KEMAMPUAN DAN KEMAUAN MEMBAYAR. PELAYANAN KESEHATAN PADA KELUARGA NELAYAN DI KABUPATEN.JEPARA

Abstract

Penelitian ini untuk menganalisis bagaimanakah kemauan dan kemampuan membayar pelayanan kesehatan pada keluarga nelayan di kabupaten Jepara. Survai dilakukan terhadap 200 sampel keluarga nelayan di kecamatan Kedung dan di Kecamatan Jepara. Kerangka konsep peneli-tian dikembangkan dari model pemanfaatanrdemand" pelayanan kesehatan oleh Andersen (1975), Sorkin (1976), Feldstein (1983) serta beberapa konsep kemampuan dan kemauan membayar Yankes. Pada analisis kemampuan membayar (Ability to pay). Yankes sebagai variabel bebas adalah pendapatan keluarga , biaya pelayanan, jumlah dan struktur keluarga. Pada analisis kemauan membayar (willingness to pay), sebagai variabel bebas yaitu : kebutuhan, pendidikan, persepsi terhadap yankes, pendapatan rumah tangga, biaya yankes, biaya transpor, lama waktu tunggu, lama waktu perjalanan dan jarak tempat pelayanan. Basil penelitian menyebutkan 79,5 % keluarga nelayan berada di bawah garis kemiskinan, 63 % hanya berpendidikan Sekolah Dasar dan beban tanggungan rata-rata 5 orang. Upaya berobat terbanyak yaitu beli obat di toko obat ( 38,46 % ), ke dokter praktek ( 32,69 %), paramedis / bidan desa ( 13,85 % ) dan Puskesmas ( 11,54% ). Alasan memilih Yankes yang terbanyak adalah merasa cocok/mantap, dekat dengan rumah dan biaya terjangkau. Rata-rata biaya pengobatan untuk upaya beli obat (Rp 897,00), dokter prak-tek (Rp 8.250,00), Paramedis /dansa (4.281,94) dan Puskesmas / Pustu Rp 530. Biaya transpor terendah adalah beli obat (Rp 106,00) dan tertinggi adalah dokter praktek (Rp 1.225). Total waktu untuk mendapatkan pelayanan yang terlama adalah pelayanan dokter praktek (71,71 menit) kemudian Puskesmas/Pustu (59,40 menit). Jarak tempat pelayanan terjauh adalah dokter praktek (3.194 meter) kemudian Puskesmas/Pustu (2.693) Sebanyak 42,55% responden (36 orang) menyatakan keberatan membayar pelayanan dokter, sedangkan untuk paramedis/bidan praktek : 7 orang (19,44%) dan Puskesmas : 6 orang (20%). Untuk upaya bell obat, responden mau membayar antara Rp. 150,00 sampai Rp. 2.000,00, Dokter praktek : Rp. 2.000,00 sampai Rp. 50.000,00 (terbanyak berpendapat Rp. 5.000,00 dan Rp. 10.000,00), Paramedis/bidan praktek : Rp. 1.000,00 sampai Rp. 4.000,00 dan Puskesmas : Rp. 500,00 sampai Rp. 800,00. Hasil analisis bivariat (korelasi) kemampuan membayar pelayanan kesehatan (ATP), variabel yang ber-.makna (p<0,05) masing-masing untuk semua upaya : biaya pengobatan, upaya beli obat : pendapatan keluarga : dokter praktek, biaya pengobatan, paramedis/bidan prak-tek : pendapatan keluarga serta Puskesmas : pendapatan keluarga dan biaya pengobatan. Hasil yang sama juga diperoleh pada masing-masing analisis multivariatnya (multiple linier regression). Hasil analisis bivariat (korelasi) kemauan memba-yar pelayanan kesebatan (WTP), variabel yang bermakna (p<0,05) masing-masing untuk semua upaya : biaya pengo-batan, biaya transpor dan jarak tempat, dokter praktek : biaya pengobatan dan jarak tempat, paramedis/bidan praktek : *iaya pengobatan, Puskesmas : biaya pengoba-tan, upaya bell obat : harga obat, biaya transport dan waktu perjalanan. Hasil analisis multivariat (multiple linier regression) semua upaya dan .paramedis/bidan praktek menunjukan hasil yang sama, sedangkan untuk dokter praktek : biaya pengobatan dan upaya bell obat : harga obat, biaya transpor, waktu perjalanan dan jarak tempat. Kemampuan membayar pelayanan kesehatan ditentukan oleh harga obat (biaya pengobatan) dan pendapatan ke-luarga. Sedangkan kemauan membayar ditentukan oleh harga obat (biaya pengobatan), biaya transpor, jarak tempat dan lama waktu perjalanan. Untuk mendekatkan pelayanan kesehatan agar ter¬jangkau oleh kelompok masyarakat yang rata-rata miskin dan berpendapatan rendah seperti nelayan perlu diperha¬tikan harga obat (biaya pengobatan) serta mendekatkan sarana pelayanan kepada mereka agar biaya dan lama waktu perjalanan dapat ditekan. Intervensi pemerintah dan pihak terkait untuk meningkatan pelayanan kesehatan sangat diperlukan seperti penerapan Kartu Sehat dan Dana Sehat, tetapi untuk mengetahui efektivitas penerapannya masih memerlukan penelitian lebih lanjut. The Objective of this research is to analize how are the ability to pay (ATP) and willingness to pay (WTP) of fisherman families about health services. With the samples 200 fisherman families in Kecamatan Jepara and Kedung in Jepara Regency, the conceptual frameworks were developed from health services use/demand by Andersen (1975), Sorkin, (1976), Feldstein (1983) and certain concept of ATP and WTP. In Health services ATP model, independent variables are household income, health services lost, the size and family structures. In health services WTP model there are independent variables : needs, education, the perception about health ser - vices, household income, health services cost, transportation cost, total time having health services and health services distance. The result of this research mentioned that 79,5 % fisherman families were under poverty time and 63 % responden had elemen-tary school education. The average of dependency burden were 5 persons. Self treatment with buy specific drugs were the highest health services used by families ( 38,46 % ). Another health services using by families are doctors ( 32,69 %), paramedics/midwives (13,85%) and Puskesmas (11,54%). The reason why most of respondens health services are suitable, nearby their house and low cost. The average of health services cost for self treatment/bought drugs (Rp 897.00), doctors (Rp 8.250.00). Paramedics/midwives (Rp 4281.94) and Puskesmas/Pustu (Rp 530). The lowest transportation cost as self treatment/bought drugs (Rp 106.50) and the highest was doctors (Rp 1.225). In order it the longest time having health services were doctors (71.71 minutes) and Puskesmas (59.40 minutes). Health services distances doctors were (3.194 meter) and Puskesmas (2.693 meter) About 36 respondent (42,55%) who are had doctor's services mentioned that they had disability paying health service cost, paramedics/midwives : 7 respondent (19,44%) and Puskesmas : 6 respondent (20%). Respondent had willingness to pay for self treat¬ment/ bought drugs : between Rp.150,00 - Rp.20.000,00 : Doctors : Rp. 2.000,00 - Rp. 50.000,00 (the most amount are Rp. 5.000,00 and Rp. 10.000,00), Paramedics/midwives : Rp. 1.000,00 - Rp. 4.000,00 and Puskesmas : Rp. 500,00 - Rp. 800,00. The result of bivariat analysis (correlation) of Ability to Pay (ATP), mentioned that significant inde¬pendent variables (p<0,05) for all services : medical cost/health services cost, self treatment/bought drugs : household income, Doctors : medical cost, paramedics /midwives : household income and Puskesmas : household income and medical cost. The result of multivariat analysis (multiple linier regression) for each health services are as same as the result of bivariat analysis. The result of correlation analysis of Willingness to Pay (WTP) mentioned that significant independent variables (p<0,05) for all services : medical cost, transportation cost and place distance, self treatment/bought drugs : drugs cost, transportation cost and transportation time, Doctors : medical cost and place distance, paramedics/midwives : medical cost and Puskesmas : medical cost. For all services and parame¬dics/midwives, the result of multivariat analysis (multiple linier regression) are as same as the result of Correlation analysis, but for doctors, the signifi¬cant variables is medical cost and self treatment/bought drugs are medical/drugs cost, transportation cost, transportation time and place distance. The ability to pay of health sevices is deter¬mined by drugs cost (medical cost) and household income. The Willingness to pay is determined by drugs cost (medical cost), transportation cost, transportation time and place distance. To reach the poor and low education community, like fishermen community, the important things, that should be intervented to increase their purchasing ability of health services are application such a program, like health card (kartu sehat) and health fund policy (dana sehat) , but the effectiveness of these methode should be studied in the next research