Gambaran Out of Pocket pada Awal Era JKN di Indonesia

Abstrak Pogram Jaminan Kesehatan Nasional (JKN) salah satunya bertujuan memberikan perlindungan finansial khususnya biaya katastropik terhadap semua peserta. Penerima manfaat JKN berhak mendapatkan berbagai layanan sebagai bagian dari paket manfaat dasar tanpa mengeluarkan biaya pelayanan, dan diharapkan Out of Pocket (OOP) akan lebih rendah dibandingkan dengan mereka yang tidak memiliki asuransi kesehatan. Tujuan penulisan akan membandingkan total pengeluaran untuk kesehatan dari peserta jaminan kesehatan dengan yang tidak memiliki jaminan kesehatan pada awal era JKN. Dalam analisis ini, pengukuran pengeluaran perawatan kesehatan hanya mencakup biaya pengobatan langsung, seperti biaya konsultasi, pemakaian kamar di rumah sakit dan obat-obatan. Analisis dengan menggunakan data Susenas 2014 terdiri dari 274.673 individu dan 71.051 rumah tangga di 33 provinsi di Indonesia. Hasil penelitian menunjukkan bahwa pada awal era JKN ada sedikit perbedaan OOP pada penduduk miskin dibandingkan dengan penduduk dimana proteksi finansial terhadap penduduk miskin untuk pengeluaran kesehatan masih rendah.Kepemilikan jaminan kesehatan memberikan proteksi finansial akibat pengeluaran biaya kesehatan, khususnya pengeluaran biaya katastropik dibandingkan dengan yang tidak memiliki jaminan kesehatan. Kepesertaan penduduk miskin ditargetkan tahun 2019 sudah terpenuhi sehingga target pemerintah tentang Universal Health Coverage (UHC) perlindungan finansial pada penduduk miskin dan hampir miskin semakin tinggi atau OOP semakin mendekati nol. Kata kunci: OOP, Pembiayaan, Asuransi Kesehatan Abstract One of the main objectives of the JKN program is to provide financial protection, especially catastrophic costs to all members. JKN beneficiaries are entitled to various services as part of the basic benefit package without incurring service costs, and it is expected that Out of Pocket (OOP) will be lower than those who do not have health insurance. The purpose of writing will be to compare the total health expenditures of health insurance participants or beneficiaries and those without health insurance. In this analysis, the measurement of health care expenditures only includes direct medical expenses, such as consultation fees, hospital room usage and medication. Using Susenas data 2014 consists of 274,673 individuals and 71,051 households in 33 provinces in Indonesia. At the beginning of the JKN implementation, there was little difference of out of pocket in the poorest population compared to the richest population. This shows that financial protection to the poor for health expenditures are still low. The ownership of health insurance tends to provide financial protection due to health expenditures, especially catastrophic expenses compared to those without health insurance. In the Year of 2019 where the government targeted to Universal Health Coverage (UHC) expected protection financial on the poor and near poor is getting higher or out of pocket or getting closer up to zero. Keywords: OOP, Financial Protection, Health Insuranc

Gambaran Kesadaran Masyarakat terhadap Kawasan Tanpa Rokok di Indonesia

Abstrak Merokok merupakan salah satu faktor risiko terhadap penyakit yang membahayakan, seperti jantung, stroke, kanker, dan lain sebagainya. Perilaku masyarakat khususnya perokok aktif yang merokok di sembarangan tempat masih cukup memprihatinkan. Perokok membebankan risiko merokok bukan hanya pada diri sendiri tetapi juga kepada orang lain yang ada di sekitarnya. Analisis dilakukan dengan menggunakan data GATS (Global Adult Tobacco Survey) 2011, dimana desain penelitian adalah cross sectional. Pemilihan sampel menggunakan teknik sampling proportional probabilitas to size (PPS). Hasil dari analisis antara lain: masyarakat yang terpapar rokok di dalam rumah lebih banyak pada kelompok laki-laki dibandingkan perempuan, yang terbanyak pada kelompok umur 45-64 tahun dengan pendidikan tidak tamat SD, tempat tinggal di pedesaan, dan pekerjaan wiraswasta. Kebijakan keluarga yang mengizinkan merokok dalam rumah sebesar 46,9%, dan seseorang yang merokok dalam rumah setiap hari mencapai 62,5%. Masyarakat yang terpapar rokok di ruang kerja sebesar 51,4%, dan kantor yang mengizinkan merokok dalam ruang kerja sebesar 38,4% dan yang tidak ada kebijakan sebesar 19,8%. Terpapar rokok di kantor pemerintahan 66,4%, di universitas 55,3%, di sekolah atau fasilitas pendidikan lainnya 40,3%, di fasilitas keagamaan 17,9%, di fasilitas kesehatan 18,4%, di bar atau klub 91,8%, dan transportasi umum 70,8%. Hasil ini dapat menjadi data dasar untuk mengembangkan intervensi program pengendalian tembakau yang efektif, termasuk menyediakan layanan berhenti merokok, terutama di fasilitas kesehatan. Pemerintah pusat dan daerah perlu meningkatkan sosialisasi tentang bahaya merokok di tempat-tempat umum dan dampaknya terhadap masyarakat khususnya yang bukan perokok; yaitu dengan membuat peraturan yang jelas dan tegas tentang pelarangan merokok di tempat-tempat umum dan memberikan sangsi yang tegas terhadap yang melanggar peraturan tersebut. Upaya layanan berhenti merokok dapat dilaksanakan dengan meningkatkan kegiatan promosi oleh tenaga kesehatan, sosialisasi ‘Quitline’ Kementerian Kesehatan, skrining CO2, bantuan konseling dan mengembangkan metode terapi berhenti merokok bagi para perokok aktif di berbagai fasilitas kesehatan yang tersedia. Kata kunci: rokok, perokok pasif, pengendalian tembakau Abstract Smoking is one of the risk factors for severe diseases, such as heart disease, stroke, cancer, and so on. The behavior of active smokers who smoke arbitrarily at many public places is still quite alarming. Smokers impose the risk of smoking not only on themselves but also to others around them. The analysis was performed using GATS (Global Adult Tobacco Survey) 2011 data, where the research design was cross-sectional. The sample selection uses a proportional probability to size (PPS) sampling technique. The results of the analysis show people who are exposed to cigarettes in the house are mostly males than females with the characteristics were at age groups 45-64 years old, educational level was not completed elementary school, living in rural areas, and self-employee. Family policies that allow smoking in the home were 46.9%, and someone who smokes in the house every day reaches 62.5%. People who are exposed to cigarettes in the workspace were 51.4% and offices that allow smoking in the workspace were 38.4% and those without any ‘free smoking area’ policy were 19.8%. Exposure to cigarettes was 66.4% in government offices, 55.3% in universities, 40.3% in schools or other educational facilities, 17.9% in religious facilities, 18.4% in health facilities, 91.8% in bars or clubs, and 70.8% in public transportation. These results could be a reference or base evidence in developing an effective tobacco control program, including providing smoking cessation services. Central and local governments need to increase awareness about the risk of smoking in public places and their impact on public health, especially for non-smokers, by issuing a strict regulation on free smoking areas in public places and enforce punishment to people who violate these regulations. The efforts to stop smoking services can be implemented by increasing promotion activities by health workers, socialization of the Ministry of Health 'Quitline', CO2 screening, counseling assistance and developing methods of smoking cessation therapy for active smokers in existing health facilities. Keywords: cigarette exposure, passive smokers, tobacco contro

Analisis Kesesuaian Klaim dengan Realitas Pembayaran Ppk Rujukan dalam Jaminan Kesehatan Masyarakat Miskin

The main goal of health development in lndonesia is providing quality health care and assuring community access to equal health services for all citizen (universal coverage). In assuring the access to health services for the poor. Ministry of Health has launched special health insurance program for the poor (Askeskin). PT Askes was assigned by MOH to manage this program. Therefore, it is very important to improve facilities and management capabilities of health insurance administering bodies and health care providers. These include, improvement in case management, hospital accounting system, medical record, etc. This will be very useful for verification process and reducing the fraud and abuse. This study was conducted in order to provide valuable input for the Improvement of financing mechanism and payment system of referral providers in health insurance program for the poor (Askeskin). The objectives of this study are to calculate hospital claim on case management of Askeskin members and its real payment by PT Askes and to calculate the differences between claim and reimbursement (real payment) based on hospital components. The study design is cross-sectional. A Stratified Random Sampling method was conducted to select the study sites based on Human Development Index (HOI) and Fiscal Capacity (refers to Ministry of Finance Data) of district and city. Districts and cities were then classified into high, middle, or low level. The 3 selected study sites were: Kampar District (HPI 34,1) in Riau Province which represent high HOI; North Bengkulu District (HPI: 30.4) in Bengkulu province which represent middle HOI, and Pontianak City (HPI: 27.7) in West Kalimantan Province which represent low HOI. The results show that tariff agreement of case management for Askeskin members was not in accordance with local real condition. Therefore, clear operational and technical Askeskin guidelines are needed to gain similar perception between PT Askes and health care providers· beside Improvement of socialization activities to the community. The amount of differences between claim and reimbursement varied among study sites. The difference was influenced by following factors: (1) existed guidelines that were not suitable with local specific real demand and (2) disparity among hospital facilities. Hospital with limited facility has difficulty to refer patient to another closed hospital which doesn't have contract with PT Askes. Furthermore, in some cases hospital with good facility cannot optimalize using their advanced equipment for treatment, because not stated in the contract with PT Askes. Contract review, tariff adjustment, and re-negotiation between hospitals and PT Askes should be encouraged to provide better services for Askeskin members

DETERMINAN YANG BERHUBUNGAN DENGAN KETAHANAN HIDUP BAYI NEONATAL DI INDONESIA

Background: Health care for children under five year in Indonesia was still a problem that should be cope with. Infant mortality (IMR), maternal mortality (MMR), and the IMR in Indonesia, ware still ranked the highest in Southeast Asia. According Soemantri (2004), infant mortality reached 46 per 1000 live births during the period 1998-2002. According SKRT 2001, the highest cause for infant mortality was perinatal disturbances (34%) and for neonatal mortality are premature and low birth weight babies (29%) and birth asphyxia (27%) (Soemantri S, et al: 2004). Baby's health is associated with several maternal factors during pregnancy and birth, infant factors, and environmental factors. The cause of death of a baby has two kinds, namely endogen and exogen. Endogen infant death or neonatal was death that happens at the first month after birth, and generally caused by factors that brought by the child since birth, obtained from the parents at the time of conception or during pregnancy. Exogen baby's death or post-neonatal mortality was happen after the age of one month until the age of one year that is affected by external environment. Obj ective: This analysis is to ascertam the probabtlity and detenninants related to the live endurance of neonatal infants. Methods: This research design was cross sectional, using data of Health Basic Research (Riskesdas) 2007. Data analysis was conducted univariate, bivariate, and multivariate with the life table method, Kaplan Meier and Cox regression. Results: The analysis indicate that premature variables and barier have relationships with the live endurance of neonatal infants, where babies those are born premature have risk 1.4 times higher for death compared with infants those ware not born premature. For a baby that is born with barier haverisk 1.5 times higher for death compared with infants born without barier. Babies born premature and have barier have risk 2.02 times higher than babies born premature, and not without barier.Key words: Live Endurance, Neonatal, Premature, Barie

Pengetahuan dan Sikap Usila terhadap Kesehatan Gigi

Health services improvement to the elderly research has been done in 6 public health centers selected in Jakarta. It was a quasi experiment, used an area control for comparation. The respondents were the patients who 55 years old and over (elderly), lived in surrounding the public health center, collected since 1996 to May 1998. The number of respondents for each public health center 50 persons male and female.The intervention covered communication, information and education to the health providers and the respondents as well. Besides, they also has been dental observed covered plaque indexand calculus index, to get the oral hygiene index.The primary data collected were the characteristics of respondents, the knowledge of thedental health, and the dental observation for the respondents has been conducted before andafter intervention. While the secondary data were the dental health program for the elderly information. The activities of monitoring has been done 4 times during 4 months, and descriptive analysed was the last activity.The results showed that the knowledge of the elderly on dental health was improve afterintervention, and they more realized that sustain dental observation was very important activity for a certain interval of time.Recommendation: Improvement the dental observation in public health center, especiallyfor the elderly, as well as the communication, information, and education about dental health program continously will be very usefull