Evaluasi Implementasi Pelayanan Jaminan Kesehatan Nasional pada Balai Kesehatan Paru Masyarakat (BKPM) Wilayah Semarang terikat Kerjasama dengan Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan 2015 ABSTRAK Agus Budiono Evaluasi Implementasi Pelayanan Jaminan Kesehatan Nasional pada Balai Kesehatan Paru Masyarakat (BKPM) Wilayah Semarang terikat Kerjasama dengan Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan xvi + 132 halaman + 27 tabel + 6 gambar + 13 lampiran Penyediaan pelayanan Jaminan Kesehatan Nasional (JKN) di Balai Kesehatan Paru Masyarakat (BKPM) Wilayah Semarang belum dilaksanakan secara optimal. Peningkatan kunjungan pasien peserta JKN tahun 2014 hanya 1% dibanding era Askes, adanya ketidak sesuaian tarif dengan biaya riil yang dikeluarkan, prasarana pelayanan kurang memadai, waktu tunggu antrian pelayanan lama dan belum adanya kesepakatan antar pemangku kepentingan menetapkan status klasifikasi fasilitas kesehatan. Tujuan penelitian untuk mengevaluasi implementasi jaminan kesehatan nasional pada Balai Kesehatan Paru Masyarakat (BKPM) Wilayah Semarang. Desain penelitian deskriptif kualitatif menggunakan wawancara mendalam dengan teknik purposive sampling dan telaah dokumentasi untuk menggali fenomena yang di evaluasi. Informan utama penelitian ini dari BKPM Wilayah Semarang yaitu Kepala BKPM Wilayah Semarang, Bendahara, 1 orang petugas Rekam Medis, 2 orang dokter klinik, dan 1 orang pengelola administrasi Jaminan Kesehatan. Informan triangulasi 1 orang seksi pembiayaan dan Jaminan Kesehatan Masyarakat Dinas Kesehatan Provinsi Jawa Tengah, 1 orang staf BPJS Kesehatan Cabang Utama Semarang. Data kuantitatif untuk mendukung data triangulasi dengan survey kepuasan pelanggan menggunakan teknik quota sampling dengaqn sample 45 orang pasien peserta JKN yang berobat di BKPM Wilayah Semarang. Teknik analisis data kualitatif dengan metode analisis isi dan kuantitatif dengan tabel frekuensi. Hasil penelitian menunjukkan bahwa: 1) Jumlah pasien PBI lebih banyak dari Non PBI, 2) Pelayanan BKPM Wilayah Semarang sesuai isi perjajian kerjasama namun masih perlu dikembangkan dan perbaikan lagi. Kepuasan pasien 79,03 % yang termasuk katagori memuaskan. 3) Pada aspek pembiayaan masih ada ketidak sesuaian tarif pelayanan BPJS dengan biaya riil pengeluaran BKPM Wilayah Semarang, 4) Koordinasi belum maksimal pada tingkat manajemen dan pelaksana di BKPM Wilayah Semarang dalam implementasi Jaminan Kesehatan di awal tahun 2014. Rekomendasi yang dapat diberikan adalah perlu dilakukan sosialiasi JKN dan pembenahan prosedur rujukan, pembuatan kajian unit cost sebagai dasar pola tarif, pengembangan prasarana pelayanan kesehatan dan peningkatan disiplin kerja dalam implementasi JKN di BKPM Wilayah Semarang. Kata Kunci : Evaluasi implementasi, Pelayanan Kesehatan, JKN. Kepustakaan : 57 (1989-2014). Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Administration and Health Policy 2015 ABSTRACT Agus Budiono Evaluation of National Health Insurance Service Implementation at Public Lung Health Centre in Work Area of Semarang linked with Provider of Health Social Insurance xvi + 132 pages + 27 tables + 6 figures + 13 enclosures National Health Insurance Service at Public Lung Health Centre (PLHC) in work area of Semarang had not been optimally implemented. The increase of patients’ visit who were members of National Health Insurance (NHI) in 2014 was only 1% compared with the era of health insurance; amount of real costs and expended costs were different; there was lack of service facilities; waiting time was too long; and there was no agreement between departments in determining status of health facility classification. The aim of this study was to evaluate the implementation of national health insurance at PLHC in work area of Semarang. This was a descriptive-qualitative study. Data were collected using an indepth interview and literature review methods to find information regarding evaluated phenomena. All informants were selected purposively. Main informants consisted of head of PLHC Semarang, treasurer, medical record officer, two physicians at a clinic, and an administrator of health insurance. Meanwhile, informants for triangulation purpose involved finance and public health insurance officer at a Health Office of Central Java Province and a staff of Health Social Insurance Provider, main Branch of Semarang. Quantitative data to support triangulation data were obtained by conducting a survey of customer satisfaction using a quota sampling technique on 45 patients who were members of NHI and visited PLHC in work area of Semarang. Furthermore, content analysis was used to analyse qualitative data whereas table of frequency was used to present quantitative data. The results of this research showed that 1) number of PBI patients was larger than number of non-PBI patients; 2) provided services at PLHC Semarang were in accordance with the contents of agreement. Notwithstanding, there needed to be improved and developed. Mostly patients were satisfied (79.03%); 3) tariff of services were not equal to real expended costs; 4) coordination had not been done optimally at levels of management and implementer in the beginning of 2014. As suggestions, there needs to do some activities as follows: socialisation of NHI; rearrangement of referral procedures; conducting a study of unit cost as a basis of tariff pattern; development of health service facilities; and improving work discipline in implementing NHI at PLHC Semarang. Key Words : implementation evaluation; health service; NHI Bibliography : 57 (1989-2014)