Implementasi Jaminan Kesehatan Nasional (JKN) oleh Bidan pada Kasus Persalinan Normal di Fasilitas Kesehatan Tingkat Pertama (FKTP) Kabupaten Brebes

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2016 ABSTRAK Suci Utami Implementasi Jaminan Kesehatan Nasional (JKN) oleh Bidan pada Kasus Persalinan Normal di Fasilitas Kesehatan Tingkat Pertama (FKTP) Kabupaten Brebes xv + 95halaman + 3tabel + 5 gambar + 8lampiran Salah satu upaya menurunkan Angka Kematian Ibu (AKI) adalah persalinan ditolong oleh tenaga Kesehatan di Fasilitas Kesehatan. Era JKN tahun 2014 bahwa persalinan normal dengan pasien BPJS Kesehatan bisa dilakukan di FKTP. Bidan Praktik Mandiri boleh melakukan pertolongan persalinan pada peserta BPJS Kesehatan bila sudah berjejaring dengan FKTP, namun dana dirasa relative kurang, Klaim untuk kehamilan hanya sebanyak 4 kali, sementara ibu hamil datang ke BPM 1 bulan sekali, dan pasien tidak boleh ditarik biaya sampai persalinan, nifas dan pemilihan alat kontrasepsi, bidanharus menambah anggaran dengan menggunakan dana pribadi. Metode penelitian yang digunakan adalah kualitatif. Jumlah informan utama 8 orang, yaitu 3 bidan di Puskesmas, 2 Bidan di Klinik dan 3 Bidan Praktik Mandiri. Informan triangulasi, yaitu 2 orang Ka.Puskesmas, 2 Orang Direktur Klinik Bersalin, 1 Dokter Keluarga dan Kepala BPJS Kesehatan. Data dikumpulkan dengan wawancara mendalam. Pengolahan dan analisis data menggunakan analisis isi. Hasil penelitian menunjukkan bahwa struktur birokrasi di BPM dan Klinik sudah berjalan baik, sedangkan di Puskesmas struktur birokrasi terlalu panjang membuat komitmen bidan di Puskesmas menjadi kurang, alokasi anggaran jasa persalinan dirasa kurang mencukupi biaya operasional, komunikasi antar pemangku kebijakan sudah berjalan baik. Disarankan kepada Dinas Kesehatan Kabupaten Brebes untuk melakukan sosialisasi berkala kepada bidan khususnya tentang etos kerja, mengalokasikan dukungan peningkatan sarana dan prasarana di Puskesmas khususnya untuk pertolongan persalinan normal, melakukan fasilitasi dengan BLUD supaya jasa pelayanan persalinan bisa turun rutin setiap bulan. Kata kunci : Implementasi, JKN, Bidan, Persalinan Normal, FKTP Kepustakaan: 44 (1975-2014) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2016 ABSTRACT Suci Utami Implementation of National Health Insurance (NHI) by Midwives on Normal Delivery Cases at First Level HealthFacility (FKTP) in District of Brebes xv + 95 pages + 3 tables + 5 figures + 8 appendices A delivery process helped by a health worker at a health facilities is one of the efforts to reduce Maternal Mortality Rate (MMR). National Health Insurance (NHI) in 2014 allowed pregnant women who were members of health BPJS to do normal delivery process at first level health facility (FKTP). Private Practice Midwives (PPM) could help delivery processfor members of health BPJS if they had a network with FKTP. However, there was lack of funding. Claim for pregnancy was just four times. Meanwhile, pregnant women visited PPM once a month and they did not ask to pay until the time for performing delivery process, postpartum, and choosing type of contraception. In addition, midwives had to spend their own money to add funding. This was a qualitative study. Number of main informants were 8persons consisted of three midwives at Health Centre, two midwives at Clinic, and three PPM. Informants for triangulation purpose consisted of two heads of Health Centres, two directors of maternity clinics, one family doctor, and head of health BPJS. Data were collected by conducting indepth interview and analysed using a method of content analysis. The results of this research showed that a structure of bureaucracy at PPM and the clinics was good, otherwise the structure of bureaucracy at the health centres was quite long. As the result, there was lack of midwives’ commitment at the health centres. In addition, budget allocation for providing delivery service was insufficient. Notwithstanding, communication between policy makers was good. As suggestions, Brebes District Health Office needs to periodically socialise about work commitment to midwives, to provide means at health centres particularly for normal delivery process, and to facilitate with BLUD in order to reduce cost for delivery service every month. Keywords : Implementation, NHI, Midwife, Normal Delivery, FKTP Bibliography: 44(1975-2014)