSN lebih
mirip dengan Social Security Act yang seperti UU
payung di Amerika Serikat. Dengan logika ini
sebaiknya UU SJSN diamandemen agar menjadi
semacam UU payung untuk melaksanakan Konvensi
ILO. Sementara itu untuk mengatur sistem jaminan
dan asuransi kesehatan diperlukan UU mengenai
asuransi/jaminan kesehatan. (Laksono Trisnantoro,
trisnantoro@yahoo.com).
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Oktarina, Oktarina
More than 50% out patients in Puskesmas at Surabaya city
came to the dentist for dental permanent extraction. The target
ratio between filling and extraction that government stated
were 1:1, but coveraged in Puskesmas at Surabaya City in
2003 were 1:5,9. Informed consent was given to patients
before the actions, consisted the diagnoses, procedures, the
medical purpose, alternative actions, risks, possible
complications and prognoses.
In Indonesia, there were not the rules yet that regulated the
informed consent before dental extraction. The law of
Indonesian Medical Practices No. 29/2004 has described the
responsibilities to do the informed consent for the actions that
purposed on preventive, diagnostic, teurapeutic and
rehabilitative. So, a dental extraction which is the teurapeutic
prosedured needs the informed consent. After all, the informed
consent should be protect both of patient as a subject and
doctor/paramedic from unpredictable conditions.
Keywords: informed consent, dental permanent extraction,
policy
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Suryawati, Sri
A national survey has been conducted to assess the
transparency in public pharmaceutical sector in Indonesia. The
survey was conducted during 2007, and writer was appointed
by the government as independent assessor. The assessment
covered five functions of government in pharmaceutical sector,
i.e., registration, control of promotion, inspection of production,
selection of essential medicines, and central procurement of
national buffer stock. Key informants were selected based on
first-hand knowledge on each function, representing
government, pharmaceutical company, academe/professionals,
and NGOs, i.e. 10 informants for each registration, control of
promotion, inspection of production, selection of essential
medicines, and 20 informants for central procurement. Data
were collected by means of in-depth interviews, using sets of
questionnaires provided by the WHO. Findings were analyzed
following a scoring system that ranging from zero to ten. The
smaller the score indicates in-transparency, and therefore
indicates the more vulnerability for corruption.
The results showed that the registration process scored 7.2,
control of promotion scored 7.6, inspection of production scored
8.7, selection of essential medicines scored only 5.5, and the
central procurement scored 7.0. In general, it is appreciated
that the functions of registration, control of promotion,
inspection, and procurement were well governed, but the
selection of essential medicines obtained a low score. There
has been remarkable lacking of written procedures that publicly
available. In regard to the selection function, there is no written
procedure in every process of selection, i.e., selection criteria
of the revision committee member, written criteria for application,
written criteria for addition, substitution and deletion, and written
procedures of decision making. Declaration of interest is to
some extents, lacking from most functions. It was
recommended that the Government should establish written
procedures of each function and make them publicly available,
establish mechanism to minimize conflict of interest in each
function i.e., by means of declaration of interest, and establish
measures to fill up regulatory gaps. By the time of publication,
corrective actions in all five functions have been made and at
the time being the Government is ready for re-assessment.
Key words: transparency, pharmaceuticals, good governance,
public sector, vulnerability for corruption
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Azwir, Azwir
Background: The nurse as a majority health worker in the
health care sector including the hospital has a significant role
in the health care. The value of nursing care that is continuous,
constant, coordinative, and advocative so the preparation,
usage, distribution, and retention of the nurse, has an important
implication to obtain the objectives of health care and its
continuity.
Purpose: This study is conducted to explore the clinical nurse
career pattern development in the Tarakan General Hospital
and to design the career pattern development which suitable
with their role and function.
Method: The qualitative method had been used in this study.
The data collection was done by indepth interview and FGD.
Result: Tarakan Hospital have 245 nurses with the
characteristics as below: 77.96% of total nurses have the
age range of 25 - 44 years old, 61.22% of nurses had working
period > 3 years, 72.24% of nurses had nursing diploma
educational background, and 41.22% of nurses are
governmental officer. The implementation of nurse career
development is not based on the competency test. The nurse
committee also did not play their role as it should be.
Conclusion: The study recommended Tarakan Hospital to
conduct advocacy toward the hospital director board to
determine the regulation of nursing career path remuneration
system based on their career rank in the hospital and to
optimally make the function of nursing committee in formulating
the competency test instrument related to the nursing career
development.
Keywords: career pattern development, clinical nurse, Tarakan
Hospital
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Hariyono, Widodo
Background: Balai Yasa PT Kereta Api (Persero) Yogyakarta
is the only diesel locomotive maintenance industry operating in
Java Island that has a major role in determining the
successfulness of whole train transportation mode operated.
A ‘new’ locomotive it produces indicates locomotive system
reliability operating. This is a result of a reliable maintaining
process. Balai Yasa Yogyakarta applies manual process in
doing its job. It means that the operator uses his hands to fix
the problems. In the meantime, working process in some units
are not ergonomics from the point of motion, working position,
and operator working hour. Besides, the application of
Occupational Safety and Health Management System is not
integrated with industry management system. This can lead to
risks such as accident and illness of work, ineffective and not
efficient work, and finally produces unqualified products.
Objective: Based on (1) strategic task of Balai Yasa
Yogyakarta, (2) product and work system produced, (3)
operator interest on occupational safety and health in production
process, and (4) Occupational Safety and Health Management
System interest in locomotive maintenance industry, the
research conducted in order to discover (a) an ergonomic
work system, on motion and operator working position, (b)
time duration in production process of work unit, (c) audit
result of Occupational Safety and Health Management System
can be applied as an integrated department with industry
management system.
Method: This is a non-experimental and observational research
using modelling style and evaluating in nature.
Result: (1) In nine work stations representing complete work
process characters, the operators show unergonomics motion
and working position. It risks work accident and illness, non
optimum work gain because of improper motion and working
position. It needs total recovery in operator motion and their
working position in two standards: standing or sitting must be
in straight back. (2) Time duration, work hour for a locomotive
is 143 hours normally. This can be the guideline to arrange a
standard in operator motion and their working position based
on time duration. (3) Occupational Safety and Health
Management System has done the audit and the standard
parameter result is 11%. The absence of Occupational Safety
and Health Committee causes occupational safety and health
run in non standard application. Occupational Safety and Health
Management System must be integrated in total industry
management system.
Conclusion: Balai Yasa Yogyakarta has not applied
Occupational Safety and Health Management System and
ergonomic program, so that it must implement ergonomic
program and Occupational Safety and Health Management
System.
Keywords: ergonomics, occupational safety and health
management system, railway affairs, work system design
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Januraga, Pande Putu
Introductions: Jembrana Health Insurance (JHI) program is
intended to provide health insurance at first level (PPK I) for
inhabitants of Jembrana District. Up till now, financing of JHI
depends on subsidy in which it is growing up and has a trend
to be out of target. Therefore, it needs to manage cost by
implementing capitation payment system. Aim of this research
was to analyze cost per capita and to identify perceptions of
JHI stakeholders towards capitation system.
Methods: This research was case study through analyzing
secondary data and performing in-depth interview. Data on
member’s utilization and claim cost were collected using forms.
Results: Result of cost per capita calculation based on real
utilization of PPK I namely Rp5.262,- per month per member is
63 % higher than cost per capita based on normal utilization of
PPK I namely Rp1.949,- per month per member. Furthermore,
result of in-depth interview shows that both policy makers
and providers have a bad perception towards capitation
system and results of cost per capita calculation.
Conclusions: Local government could apply principles of
managed care by controlling cost and quality by developing
capitation payment system for PPK I based on normal utilization.
Keywords: health insurance, cost per capita, capitation
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Sudarianto, Sudarianto
Background: Health information system is one of four health
development major strategies. Health Office of South Celebes
Province has tried to implement an electronic information system
in health centers (Puskesmas) which is named Puskesmas’
Transaction Information System (SITRAPUS) in Bantaeng
District since 2006. However, its performance and
effectiveness have not been evaluated yet.
Objectives: The research aimed to evaluate the implementation
of SITRAPUS in Bantaeng District from aspects of development
process, the output, the barriers and entries during the
implementation.
Methods: This was a qualitative study. The data was gathered
by in-depth interview and observation in health centers,
Bantaeng District Health Office, and Health Office of South
Celebes Province.
Results: From the development process, the result showed
there was lack of operator participation in the process of
SITRAPUS designing; the use of SITRAPUS was not well
socialized so that the users were not familiar with the system;
there was no a division which managed the information system,
less supervisory; and there was no technical support for the
SITRAPUS maintenance. The SITRAPUS output were disease
reports but they were not accurate and irrelevant with the
organization needs. Nevertheless, the users felt that the system
could make their works easier, especially in data searching.
The SITRAPUS output were used by the health centers in
calculating the retribution, meanwhile data access to the district
was not up to date and timely.
Conclusions: The SITRAPUS implementation in Bantaeng
District was not optimal, because this implementation did not
accordance to the system development life cycle and the output
was only report.
Keywords: evaluation of information system, information
system of health center transactions
Jurnal Manajemen Pelayanan Kesehatan
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Rahajeng, Ida Ayu
Background: Hospital industry competition in Indonesia is
getting more intense. Identifying image position and positive
image building of new hospital become one of important
strategies in anticipating competitive situation and consumers’
characteristics that are getting more critical in the choice of
health service. Positive image building of hospitals encourage
patients to pay more for health services they get and helps to
decide purchase of the community.
Objective: To identify perception of patients and visitors about
image of BaliMéd Hospital Denpasar, and to identify effect of
respondent demography characteristics toward perception
about image of BaliMéd Hospital Denpasar.
Method: The study used cross sectional survey design with
quantitative as well as qualitative method as supplement.
Primary data were obtained through questionnaire distributed
to 200 patients and visitors as respondents at BaliMéd Hospital
Denpasar. Qualitative method was applied through in-depth
interview to 4 patients and 3 visitors of BaliMéd Hospital
Denpasar. Data were analyzed descriptively, using
independent t-test and U Mann – Whitney test followed by
multiple regression analysis to identify the effect of
respondents’ characteristics to perception about image of
BaliMéd Hospital Denpasar.
Result: Average perception of patients (150.12) about the
image of BaliMéd Hospital Denpasar showed positive image
whereas average perception of visitors (144.68) showed
neutral image. The result of independent t-test with p=0.003
(p<0.05) showed there was significant difference in perception
about the image of BaliMéd Hospital Denpasar between the
patients and the visitors. R=5.5% indicated low contribution of
effect of variables of education, income, and frequency of
health service utilization to perception about the image of
BaliMéd Hospital Denpasar. Only the variable of frequency of
health service utilization at regression coefficient 1.658 that
had significant effect p=0.016 (p<0.05) to perception about
hospital image.
Conclusion: Perception of patients about the image of BaliMéd
Hospital Denpasar was positive image but visitors had neutral
image. In general, patients and visitors had significant
difference in perception about the image of BaliMéd Hospital
Denpasar. Only the frequency of health service utilization that
had positive and significant effect to the image of BaliMéd
Hospital Denpasar. Education, income and frequency of health
service utilization all together did not have significant effect to
the process of perception building on the image of BaliMéd
Hospital Denpasar.
Keywords: image of hospital, perception
Jurnal Manajemen Pelayanan Kesehatan
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https://journal.ugm.ac.id/jmpk/article/view/2618
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Rivany, Ronnie
The National Social Security System Law (SJSN / Law No. 40 of 2004) was set on 2004 and consists of 9 chapters, 53 articles, and 112 clauses. The law regulates the formation for The National Social Security Council and the conduct of Tri Partit between 1)The Social Insurance Management Agency, 2) the participants and 3) Healthcare Facilities owned by the Government or Private Companies who collaborated with The Social Insurance Management Agency. For article 24 clause (1) and (3) about quality of health services and cost affectivityefficiency, few of the working procedures is still unclear, such as how the management of the patients is ranging from admission until discharge process (clinical pathway), and the exact amount of the cost or tariff and capitation to be agreed on as the cost of treatment between The Social Insurance Management Agency and the existing healthcare facilities/ hospitals, in order to achieve mutual agreement based on the principles of fairness and win-win solution. Keywords: INA DRG, clinical pathway, cost of treatment, The National Social Security Law
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