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"ABSTRAK

Pemerintah Indonesia mereformasi sistem asuransi kesehatan publik untuk masyarakat miskin pada tahun 2008 tetapi di sisi lain Indonesia masih menghadapi masalah kesenjangan akses terhadap pusat kesehatan masyarakat (puskesmas). Penelitian ini menganalisis apakah reformasi sistem asuransi kesehatan publik di tahun 2008 justru meningkatkan   kesenjangan kesehatan masyarakat miskin.   Dengan menggunakan data IFLS dan PODES, penelitian ini menemukan indikasi bahwa setelah reformasi, kesenjangan kesehatan masyarakat miskin meningkat yang ditandai dengan meningkatnya gap kecenderungan untuk melakukan klaim asuransi kesehatan sesuai dengan level kemudahan untuk menjangkau puskesmas. Oleh karena itu, untuk melindungi masyarakat miskin dari pengeluaran katastropik, selain penyediaan asuransi kesehatan, pemerintah juga harus memperhatikan kemudahan menjangkau puskesmas, termasuk meningkatkan kualitas jalan untuk meningkatkan akses terhadap infrastruktur kesehatan.

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ABSTRACT

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Though the Indonesian government reformed its public health insurance system for the poor in 2008, the country still faces challenges with the disparity of accessibility to primary healthcare centres (puskesmas). This study examines whether the 2008 healthcare system reforms increased health inequality of the poor. Using data from the RAND Indonesian Family Life Survey (IFLS) and The Village Potential Statistics (PODES), this study found an indication that, in the aftermath of the reforms, the gap widened in the tendency for the poor to make insurance claims depending on their level of access to healthcare centres. Therefore, to protect the poor from catastrophic out-of-pocket expenditure, besides the provision of public health insurance, the government needs to be concerned about the accessibility of public health care, which includes not only the provision of direct healthcare infrastructure, but also improving road access conditions.

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"Adanya ex ante moral hazard (EAMH) dapat menyebabkan inefisiensi dan mengancam keberlanjutan program asuransi kesehatan yang dikembangkan oleh pemerintah Indonesia. Defisit dana Jaminan Kesehatan Nasional (JKN) dan peningkatan jumlah perokok di Indonesia dapat menjadi indikasi adanya EAMH tersebut. Terdapat beberapa penelitian terkait EAMH, namun simpulannya masih belum konklusif mengenai adanya EAMH sebagai dampak kepemilikan asuransi kesehatan terhadap perilaku merokok individu. Panel Data IFLS gelombang 2, 3, 4, dan 5 digunakan pada penelitian ini sebagai sumber data. Dengan mengombinasikan/menggabungkan metode matching dan Difference-in-Differences (DiD) dalam mengeliminasi berbagai potensi bias, penelitian ini bertujuan untuk memperlihatkan dampak keikutsertaan subsidi asuransi kesehatan terhadap perubahan intensitas merokok penerima program subsidi premi asuransi kesehatan bagi masyarakat miskin dan hampir miskin (Askeskin). Penelitian ini menyimpulkan bahwa secara umum kebijakan Askeskin tidak mengindikasikan adanya EAMH (ex ante moral hazard) dalam konteks perilaku merokok, namun pada subset data menunjukkan adanya indikasi EAMH pada meningkatnya pengeluaran merokok individu miskin perkotaan......The existence of ex ante moral hazard (EAMH) can cause inefficiency and threaten the sustainability of the health insurance program developed by the Indonesian government. The deficit in National Health Insurance (JKN) funds and the increase in the number of smokers in Indonesia can be an indication of the presence of EAMH. There are several studies related to EAMH, but the conclusions are still not conclusive regarding the existence of EAMH as an impact of health insurance ownership on individual smoking behavior. This study will use panel data provided by IFLS wave 2, 3, 4, and 5. By combining the matching and Difference-in-Differences (DiD) methods to eliminate various potential biases, this research aims to reveal the impact of participating in subsidized health insurance on changes in smoking intensity among beneficiaries of a government program that subsidizes health insurance premiums for individuals categorized as poor and near-poor (Askeskin). This research findings suggest that, overall, the Askeskin policy does not suggest the existence of EAMH (ex ante moral hazard) in relation to smoking behavior. Nevertheless, within a specific subset of the data, there are indications of EAMH linked to the rising smoking expenses among poor urban individuals."

"Kesehatan merupakan suatu kebutuhan dasar bagi seluruh manusia, Kesehatan masuk ke dalam The United Nation’s Sustainable Development Goals (SDGs 2017) yang memastikan pada tahun 2030 seluruh masyarakat di dunia telah mendapatkan kesehatan yang layak untuk semua di segala usia. Indonesia sendiri sudah melakukan upaya untuk memberikan pelayanan kesehatan bagi seluruh masyarakat di Indonesia seperti pembangunan fasilitas pelayanan kesehatan, seperti puskesmas. Di Indonesia permasalahan kesehatan masih menjadi permasalahan khususnya di wilayah rural, masih terjadi disparitas terhadap fasilitas kesehatan. salah satu wilayah di indonesia yang di dominasi oleh wilayah rural adalah Kabupaten Sukabumi, dengan kondisi fisik wilayah yang sangat beragam. Faktor penyebab terjadinya disparitas terhadap fasilitas kesehatan adalah ketimpangan tenaga medis dengan jumlah penduduk, jangkauan pelayanan puskesmas dan aksesibilitas. Sehingga dalam penelitian ini ingin mengetahui bagaimana jangkauan pelayanan puskesmas dan aksesibilitas masyarakat di Kabupaten Sukabumi untuk mendapatkan pelayanan kesehatan serta mencari tahu faktor yang menyebabkan perbedaan aksesibilitas permukiman terhadap puskesmas. untuk mengetahui jangkauan pelayanan puskesmas, dibuat klasifikasi dahulu untuk yang lebih dari >5 km dianggap di luar jangkauan ideal, selanjutnya memanfaatkan Network Analysis memanfaatkan tool service area, didapatkan bahwa masih banyak permukiman yang berada di luar jangkauan ideal. Sedangkan untuk aksesibilitas permukiman, memanfaatkan metode enhanced two-step floating catchment area yang mana pada perhitungannya menghasilkan indeks aksesibilitas, hasilnya aksesibilitas sangat beragam, dan perbedaan dari sebaran nilai aksesibilitas di setiap Kecamatan banyak dipengaruhi oleh faktor seperti ketersediaan jaringan jalan, kondisi fisik wilayah, serta rasio tenaga kesehatan yang berbeda-beda pada setiap Kecamatannya.

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Health is a basic need for all human beings, Health is included in The United Nation's Sustainable Development Goals (SDGs 2017) which ensures that by 2030 all people in the world have received decent health for all at all ages. Indonesia itself has made efforts to provide health services for all people in Indonesia, such as the construction of health service facilities, such as health centers. In Indonesia, health problems are still a problem, especially in rural areas, there are still disparities in health facilities. One of the areas in Indonesia that is dominated by rural areas is Sukabumi Regency, with very diverse physical conditions. Factors that cause disparity in health facilities are the gap between medical personnel and population, reach of puskesmas services area and accessibility. So, in this study, we want to find out how the puskesmas services area and community accessibility in Sukabumi Regency to get health services and find out the factors that cause differences in the accessibility of settlements to puskesmas. To find out the reach of puskesmas services, a classification was made first for those more than > 5 km considered outside the ideal range, then using Network Analysis using the service area tool, it was found that there were still many settlements that were outside the ideal range. As for the accessibility of settlements, utilizing the enhanced two-step floating catchment area method which in its calculation produces an accessibility index, the results of accessibility are very diverse, and the difference in the distribution of accessibility values ​​in each sub-district is much influenced by factors such as the availability of the road network, the physical condition of the area, and different ratios of health workers in each sub-district. "

"Pasien kanker membutuhkan perawatan paliatif untuk menangani gejala dan meningkatkan kualitas hidupnya. Pasien seharusnya dirujuk kembali ke layanan primer untuk mendapatkan perawatan paliatif. Di Indonesia, rujuk balik kasus kanker belum berjalan dengan baik, karena dalam cakupan program rujuk balik BPJS, kanker belum termasuk didalamnya. Penelitian bertujuan untuk menilai situasi terkini terkait rujuk balik kanker di Indonesia dan menganalisis kesenjangan yang ada. Penelitian merupakan studi deskriptif analisis kuantitatif dan kualitatif. Data kuantitatif didapatkan dari kuesioner yang disebarkan secara daring ke 1209 Puskesmas di Indonesia. Data kualitatif didapatkan berdasarkan hasil wawancara mendalam dan diskusi kelompok terarah. Didapatkan 1124 puskesmas yang mengisi kuesioner, 82.4% puskesmas yang mendapatkan rujukan balik kasus paliatif dari Rumah Sakit, dengan hanya 25.7% diantaranya mendapatkan rujuk balik paliatif kasus kanker. Berdasarkan data kualitatif dari wawancara dan diskusi kelompok terarah didapatkan faktor yang mempengaruhi kesenjangan implementasi pelaksanaan rujuk balik paliatif kanker di Indonesia, yaitu faktor regulasi, pembiayaan, kompetensi, akses, komunikasi, pengetahuan pasien, integrasi layanan kesehatan, dan kolaborasi rumah sakit dengan puskesmas serta kerjasama lintas sektor. Implementasi rujuk balik kanker di Puskesmas Indonesia saat ini belum berjalan dengan baik. Banyak faktor yang mempengaruhi implementasi rujuk balik kanker. Dibutuhkan upaya mulai dari pemangku kebijakan hingga pelaksana untuk meningkatkan implementasi rujuk balik kanker.

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Cancer patients need palliative care to manage their symptoms and improve their quality of life. Patients should be referred back to primary care for palliative care. In Indonesia, cancer referral has not gone well, because in the scope of the BPJS referral program, cancer is not included. This research aims to assess the current situation regarding cancer referral back in Indonesia and analyze the existing gaps. This research is a descriptive study of quantitative and qualitative analysis. Quantitative data was obtained from questionnaires distributed online to 1209 Community Health Centers (CHC) in Indonesia. Qualitative data was obtained based on the results of in-depth interviews and focus group discussions. There were 1124 CHC that filled out the questionnaire, 82.4% received palliative case referrals from the hospital, and only 25.7% of them received palliative cancer case referrals. Based on qualitative data from interviews and focus group discussions, it was found that the factors influencing the gap in the implementation of cancer palliative referral back in Indonesia were regulation, financing, competency, access, communication, patient knowledge, integration of health services, and collaboration between hospitals and CHC as well as multisectoral cooperation. The implementation of cancer referral at the Indonesian CHC is currently not going well. Many factors influence the implementation of cancer back referral. Efforts from policy makers to health workers are needed to improve the implementation of cancer referral."

"Penelitian ini membahas mengenai pengaturan pengenaan sanksi tidak mendapatkan pelayanan publik atas pemenuhan kewajiban dalam Program Jaminan Kesehatan Nasional (Program JKN). Melalui Program JKN, negara memenuhi hak masayarakat atas kesehatan serta memberikan perlindungan dari risiko finansial yang timbul akibat gangguan kesehatan. Untuk memastikan keberlangsungan Program JKN perlu dilakukan upaya peningkatan cakupan universal health coverange (UHC). Salah satunya melalui pengenaan sanksi tidak mendapatkan pelayanan publik. Permasalahan yang dibahas dalam penelitian ini adalah bagaimana pengaturan jaminan sosial kesehatan di Jepang dan Korea Selatan dapat mendorong capaian UHC dan bagaimana pengaturan Program JKN dapat meningkatkan capaian UHC di Indonesia. Penelitian ini merupakan penelitian hukum yuridis normatif dengan tipologi penelitian problem indentification. Analisa dilakukan terhadap pengaturan Program JKN untuk meningkatkan capaian UHC yang dititikberatkan pada pengaturan pengenaan sanksi tidak mendapatkan pelayanan publik tertentu dalam Program JKN. Selain itu dilakukan studi perbandingan pengaturan sistem jaminan sosial di Jepang dan Korea Selatan dalam mendorong peningkatan capaian UHC. Hasil penelitian menunjukkan bahwa meskipun terdapat perbedaan penerapan sanksi tidak mendapatkan pelayanan publik dalam penyelenggaraan jaminan sosial kesehatan di Jepang dan Korea Selatan, kedua negara telah berhasil mencapai UHC. Faktor sejarah perkembangan asuransi kesehatan sosial dan budaya yang didukung dengan sistem administrasi kependudukan yang stabil berpengaruh pada pencapaian UHC kedua negara. Berbeda dengan Indonesia, meskipun Pemerintah telah menyediakan sistem jaminan sosial kesehatan melalui Program JKN, namun tingkat literasi dan budaya masyarakat dalam berasuransi menjadi penghambat pencapaian cakupan kepesertaan Program JKN. Oleh karenanya, sanksi tidak mendapat pelayanan publik masih diperlukan dalam upaya mencapai cakupan UHC Program JKN.

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This study discusses the regulation of the imposition of sanctions of not getting public services for unfulfilling obligations in the National Health Insurance Program (JKN). Through the JKN, the state fulfills the people's right to health and provides protection from financial risks due to health problems. To ensure the sustainability of the JKN, universal health coverage (UHC) are needed to be achive. One of them is through the imposition of sanctions of not getting certain public services. The problems discussed in this research are how the national health insurance’s regulation in Japan and South Korea can support the achievement of UHC and how the regulation of the JKN can improve UHC in Indonesia. This research is a normative juridical law research with a typology of problem identification research. The analysis was carried out on the JKN’s regulation to improve UHC achivement, which focused on the regulation of the enforcement of publics service restriction as an administrative sanction. In addition, a comparative study of the social security system in Japan and South Korea was conducted in encouraging the improvement of UHC achievement. The results show that although there are differences in the application of sanctions of publics service restriction in the implementation of national health insurance in Japan and South Korea, both countries have succeeded in achieving UHC. The historical factor, the development of national health insurance and the culture which is also supported by the resident registration system are the crusial factor of the achievement of UHC in both countries. In contrast to Indonesia, although the Government has provided a social security system through the JKN, the literacy level of insurance and culture of the community are obstacles to the implementation of the JKN. Therefore, the enforcement of publics service restriction as an administrative sanction is still needed to reach the UHC of JKN."

"Studi ini menganalisis pengaruh dari perlindungan asuransi kesehatan terhadap pengurangan kematian bayi di Indonesia. Untuk mengestimasi pengaruh asuransi kesehatan terhadap kematian bayi di Indonesia, studi ini menggunakan data yang berupa data panel dan menggunakan survey berkelanjutan keluarga Indonesia pada tahun 2000 dan tahun 2007. Model yang digunakan adalah model logit yang bersyarat untuk menangkap karakteristik yang tidak teramati. Hasil estimasi memperlihatkan bahwa pengenalan asuransi kesehatan di Indonesia mempunyai pengaruh yang signifikan dalam mengurangi kematian bayi.

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This study analyzes the effect of health insurance coverage on infant mortality reduction in Indonesia. To estimate the impact of health insurance coverage on infant mortality reduction in Indonesia, this study utilizes balanced panel data and uses Indonesia Family Longitudinal Survey (IFLS) in year 2000 and 2007. This study uses the conditional logit model to capture unobserved characteristics. The result shows that the introduction of health insurance in Indonesia significantly reduces the probability of infant mortality."

"Skripsi ini membahas mengenai sistem informasi Jamkesmas mulai dari pencatatan hingga pelaporan di Puskesmas Seroja Kota Bekasi. Analisis menggunakan prosedur penilaian cepat dalam pengumpulan data primer, serta pendekatan sistem dan metode prototype. Hasil analisis memberikan informasi akurat tentang data kepesertaan, pelayanan, dan pendanaan berdasarkan indikator program Jamkesmas yang berlaku melalui sistem basis data. Hal ini dikarenakan data rutin yang berperan sebagai tolak ukur keakurasian data belum terkelola dengan baik. Pendokumentasian data harian hanya sebatas pencatatan diatas kertas saja sehingga data belum bisa diintegrasikan satu sama lain. Akibatnya data Jamkesmas yang ada belum dimanfaatkan secara optimal.

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This thesis describe about Information System of Health Insurance for the Poor (Jamkesmas), start from data collecting until produce a report at Seroja Health Centre Bekasi City. The Analysis using Rapid Asessment Procedure in main data collecting, also system approaching and Prototyping Method. Result of analysis gives accurate information about participant data, service, and financing based on indicator Jamkesmas program applied through data base system. This thing is because of routine data standing as accuration yardstick of data has not been managed carefully. Documentation of daily data only limited to recordkeeping to just paper so that data has not can be integrated one another. As a result the Jamkesmas data has not been exploited in an optimal perform."

"Penelitian ini membahas mengenai aspek behavioral finance utamanya pengaruh yang ditimbulkan oleh usia dan jenis kelamin terhadap preferensi risiko investor di Indonesia. Lebih lanjut, penelitian ini juga membahas mengenai pengaruh preferensi risiko terhadap pemilihan investasi saham berbasis dividen saat telah berlakunya fasilitas pembebasan pajak atas dividen pada level investor di Indonesia serta efek moderasi awareness investor dari fasilitas pembebasan pajak tersebut. Dengan menggunakan data dari 321 responden, didapatkan hasil atas pengaruh usia terhadap preferensi risiko yang bervariasi namun, condong semakin bertambah usia investor semakin tinggi pula preferensi risikonya. Hal ini bertolak belakang dengan stigma dan kebanyakan hasil penelitian sebelumnya. Untuk jenis kelamin ditemukan laki-laki memiliki preferensi risiko lebih tinggi daripada perempuan. Sementara itu, orang dengan preferensi risiko tinggi akan tetap cenderung memilih saham yang menghasilkan dividen karena memperlakukan dividen sebagai short-term return dan awareness akan fasilitas pembebasan pajak atas dividen tersebut menguatkan hubungan preferensi risiko terhadap pemilihan investasi saham berbasis dividen karena mampu memberikan insentif tersendiri.

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This research discusses aspects of behavioral finance, especially the influence that age and gender have on investors' risk preferences in Indonesia. Furthermore, this research also discusses the influence of risk preferences on the choice of dividend-based stock investment when the tax exemption facility for dividends has been implemented at the investor level in Indonesia as well as the moderating effect of investor awareness of this tax exemption facility. Using data from 321 respondents, results were obtained regarding the influence of age on risk preferences which varied, however, the older an investor tends to be, the higher their risk preferences. This is contrary to stigma and most previous research results. For gender, it was found that men had a higher risk preference than women. Meanwhile, people with high-risk preferences will still tend to choose shares that produce dividends because they treat dividends as short-term returns and awareness of the tax exemption facility for dividends strengthens the relationship between risk preferences and the choice of dividend-based stock investments because they are able to provide their own incentives."

"Tesis ini menganalisis pemanfaatan layanan rawat jalan dan rawat inap di Puskesmas, rumah sakit umum/pemerintah, dan rumah sakit swasta untuk responden yang memiliki kartu Askeskin dan tidak memiliki kartu Askeskin. Selain itu, juga akan diperhatikan perbedaan periode sebelum dan setelah adanya program Askeskin, sehingga akan terlihat dampak program Asuransi Kesehatan Masyarakat Miskin (Askeskin) terhadap pemanfaatan layanan rawat jalan dan rawat inap. Permasalahan dianalisis dengan menggunakan dua metode analisis. Pertama, statistik deskriptif untuk menggambarkan kepemilikan kartu Askeskin dan pengguna kartu Askeskin untuk pemanfaatan pelayanan rawat jalan dan rawat inap. Pada tahap ini, pembagian dan penamaan kelompok responden terbatas pada kriteria pengelompokan data yang digunakan dalam penelitian ini dan tidak bisa dikaitkan dengan kriteria yang dikenal dalam konsep kemiskinan Indonesia. Metode kedua menggunakan analisis regresi logistik untuk menjelaskan probabilitas responden (yang memiliki maupun yang tidak memiliki kartu Askeskin) dalam memanfaatkan layanan rawat jalan dan rawat inap dengan berbagai variabel penjelas. Hasil analisis menunjukkan bahwa program Askeskin mampu mendorong pemanfaatan layanan rawat jalan di Puskesmas. Kepemilikan kartu Askeskin juga merupakan faktor dominan dengan peluang terbesar ketika responden memutuskan akan memanfaatkan layanan rawat jalan di Puskesmas. Sedangkan faktor ekonomi, yaitu penggunaan listrik dalam rumah tangga merupakan faktor dominan dengan peluang terbesar ketika responden memutuskan untuk memanfaatkan layanan rawat jalan dan rawat inap di rumah sakit umum/ pemerintah, ketika akan memanfaatkan layanan rawat jalan dan rawat inap di rumah sakit swasta, dan ketika akan memanfaatkan layanan rawat jalan anak di Puskesmas.

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This thesis analyzes the utilization of outpatient and hospitalization service at health centers, public/government hospitals, and private hospitals to respondents who have Askeskin cards and those who do not have Askeskin cards. In addition, it also consider the period of implementation before and after Askeskin program to find out the impact of Askeskin program on the utilization of outpatient and hospitalization service. The problem is analyzed by using two analysis methods.

First method is descriptive statistics to describe the Askeskin card holder and Askeskin card user to the services. At this stage, the division and naming the group of respondents is limited to criteria of data grouping used in this study and could not be attributed to the known criteria in the concept of poverty in Indonesia.

The second method is logistic regression analysis to explain the probability of respondents (the Askeskin card holder and non card holder) in utilizing the facilities of outpatient and hospitalization services with various explanatory variables.

The analysis shows that the Askeskin program can improve the use of outpatient services at the health center. It also shows that the ownership of Askeskin card is a dominant factor with the greatest probabilities. While economic factors, namely electricity usage in the household, is the dominant factor with the greatest probabilities when respondents decided to use outpatient and hospitalization services in public/government hospitals, and private hospital, and when they use outpatient services at the child health center."

"The distribution and allocation of basic health service to poor society were determined as according to amount of poor society existing in puskesmas. The determination followed with rule type of health service without expense per service causing difficulty mounted in puskesmas to determine distribution the expense of per service such as those which as described in Minister of Health Regulation. More than anything else with there is no accurate data in this level of expense set of the the service also complicate to give the service to determine proportion of expense which must be released as according to service which have been given, that answering the demand, insuffiency, or excessive.This research is calculation the expense of primary health care, hospital health care and the health service outside building to poor society in Puskesmas Air Ram Pangkalpinang in 2005 that is to know distribute expense for the basic health service to poor society of health service in society, take care of hospitality and also the health service of outside building.This research is quantitative research by desain in economic evaluation with calculation cost analysis basic health service in 2005 collected from poor society health service data in region work Puskesmas Air Itam Itam Pangkalpinang and from data record of Puskesmas Air Itam, and also the related/relevant data from Public Health Service of Pangkalpinang processed by using Activity-Based Costing with spread sheet program.The result of this research is distribution of the expense the basic health service to poor society in Pangkalpinang with total cost required is equal to Rp. 40.333.820,49 totally budget of equal to Rp. 35.819.000,00 so that there are insuffiency of equal to Rp. 4.514.820,49.Needing the existence calculation of the expense service for all service type, good service which accounted by government routine service, existence of cost standard per service to be able to estimate requirement of the expense of health service in puskesmas and also need the existence of research which of a kind other puskesmas as data comparator and expense of which have been counted/calculated."