Are smokers rational addicts? Empirical evidence from the Indonesian Family Life Survey

<p>Abstract</p> <p>Background</p> <p>Indonesia is one of the largest consumers of tobacco in the world, however there has been little work done on the economics addiction of tobacco. This study provides an empirical test of a rational addiction (henceforth RA) hypothesis of cigarette demand in Indonesia.</p> <p>Methods</p> <p>Four estimators (OLS, 2SLS, GMM, and System-GMM) were explored to test the RA hypothesis. The author adopted several diagnostics tests to select the best estimator to overcome econometric problems faced in presence of the past and future cigarette consumption (suspected endogenous variables). A short-run and long-run price elasticities of cigarettes demand was then calculated. The model was applied to individuals pooled data derived from three-waves a panel of the Indonesian Family Life Survey spanning the period 1993-2000.</p> <p>Results</p> <p>The past cigarette consumption coefficients turned out to be a positive with a <it>p</it>-value < 1%, implying that cigarettes indeed an addictive goods. The rational addiction hypothesis was rejected in favour of myopic ones. The short-run cigarette price elasticity for male and female was estimated to be-0.38 and -0.57, respectively, and the long-run one was -0.4 and -3.85, respectively.</p> <p>Conclusions</p> <p>Health policymakers should redesign current public health campaign against cigarette smoking in the country. Given the demand for cigarettes to be more prices sensitive for the long run (and female) than the short run (and male), an increase in the price of cigarettes could lead to a significant fall in cigarette consumption in the long run rather than as a constant source of government revenue.</p

People’s Support on Sin Tax to Finance UHC in Indonesia, 2016

AbstractIndonesia has the highest prevalence of smokers with 67% of adult males were smokers. Smoking prevalence among all adults increased sharply from 27% in 1995 to 36.3% in 2013. High consumption of cigarettes has been correlated with low price and excise of cigarettes. Experiences from other countries showed that one of the most effective way to reduce cigarette consumption is by increasing cigarette price and excise. Burden of tobacco related diseases has increased. The health burden will increase claims of JKN or Universal Health Coverage which currently has claim ratio of 115% and the quality of care remain low. The difficulties in collecting contribution from non salaried workers are blamed to contribute the deficit. Many countries have earmarked cigarette excise to supplement financing of (UHC) both in tax-funded system or in social health insurance system. The question is do people support? This study explored the possibility the people’s support to increase cigarette prices and excise to meet financial shortage of the JKN.ObjectivesThis polling conducted to explore cigarette consumption and supports of price increase to finance JKN or UHC.MethodsThis study used telephone polling conducted form December 2015 to January 2016. The sample (n=1,000) was randomly selected using systematic random by the interval of 20,000 of mobile phones numbers. Analysis is focused on how various groups support incrasing cigarette prices and excise. The final analysis is logistic regression to assess any difference in supporting the excise increase.Results and DiscussionThe polling (65.9% males and 3.3% females) showed 41.3% respondents consume 1-2 pack cig­arette per day with spending of IDR 450 – 600 thousands per month. In total, 80.3% respondents support increasing cigarette price and exice to supplement health financing of JKN. The proportion of non smokers who supported the earmarking was higher (83.4% ) compared to smokers (75.9%), but the difference is not significance in the final model. The proportion of smokers who know that cigarette is harmful reached 96.8% but the large majority of them had difficulties to quit smoking. There are plenty of room to mobilize money through increasing price and excise of cigrettes since more than 72.3% of smokers said that they would stop smoking if the price of cigarette is above IDR 50,000 per pack; far above current prices. If the prices of cigarettes are double and the excise level reaching maximum allowable levels, there is potential to increase revenue up to IDR 70 Trillion that is almost equivalent to estimate all claim of JKN in 2016. In the logistic model, all groups of respondents unanimously support increasing prices and excise of cigarettes to finance JKN.ConclusionThe prevalence of cigarette smoking is high because of prices of cigarette is relatively cheap and the excise levels have not reduced consumption. This study found that large majority (80%) of non smokers and 76% smokers supported increasing cigarette prices and excise to supplement financing for the JKN. The potential money to supplement JKN is double of the current revenue of JKN

Berbagai Faktor yang Berhubungan dengan Beban Biaya Obat Pasien Rawat Inap Program Askeskin, di Cirebon Tahun 2005

Askeskin membayar klaim pengobatan rumah sakit untuk penduduk miskin dengan tarif yang ditetapkan. Namun, resep obat tidak terdaftar yang tidak boleh dibebankan pada pasien justru menjadi beban rumah sakit. Inisiatif pimpinan RSUD Gunung Jati menyediakan dana pendamping menjadi beban secara fi-nansial. Pada tahun 2005, rujukan pasien rawat inap kelas III, meningkat 153 % dan beban pasien luar kota meningkat 331 %. Tujuan penelitian ini mengetahui faktor-faktor yang mempengaruhi beban RS menutupi biaya perawatan, khususnya obat non DPHO yang tidak dapat diklaim ke Askes. Penelitian me-nggunakan Sumber data catatan medik, catatan klaim dan studi kualitatif wawancara mendalam. Ditemukan bahwa pasien luar yang dirawat di SMF bedah menghabiskan dana dua kali lebih besar daripada pasien yang berasal dari Cirebon dan dirawat di SMF non Bedah. Lama pasien dirawat berbanding lurus dengan besar biaya yang menjadi beban rumah sakit. Penelitian ini juga menemukan visi dan persepsi institusi terkait tentang tanggung jawab pemda yang tidak-sinkron. Hal ini menyebabkan dana pelayanan kesehatan pasien miskin di RSUD Gunung Jati tidak tersedia. Disarankan untuk membentuk forum bersama antara pemda terkait di wilayah III Cirebon guna menangani tanggung jawab pendanaan kesehatan masyarakat miskin dan mekanismenya. Juga diperlukan sosialisasi efektif tentang obat DPHO kepada dokter di rumah sakit.Kata kunci : Asuransi kesehatan, DPHO, askeskin.AbstractAskes—the health insurance corporation—pay hospitals according to predetermined prices, but the hospital must finance the costs of those non-covered drugs and medical supplies prescription because of prohibition of charging the poor. In Gunung Jati Hospital, funding for the poor from local governments which is the responsibility of local governments is not available. The hospital should finance the gap which in turn putting high financial burden to the hospi-tal. Askeskin removes financial barriers to access inpatient care producing an increase of 153% of the third class hospital inpatient from the level of 2004. The objective of this study is to know the factors related to the high financial burden to the hospital in order to finance non covered drugs and medical supplies. The study used survey method complemented by in depth interview in the qualitative part of the study. This study concludes that the average costs of non-covered services are more than twice more expensive among patients coming from out of Cirebon and hospitalized in surgical wards. In addition, length of stay positively correlated with higher burden to the hospital. Inconsistencies and misunderstanding among policy makers regarding vision and mission of caring the poor resulting to no allocation of fund to the hospital. The researchers suggest that a forum is established to delineate local government responsi-bility and funding for non-covered services to complement the national program of Askeskin. In addition, effective communication to physicians to prescribe from formularium would reduce the financial burden of the hospital.Keywords : Health insurance, DPHO, medicai

Efektivitas Biaya Strategi DOTS Program Tuberkulosis antara Puskesmas dan Rumah Sakit Swasta Kota Depok

AbstrakAngka penemuan Tuberkulosis (TB) tahun 2016 adalah sebesar 77% di dunia, sebesar 46,5% di Asia Tenggara dan sekitar 32 - 33% di Indonesia. Di Kota Depok angka penemuan TB mencapai 58%. Sektor swasta menjangkau 18,7% kasus TB di Kota Depok meskipun baru 40% RS swasta yang terlibat. Penelitian ini bertujuan untuk mengetahui apakah penerapan strategi DOTS di Rumah Sakit swasta Kota Depok lebih menghemat biaya dibandingkan di Puskesmas. Penelitian dilakukan selama 6 bulan dengan kohort retrospektif di Puskesmas DOTS, RS DOTS dan RS Non DOTS menggunakan 36 sampel per kelompok. Penghitungan dari perspektif societal dengan microcosting berdasarkan tarif, harga pasar, serta nilai anggaran. Outputnya angka pengobatan lengkap (Success Rate). Hasil penelitian menunjukkan Success Rate di puskesmas paling tinggi yaitu 86,1%, RS DOTS sebesar 77.78 % dan Non DOTS 63.89 %. Penambahan biaya provider terutama tenaga pelaksana khusus di puskesmas dan RS DOTS meningkatkan success rate. Biaya societal di puskesmas 42% dari biaya di RS swasta. ACER (Average Cost Effectiveness Ratio) menunjukkan RS yang melaksanakan strategi DOTS lebih cost effective. Untuk menaikkan 1% angka kesuksesan pengobatan membutuhkan biaya Rp 10.084.572 dengan melakukan intervensi program DOTS ke RS Swasta. Uji t independen menyatakan bahwa terdapat perbedaan bermakna biaya societal pengobatan tuberkulosis antara puskesmas, RS DOTS, dan RS Non DOTS. AbstractGlobal TB notification rate at 2016 was 77% and 46.5% in Southeast Asia. Indonesia last 5 years still remain at 32-33% where Depok City reached 58%. In Depok City, private sector contributed 18.7% of the notified TB case in 2016 although only 40% of private hospitals were involved. The aims of this study is to determine cost-effectiveness of DOTS strategy implementation at private hospital and Public Health Centre (PHC). Comparative study carried out for six months with cohort retrospective between PHC, DOTS and non DOTS hospitals using 36 samples per group. The calculation of the societal perspective with micro costing based on tariffs, market prices and budget value. Output is Success Rate, where at PHC 86.1%, DOTS hospital 77.78% and Non DOTS hospital 63.89%. The addition cost providers especially person in charge at PHC and DOTS hospital increase success rate. The cost of TB treatment in PHC 42% of private hospital. ACER (Average Cost Effectiveness Ratio) is obtained that the hospital which carry out the DOTS strategy is cost effective. To increase 1% success rate of TB treatment costs Rp 10,084,572 with intervention DOTS programs into a private hospital. An Independent t test stated that cost-effectiveness societal perspectives on TB treatment has a significant difference between PHC, DOTS hospital and Non DOTS hospital

Model Spesifikasi Dinamis Permintaan Rokok: Rasionalkah Perokok Indonesia?

This study estimates a dynamic model specification of demand for cigarette in Indonesia. The objectives are to test the rational addiction hypothesis of cigarettes demand, and to calculate price elasticity of cigarettes in the short-run and long-term. The data for this analysis were aggregate individual data from three-wave a panel surveys of the IFLS (Indonesian Family Life Survey) from 1993-2000. This study explores several econometric approaches, and selects the best fit of several statistical measures. The results indicate that cigarette indeed an addictive good (the lags consumption coefficients are a positive with p-value <1%). Whilts a negative coefficient and significancy of future consumption indicate that smokers are myopic addicts, they are not rational. The study also confirms that the demand is more price sensitive for the long-run than the short-run. The finding of myopic addiction has pratical implications with which policy-makers should re-design current public health campaign against cigarette smoking in the country. Various policy implications of the research findings are also discussed in this article

Faktor-Faktor Yang Berhubungan Dengan Budaya Keselamatan Pasien Di Rumah Sakit Karya Bhakti Pratiwi Bogor Tahun 2015

ABSTRAKInsiden Keselamatan Pasien ( IKP ) di RSKBP berkisar antara 0,31% sampai dengan 3,01% dengan angka kematian 2,22%.IKP di RSKBP dinilai masih under reporting karena kebanyakan IKP tidak dilaporkan.Membangun budaya keselamatan pasien merupakan elemen penting untuk meningkatkan keselamatan pasien dan kualitas pelayanan.Penelitian ini bertujuan untuk mengetahui budaya keselamatan pasien dan faktor-faktor yang berhubungan dengan budaya keselamatan pasien di RSKBP tahun 2015. Penelitian dilakukan bulan Maret sd April 2015, dengan sampel 115 responden. Desain penelitian explanatory sequential. Analisa data dilakukan dengan regresi logistic.Penelitian menunjukan budaya keselamatan pasien di RSKBP masih kurang. Faktor-faktor yang berhubungan dengan budaya keselamatan pasien di RSKBP adalah umpan balik laporan insiden ( p=0,021 α=0,05, OR= 15,516 ) budaya tidak menyalahkan ( p=0,019 α=0,05, OR= 14,396 ) dan budaya belajar ( p=0,006 α=0,05, OR= 0,096 ).Disarankan agar RSKBP dapat memperbaiki budaya keselamatan pasien dengan upaya yang komprehensif dan terstruktur. ABSTRACTAdverse even ( AE ) in RSKBP ranged from 0.31% to 3.01% with a mortality rate of 2.22%.AE in RSKBP still considered under-reporting because most AE  not reported. Building a culture of patient safety is an important element to improve patient safety and quality. This research aims to know the culture of patient safety and the factors related to the patient safety culture in RSKBP 2015. The study was conducted in March to April 2015, with a sample of 115 respondents It is Sequential explanatory research design. The data analysis with regression logistic.Patient safety culture in RSKBP still lacking. Factors related to the patient safety culture in RSKBP feedback is incident report (p = 0.021 α = 0.05, OR = 15.516) culture is not to blame (p = 0.019 α = 0.05, OR = 14.396) and a learning culture (p = 0.006 α = 0.05, OR = 0.096) .RSKBP sugest to  improve patient safety culture with a comprehensive and structured efforts

Cost Effectiveness Analysis Between Hemodialysis and Peritoneal Dialysis

Abstract The number of patients with End Stage Renal Disease (ESRD) in Indonesia is growing. Increasing prevalence of hypertension and diabe­tes mellitus contributes to higher prevalence of ESRD. The majority of patients (94%) with ESRD are undertaking hemodialysis (HD) at public and private hospitals. However, continuous ambulatory Peritoneal Dialysis (PD) has been prescribed to small portion of patients with ESRD. The aim of this study was to examine the cost effectiveness between HD and PD on ESRD patients. This study compared 78 HD patients at Hospital X in Bogor and 10 PD patients at Hospital Y in Jakarta. Patient’s quality of life (QoL) was measured using SF 36 questionnaires. The costs were measured by direct medical costs using CBGs prices, direct non-medical costs (transportation, food for patient and family), and indirect medical costs (opportunity costs). The study found that the HD cost per year per patient was IDR 133.4 million and the comparative cost for PD was IDR 81.7 million. The study found lower QoL of HD patients (46.2%) com­pared to QoL of PD patients (90%). In addition, PD patients had significant better quality of physical activities, emotional states, social function, and sanity. The study found the incremental costs for to HD to reach similar emotional states was IDR 2.0 million compared to PD and IDR 1.8 million for extra physical role gained. It is concluded that PD was more cost-effective than HD in achieving a certain level of quality of life among patients with ESRD in two hospitals in Indonesia. Abstrak Jumlah pasien Gagal Ginjal Stadium Akhir (GGSA) di Indonesia terus meningkat. Meningkatnya prevalensi hipertensi dan diabetes mellitus (DM) berkontribusi terhadap prevalensi kasus GGSA. Mayoritas pasien (94%) dengan GGSA menjalani terapi hemodialisis (HD) baik pada Rumah Sakit (RS) swasta ataupun pemerintah. Bagaimanapun, dialisis peritoneal ambula­tori berkelanjutan (continuous ambulatory peritoneal dialysis/CAPD) telah diberlakukan pada sebagian kecil pasien dengan GGSA. Tujuan dari studi ini adalah untuk mengukur efektivitas harga dari HD dan CAPD pada pasien GGSA. Studi memband­ingkan 78 pasien HD di RS X Bogor dan 10 pasien CAPD pada RS Y Jakarta. Kualitas hidup pasien diukur menggunakan kue­sioner 36. Biaya diukur dengan biaya langsung medis (menggunakan harga CBGs), biaya langsung non-medis (transportasi dan biaya makan), serta biaya medis tidak langsung (biaya kesempatan). Studi menunjukkan bahwa HD membutuhkan biaya Rp 133,4 juta per orang per tahunnya, dibandingkan dengan CAPD sebanyak Rp 81,7 juta. Studi menemukan kualitas hidup yang lebih rendah pada pasien HD (46,2%) dibanding CAPD (90%). Selain itu, pasien CAPD memiliki kualitas yang lebih baik dari segi aktivitas fisik, status emosi, fungsi sosial, dan kejiwaan. Studi menemukan bahwa harga inkremental HD, untuk men­capai status emosional yang sama, dibanding CAPD yakni sebanyak 2 juta rupiah; dan 1,8 juta rupiah untuk mencapai peran fisik bila HD dibanding dengan CAPD. Dapat disimpulkan bahwa CAPD lebih efektif dari segi biaya dibanding HD dalam mencapai tingkatan kualitas hidup yang lebih baik pada pasien-pasien GGSA di dua RS di Indonesia

Perbandingan Klaim Penyakit Katastropik Peserta Jaminan Kesehatan Nasional di Provinsi DKI Jakarta dan Nusa Tenggara Timur Tahun 2014

AbstrakBeberapa penyakit yang pada tingkat rumah tangga tergolong katastropik adalah gagal ginjal, kardiovaskular, kanker, thalassemia dan hemophilia. Penderita penyakit tersebut merupakan kelompok yang paling menikmati Jaminan Kesehatan Nasional (JKN) dan penyakit-penyakit tersebut menyerap klaim besar dalam JKN yang perlu mendapat perhatian serius. Karena sebaran fasilitas kesehatan dan kompetensi tenaga medis yang berbeda serta bayaran CBG yang tidak adil, disinyalir terjadi serapan dana yang tidak seimbang antara propinsi. Penelitian bertujuan untuk menganalisis besaran klaim penyakit tersebut di dua proponsi Jakarta dengan pendapatan per kapita tinggi dan NTT dengan pendapatan per kapita rendah. Penelitian ini menggunakan data klaim di BPJS Kesehatan tahun 2014 yang berjumlah 309.301 klaim di kedua propinsi tersebut untuk mengekplorasi sejauh mana perbedaan klaim klaim. Hasil analisis menunjukkan ada perbedaan bermakna rata-rata klaim klaim per CBG, per perawatan, per hari rawat . Faktor terbesar perbedaan tersebut adalah besaran CBG yang tidak member insentif pemerataan dokter spesialis ke RS kelas B, C, dan D di daerah dengan pendapatan per kapita rendah. Penelitian ini tidak membuktikan bahwa dana dari provinsi NTT terserap di provinsi DKI.AbstractSeveral diseases that at the household level become catastrophic are end stage renal diseases, cardiovascular, cancer, thalasemia, and haemphilia. Patients of those diseases are benefitted the most of the National Health Insruacen (JKN) and those diseases absorbed high claim costs of the JKN. Special attentions are needed to manage those diseases. Disparity of health care facilities, specialists, and differentials of Casemix Base Group (CBG) payment are susptected to be important contributing factors that create absosrbtion of JKN fund across provinces. This study use 2014 claim data of BPJS Kesehatan in Jakarta and East Nusa Tengga (NTT) provinces to explore the size of differences. The total number of claims analyzed was 309,301 claims. The results show statistically difference of claim payment per case, per admission, and per hospital day. The differences are atributable mostly by differentials of CBG prices that are not providing incentives for specialists to be deployed in smaller hospitals of class B, C, and D in low income provinces.This study does not prove transfer of JKN fund from NTT to Jakarta

The Political Aspects of the Establishment of the Planning and Budgeting Policy for The Directorate of Occupational and Sports Health of the Ministry of Health

The process to establish a planning and budgeting policy in the Directorate for Occupational and Sports Health is very dynamic and it fluctuates according to the goals and priorities of the policy. This research aims to ascertain how far the political aspects influences the establishment process. This research was a qualitative research accomllished through in-depth interviews with related parties. The framework used the planning and budgeting systems model and process/cycle. Results of this research indicated that politics played a major role in the policy establishment process in conflicts, cooperation, and negotiations when setting the size and allocation of the budget and the targets aimed. The main points in the process are the priorities of the program, the fiscal capacity of the nation, and the results of the previous year’s evaluation. We recommend that the human resources of the directorate are equipped abilities to advocate the importance of the occupational and sports health progra

Biaya dan Outcome Hemodialisis di Rumah Sakit Kelas B dan C

 Gagal Ginjal Kronis (GGK) merupakan kondisi yang semakin meningkat kejadiannya di Indone­sia, menghabiskan banyak dana publik Jaminan Kesehatan Nasional (JKN). Dalam program JKN, hemodi­alisis (HD) untuk penanganan GGK dijamin tetapi perleu keseimbangan antara biaya dan outcome. Sejak 2014, BPJS menanggung hampir seluruh biaya HD di Indonesia dengan besaran tarif Casemix Base Group (CBG) yang berbeda menurut kelas Rumah Sakit (RS). Tujaun dari penelitian ini adalah untuk mengetahui perbedaan biaya Hemodialisis pada Rumah Sakit Kelas B dan Kelas C.Studi evaluasi ekonomi ini dilakukan di dua RS dengan kelas berbeda: kelas B (RS B) dan kelas C (RS C) dengan perbedaan kepemilikan. Kepemilikan RS B adalah pemerintah daerah sedangkan RS C dimiliki oleh yayasan swasta. Outcome HD diukur dengan suatu survey ke pasien HD. Analisis outcome dilakukan dengan penilaian kualitas hidup (instrumen EQ-5D) dengan Indeks EQ, EQ VAS, intermediate outcome berupa rerata Intra Dialytic Weight Loss (IDWL), dan rerata Hb. Perbedaan rerata nilai hasil diuji dengan Student’s t-test. Responden dipilih dari pasien GGK yang menjalani HD di kedua RS selama Feb­ruari-April 2016. Analisis biaya menurut perspektif pasien, meliputi biaya langsung medis, biaya langsung non medis, dan biaya tidak langsung. Biaya sebenarnya yang dikeluarkan oleh RS dikumpulkan dari doku­men RS. Studi kualitatif tambahan dilakukan dengan wawancara mendalam kepada informan kunci di RS yang bertanggung jawab atas unit HD. Pada penelitian ini, total responden sebanyak adalah 100 orang (di RS B 76 orang & di RS C 24 orang). Menurut perspektif pasien, biaya langsung medis HD selama sebulan di RS B Rp 5.215.331 dan di RS C Rp 7.781.744. Besaran tarif CBG untuk RS kelas B adalah Rp 962.800 dan kelas C adalah Rp 893.300. Menurut perspektif RS, tidak terdapat perbedaan biaya operasional HD antar kelas RS. Biaya langsung non medis HD selama sebulan di RS B Rp 566.260 dan di RS C Rp 334.500. Biaya tidak langsung HD selama sebulan di RS B Rp 165.530 dan di RS C Rp 45.830. Rerata total biaya HD selama sebulan di RS B Rp 6.149.285 dan di RS C Rp 8.162.077. Pada intermediate outcome didapatkan bahwa rerata Hb pada RS B sebesar 10,26 g% berbeda secara signifikan dengan RS C (8,21 g%), p= 0,000. Rerata IDWL pada RS B (0,0403) tidak berbeda secara signifikan dengan RS C (0,0438), p= 0.188. Rerata EQ Indeks sebesar 0,7178 dan EQ VAS sebesar 64,74 di RS B tidak berbeda secara signifikan dengan rerata EQ Indeks sebesar 0,7208 dan EQ VAS sebesar 64,79 di RS C, dengan p value secara berurutan p=0,94 dan p= 0,98