Analisis Permintaan Rujukan Non Indikasi Peserta Jaminan Kesehatan Nasional (JKN) di Puskesmas di Wilayah Kota Magelang

Wardoyo, Wardoyo and Jati, Sutopo Patria and Warsono, Hardi (2015) Analisis Permintaan Rujukan Non Indikasi Peserta Jaminan Kesehatan Nasional (JKN) di Puskesmas di Wilayah Kota Magelang. Masters thesis, UNIVERSITAS DIPONEGORO.

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Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan 2014 ABSTRAK Wardoyo Analisis Permintaan Rujukan Non Indikasi Peserta Jaminan Kesehatan Nasional (JKN) di Puskesmas di Wilayah Kota Magelang xvi + 206 halaman + 27 tabel + 3 gambar + 23 lampiran Sistem rujukan berjenjang pada Program JKN bertujuan agar pelayanan kesehatan efektif dan efisien. Pemanfaatan layanan kesehatan hendaknya bertahap dari level primer. Kenyataannya banyak pasien di puskesmas memaksa minta dirujuk meskipun tanpa indikasi. Jenis penelitian observasional, dengan rancangan cross sectional, metode utama adalah kuantitatif diperkaya metode kualitatif. Seluruh pasien di semua puskesmas induk di Kota Magelang yang tergolong rujukan non indikasi menjadi populasi sekaligus sampel penelitian (total sampel / sensus), yang menururut pendataan pada Bulan Juni 2014 ada sebanyak 51 pasien. Hasil analisis bivariat menunjukkan bahwa variabel terikat intensitas permintaan rujukan non indikasi berhubungan dengan penilaian pada penyakit terutama rasa khawatir yang berlebihan pada penyakitnya, berhubungan dengan pendidikan dan juga dengan kemampuan menambah biaya berobat yaitu berkaitan dengan gaya hidup khususnya kebiasaan berobat, berhubungan dengan kepercayaan pada dokter yaitu merasa lebih yakin dan mantap pada dokter spesialis di rumah sakit karena ilmu dan pengalamannya lebih mendalam, berhubungan dengan persepsi pada faskes terutama terkait obat-obatan puskesmas yang dinilai kurang bagus dan kurang legkap, serta dan tidak berkorelasi dengan umur dan gender. Hasil analisa multivariat, intensitas permintaan rujukan non indikasi secara simultan dipengaruhi oleh pendidikan, kepercayaan pada dokter, penilaian pada penyakit, dan persepsi pada faskes. Kendala lain pelaksanaan rujukan berjenjang terutama adalah belum diterapkannya aturan rujukan secara ketat, dan kurangnya komitmen dari pihak terkait untuk menjalankan sistem rujukan sesuai prosedur. Disarankan agar sosialisasi sistem rujukan berjenjang lebih intensif, meningkatkan kompetensi (teknis dan komunikasi) dokter puskesmas, saat pelayanan dokter puskesmas lebih intensif dalam menjelaskan penyakit pasien, memperbaiki pengadaan obat puskesmas, mengefektifkan penerapan aturan dan kinerja sistem rujukan berjenjang dengan memperbaiki komitmen semua pihak terkait dan memperbaiki semua aspek penunjangnya, serta adanya opsi jika peserta JKN menghendaki obat/pemeriksaan di luar standar, bisa dengan menambah biaya sendiri. Kata kunci : Permintaan rujukan non indikasi, Puskesmas, JKN Pustaka : 58 (2000 – 2014) Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Administration and Health Policy 2014 ABSTRACT Wardoyo Analysis of Non-Indication Referral Demand among Members of National Health Insurance (NHI) at Health Centres in Magelang City xvi + 206 pages + 27 tables + 3 figures + 23 enclosures A tiered referral system on a National Health Insurance (NHI) program was aimed to provide health services effectively and efficiently. The use of health services needs to be started from a primary level. However, most of the patients at health centres insisted to be referred even though they did not have indications. This was observational research with cross-sectional approach. A quantitative method was mixed with a qualitative method. All 51 patients based on recorded data in June 2014 at all main health centres in Magelang City categorised as non-indication referral were being a study population of this research. The result of bivariate analysis showed that variables of disease assessment particularly feeling anxious to a disease, education, ability to increase cost of treatment related to a lifestyle, namely health care seeking behaviour, trust to a physician, feeling more confident to specialists at a hospital due to their knowledge and experiences, and perceptions of health facilities particularly regarding low quality and incomplete medicines at health centres had significant relationship with the intensity of non-indication referral demand. In contrast, factors of age and gender were not significant. Multivariate analysis revealed that variables of education, trust to a physician, disease assessment, and perceptions of health facilities influenced the intensity of non-indication referral demand. The main barriers of tiered referral implementation were as follows: a referral regulation had not been strictly implemented and lack of commitment from related sectors to conduct a referral system in accordance with a procedure. Some recommendations were as follows: conducting socialisation of a referral system intensively, improving competency (technical and communication) of doctors at health centres, improving a drug procurement system at health centres, streamlining the implementation of regulations and performance of a tiered referral system by improving commitment of all related sectors and supporting aspects, and providing options if members of NHI wants medicines/treatments outside a standard by adding cost using their own money. Key Words : Non-indication Referral Demand, Health Centre, NHI Pustaka : 58 (2000-2014)

Item Type:Thesis (Masters)
Subjects:Q Science > Q Science (General)
Divisions:School of Postgraduate (mixed) > Master Program in Public Health
ID Code:45298
Deposited By:Mr. Mikm Undip
Deposited On:12 Mar 2015 09:53
Last Modified:12 Mar 2015 09:53

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