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"ABSTRAKBenefit for the middle-class elderly are generally distributed through such social insurance programs as Social Security Old Age Insurance and Medicare. The inclusion of long-term nursing home services for the elderly in Medicaid provides an opportunity to gauge the relationship of the "middle class" to a means-tested public assistance program. This article develops the analysis by focusing on the nature of the recent changes in financial eligibility, the use of so-called Medicaid planning strategies by the elderly to gain eligibility, and a discussion of competing scenarios for the evolution of these policies in the near future. The analysis finds that the middle-class elderly are both an elusive socioeconomic group and a powerful cultural symbol which simultaneously constrains and supports their inclusion as recipients of Medicaid nursing home coverage."

"Posbindu lansia merupakan pelayanan kesehatan yang bertujuan untuk meningkatkan derajat kesehatan para lansia. Keterampilan kader merupakan salah satu kunci keberhasilan pelayanan di posbindu lansia. Penelitian ini bertujuan untuk menganalisis peran kader dalam pemanfaatan posbindu lansia. Jenis penelitian yaitu deskriptif analitik dengan metode kualitatif. Informan utama adalah 17 orang kader dan informan kunci yang terdiri dari 1 orang Kepala Puskesmas Bantargebang Bekasi, 1 orang Pemegang Program Lansia, dan 3 orang Lansia yang memanfaatkan posbindu lansia di wilayah kerja Puskesmas Bantargebang Bekasi. Hasil penelitian menunjukkan bahwa kader belum berperan besar dalam pemanfaatan posbindu lansia di wilayah kerja Puskesmas Bantargebang sehingga diperlukan adanya upaya pelatihan dan pembinaan untuk petugas kesehatan dan kader posbindu lansia, serta sosialisasi kepada seluruh sasaran posbindu lansia. Penyediaan fasilitas posbindu lansia yang lengkap diharapkan dapat memaksimalkan peran kader dalam usaha pemanfaatan posbindu lansia. Komunikasi sesama kader juga harus dibangun agar mereka dapat bertukar informasi dan pengalaman mengenai peran mereka dalam pemanfaatan posbindu lansia.

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Elderly's integrated health care is health services which aims to improve the health status of the elderly. Skills of cadres is one of the keys to success in elderly's integrated health care. This study aims to analyze the role of cadres in the use elderly's integrated health care. This research is descriptive analytic with qualitative method. The main informants were 17 cadres and key informants consisting of 1 chief of Bantargebang Public Health Care Bekasi, 1 holder of elderly programs, and 3 elderly peoples who utilize elderly's integrated health care in Bantargebang Public Health Care Bekasi working area.

The results showed that the cadres have not played a major role in the utilization of elderly's integrated health care in Bantargebang Public Health Care Bekasi working area thus efforts are required in training and coaching for health workers and cadres elderly's integrated health care, and socialization to all elderly's integrated health care target. Provision of complete elderly's integrated health care facilities is expected to maximize the role of cadres in the utilization of it. Communication fellow cadres should also be constructed so that they can exchange information and experiences regarding their role in the utilization of elderly's integrated health care."

"background: The health status of mothers and children in Indonesia is still need special attention of concern because maternal and infact mortality rates are still high. The low public awareness of health services by trained health worker is a factor to consider in addressing there issue. This study aims to determine the trends in the use of maternal health services in Indonesia in 2001-2007. Methods: This analysis used National Socio _economic Survey (NSES) Core 2001, 2004 and 2007. The design of NSES was descriptive cross sectonal cover all providers in Indonesia as the sample. Result: The study shows taht in seven years period (2001-2007), skilled health providers (doctors and midwives) are commonly reported as the source of antenatal care. The result showed bivariate analysis from type of residence (urban/rural) toward the islands, maternal education, maternal age group, ownership of health insurance, and the sociecomic played a role in the selection of delivery attendant. Recommendation: Developing croos sectoral cooperation to improve people's lives as well improved access to healt sevices in rural areas should be very beneficial to the community."

"Kementerian Kesehatan melaksanakan program peningkatan kinerja sumber dayakesehatan melalui pendidikan dan pelatihan; khususnya pelatihan tenaga pelayanankesehatan tradisional; melalui pelatihan pelayanan akupresur bagi Puskesmas; namunpelayanan akupresur belum berjalan di Puskesmas. Di Kota Jakarta Selatan Puskesmasyang sudah menyelenggarakan pelayanan akupresur hanya dua 2 . Penelitian ini adalahpenelitian kualitatif; dan bertujuan untuk menganalisis kebijakan dan implementasipelaksanaan pelayanan akupresur di Puskesmas serta hambatannya. Informan dalampenelitian berjumlah 11 orang; yaitu Kementerian Kesehatan; Sudinkes Jakarta Selatan;Kepala Puskesmas; Dokter poli; pelaksana program. Metode pengumpulan data melaluiWM dan telaah dokumen. Hasil penelitian dari komponen input sudah berjalan; adanyadukungan Kepala Puskesmas; SOP pelayanan; dan SK penugasan namun belum optimalrotasi staf menjadi salah satu kendala; komponen output dan outcome belum optimal.Aspek komunikasi kejelasan dan konsistensi belum efektif tentang informasi regulasikebijakan yang ada dari penentu kebijakan kepada pelaksana; aspek pembiayaan belumdidukung peraturan daerah; aspek birokrasi masih kurang koordinasi dan sosialisasikebijakan dari Dinas Kesehatan ke Sudinkes dan Puskesmas.

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The Ministry of Health is implementing programs to improve the performance of healthresources through education and training; especially training of traditional health careworkers; through the training of acupressure services for Primary Health Care; butacupressure service has not been run in Primary Health Care. In South Jakarta; PrimaryHealth Care that have been providing acupressure service are only two 2. Thisresearch is a qualitative research; and aims to analyze the policy and implementation ofacupressure service in Primary Health Care and its obstacles. Informants in the studyamounted to 11 people; namely the Ministry of Health; Sudinkes South Jakarta; Head ofPrimary Health Care; Doctor; program implementer. Methods of data collection throughWM and document review.

The result of research of input component have beenrunning; existence of support of Head of Puskesmas; service SOP; and SK ofassignment but not optimal rotation of staff become one of obstacle; component ofoutput and outcome not yet optimally. The communication aspect clarity andconsistency has not been effective about the existing policy regulation informationfrom the policy makers to the implementers; the financing aspect has not been supportedby local regulations; the bureaucratic aspects are still lacking coordination and thepolicy socialization from the Health Service to tribe of health service and PrimaryHealth Care. "

"Akreditasi Puskesmas merupakan upaya peningkatan mutu dan kinerja pelayanan Puskesmas sebagaimana tercantum dalam Permenkes Nomor 46 Tahun 2015. Dari 38 puskesmas di Kabupaten Brebes baru 10 puskesmas yang terakreditasi. Dasar pengajuan roadmap akreditasi puskesmas di Kabupaten Brebes hanya berdasarkan penunjukkan langsung, tanpa mengukur kesiapan puskesmas baik dari segi kelengkapan dokumen, penilaian assessment, serta ketersediaan sumber daya meliputi SDM, dana dan fasilitas sarana prasarana sesuai standar instrumen akreditasi puskesmas. Tujuan penelitian ini adalah mengetahui kesiapan akreditasi puskesmas di Kabupaten Brebes ditinjau dari sisi input, proses dan output berdasarkan variabel sumber daya dan tahapan kesiapan prasurvei akreditasi. Penelitian kualitatif ini proses pengumpulan datanya dilakukan dengan wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa ketersediaan dana, sarana dan prasarana dinilai cukup siap untuk mendukung penilaian akreditasi puskesmas, namun hasil skoring assessment pada keterpemenuhan kompetensi SDM dan kelengkapan dokumen masih rendah. Rekomendasi yang diajukan adalah memenuhi syarat pengembangan kompetensi SDM, dan melengkapi dokumen serta melakukan self assessment secara rutin dan terjadwal.

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Accreditation of public health centers is an effort and performance enhancement public health centers services as listed in the Permenkes 46/2015. From 38 public health centers in Brebes District, just 10 public health centers are accredited. The basis of the filing of a roadmap of accreditation of public health centers in Brebes District only upon appointment directly, without measuring the readiness of public health centers both in terms of completeness, valuation assessment documents, as well as the availability of resources includes human resources, funds and facilities infrastructure standard instrument of accreditation of public health centers.

The purpose of this research is to know accreditation readiness of public health centers in Brebes District reviewed the input, process and output based on variable phase and readiness resources preaccreditation survey. Qualitative research is the process of collecting data using in-depth interviews conducted with the review document.

The results showed that the availability of funds and infrastructure are rated quite ready to support, but the public health centers accreditation assessment skoring assessment results on the fulfillment of human resource competency and the completeness of the documents is still low. A proposed recommendation is a qualified human resource competencies, and complete paperwork and do a self assessment regularly and scheduled."

"ABSTRAKJepang merupakan negara dengan penderita gangguan mental yang tinggi. Penderita gangguan mental di Jepangtercatat sebagai yang tertinggi di antara negara OECD berdasarkan indikator angka ranjang rawat inap. Angkaranjang rawat inap tersebut bisa dijadikan indikator tingginya angka penderita gangguan mental berdasarkanpenanganan terhadap penderita gangguan mental di Jepang yang masih terfokus pada penanganan di dalaminstitusi kesahatan dan bukan penanganan berbasis masyarakat. Masalah kesehatan mental yang semakinberkembang di Jepang tidak diiringi dengan pemahaman masyarakat umum mengenai hal tersebut sehinggamuncul stigma negatif terhadapnya. Tulisan ini mencoba menjelaskan stigma negatif terhadap penderitagangguan mental di Jepang. Corrigan Watson menjelaskan teori stigma yang terdiri dari stereotip, prasangka,dan diskriminasi. Teori tersebut dapat menunjukkan bentuk stigma terhadap penderita gangguan mental. Hasilanalisis menunjukkan bahwa stigma negatif terhadap penderita gangguan mental di Jepang muncul akibatadanya penolakan terhadap perbedaan, minimnya peran keluarga dalam perawatan anggota keluarga penderitagangguan mental dan keinginan keluarga untuk membentuk jarak, serta rendahnya pengetahuan masyarakatmengenai kesehatan mental sehingga menimbulkan banyak asumsi dan membentuk sikap tergeneralisasiterhadap penderita gangguan mental sehingga membentuk jarak sosial.

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ABSTRACTJapan is a country with high number of mental disorder patients. The number of patients with mental disorder inJapan is the highest among OECD countries based on the inpatient bed numbers indicator. The inpatient bednumbers can be used as the indicator to show the high number of mental disorder patient based on the treatment that is still focused on institutionalization of the patients with mental disorder and not by a community-based treatment. The growing problem concerning mental health in Japan is not in accordance to the general public rsquo;s understanding thus creating a negative stigma about it. This paper attempts to explain the negative stigma towards mental disorder patients in Japan. Corrigan Watson describe the theory of stigma that includesstereotype, assumption, and discrimination. This theory can explain the stigma towards mental disorder patients. The result shows that the negative stigma towards mental disorder patients in Japan is caused by rejection towards difference, lack of family involvement to attend family member with mental disorder and desire tomake a distance, and also the lack of general public rsquo;s knowledge about mental health that arouses assumptionand form a generalized attitude towards people with mental disorder so as to form a social distance."