Implementasi Kebijakan Jaminan Sosial Kesehatan Sumatera Selatan Semesta di Puskesmas Se-kota Palembang Tahun 2009

Abstract

Background and objective: Universal Social Health Insuranceof South Sumatera (Jamsoskes) is an effort undertaken by theGovernment of South Sumatera to improve the accessibility ofhealth services for the people in South Sumatera, held since22 January 2009. The aim of this study was to analyze theimplementation of Jamsoskes policy in the community healthcenters in Palembang during the year 2009.Methods: This was a policy analysis research with qualitativeand quantitative approaches. Data were obtained in HealthOffice of South Sumatera Province, Health Office of PalembangCity, 38 community health centers in Palembang and users ofJamsoskes. Qualitative data were collected through: in-depthinterviews and FGDs, then quantitative data were collectedthrough review of documents related to Jamsoskes. Contentanalysis was used to analyze qualitative data and quantitativedata were analyzed by univariate statistics.Results: Results showed that: 1) Implementation of Jamsoskeshas been according to district regulation of South SumateraProvince Number 2/2009 and Governor Regulation Number 23/2009; 2) Source of funds were contribution from budget ofSouth Sumatera Province and Palembang City; 3) Organizingconsist of the provincial coordination team, the city coordinationteam, the service managers team, and verification officers. 4)The utilization of Jamsoskes in 38 community health centerswas 408.830 people and the total of referral 9.089 people. 5)Several problems in implementation of Jamsoskes i.e. on aspectof membership administration, services administration, andfinancial administration. There were incomplete identities inmembership administration, in services administration aspect,medical diagnosis or treatments sometimes were not appropriate,whereas in the financial administration, the claims cost werenot in accordance with district regulation. During the year 2009the difference between billing and approval of claims in 38community health centers at total of Rp21.037.000,00Conclusion: Health financing policy in Palembang City throughJamsoskes program was not optimal, as seen from severalproblems: membership, services, and financial administration.Recommendation for Health Office of South Sumatera Provinceto build membership database and not use Jamkesmasverificator for Jamsoskes verificator in order to reduce workoverload. Health Office of Palembang City need to disseminateroutinely of data verification to community health centers andalso to verificators. Community health centers need to intensifyprovisia of information to society about prerequirements to getJamsoskes service.Keywords: healthcare financing, social health insurance,community health center