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COMPARISON OF HEALTH SERVICES UTILIZATION

BY NATIONAL HEALTH INSURANCE
IN THE HEALTH DISTRICT SLEMAN, PROVINCE D.I. YOGYAKARTA
COMPARED TO
IN THE HEALTH DISTRICT SOUTH HALMAHERA,
NORTH MALUKU PROVINCE
YEAR OF 2014

Thesis Summary

Health Financing Policy and Health Insurance Management

Postgraduate Study of Public Health

Writen by :
CAHYA SUSETYA
NIM : 11/323620/PKU/12474

To
POSTGRADUATE PROGRAM
FACULTY OF MEDICINE
GADJAH MADA UNIVERSITY
YOGYAKARTA
2016

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COMPARISON OF HEALTH SERVICES UTILIZATION

BY NATIONAL HEALTH INSURANCE
IN THE HEALTH DISTRICT SLEMAN, PROVINCE D.I. YOGYAKARTA
COMPARED TO
IN THE HEALTH DISTRICT SOUTH HALMAHERA,
NORTH MALUKU PROVINCE
YEAR OF 2014
1
Susetya, C. , Pramono, D.2, Kusnanto, H.3
ABSTRACT
tar Belakang: Alokasi anggaran jamkesda Kota Cirebon selalu turun

Background: The National Health Insurance has started and has the objective to
facilitate access to health services in Indonesia. Conditions are very different each
area can affect the utilization of health services among districts/municipalities in
Indonesia. Based on this research must be done to determine the actual utilization
and costs of health services between Sleman Regency of South Halmahera where
Sleman estimated to have better access than South Halmahera.
Objective: This study aimed to determine differences in utilization and the actual
cost of health care clinics in Sleman than in South Halmahera.
Methods: The study used secondary data of health services at the health center
with cross sectional design. The data is then processed in the form of tabulation
and statistical Mann Whitney U Test was done using MINITAB Trial Version 17
to determine differences in utilization and the actual cost of health care.
Results: Sleman has a geography that is more accessible to participants JKN and
health human resources are owned by more than a health center in the district of
South Halmahera. Health care utilization ratio in Sleman higher than in South
Halmahera District and the actual cost of health care in Sleman lower than in
South Halmahera. There is a significant difference between utilization ratio and
the actual cost of health care centers in Sleman than in South Halmahera.
Conclusions and Recommendations: Participants JKN in Sleman have access to
health services is higher than in South Halmahera. Therefore, the government is
expected to undertake concrete efforts to improve access to health services,
especially in South Halmahera District and the entire area has low access to health
services.
Keywords: National Health Insurance, Health Services, Equity
1. Health Insurance & Finance Management, Postgraduate Study of Public Health, Faculty of
Medicine, Universitas Gadjah Mada.
2. Public Health Departement, Faculty of Dentistry, Universitas Gadjah Mada.
3. Public Health Departement, Faculty of Medicine, Universitas Gadjah Mada.

INTRODUCTION
Health Insurance aims to provide certainty basic protection to Indonesian citizens.
Health insurance is organized by the social insurance principle and the principle of
equity. BPJS give assurance that the social insurance system being run has had the
providers that the Social Security Agency of Health (BPJS). One of the tasks BPJS is
financed health services that have been performed by the health facility to the
participants in accordance with the provisions of the program as health insurance.
Health facilities can cooperate with BPJS is a health center (Puskesmas). Puskesmas as
FKTP which has cooperated with BPJS paid by the capitation system.1
The membership of the National Health Insurance (JKN) is mandatory that requires
all residents participated in JKN (universal coverage), which is implemented in stages.
Efforts to achieve a comprehensive participation (universal coverage) required an
analysis of the number, development, distribution and characteristics of the population
of Indonesia as a whole. The total area of Indonesia and the low population density in
certain areas cause problems even distribution of health facilities to serve the
participants JKN. In areas with small population, the number of health facilities so that
residents are also slightly more difficult to access services kesehatan.1
JKN purpose is to facilitate the public to obtain quality health services. Inequality
availability of health facilities, health workers and geographical conditions may result
ininequities between regions in Indonesia. Utilization of first-level health facilities in
the city of Bengkulu, Seluma and Kaur District still low compared to the Special
Province Yogyakarta. Utilization of referral health facilities remains low in Bengkulu
province of Yogyakarta Province. Still low utilization of first-level health facilities and
referral injustice affect access to services BPJS participants because of the availability
of service facilities is not enough.2
This study chose Sleman and South Halmahera District because they represent very
different conditions between districts/municipalities in Indonesia. Sleman has an area
that is narrower and there is no ocean while South Halmahera District has an area wider
and largely consists of the oceans so that easier access to health services in Sleman than
in South Halmahera. Means of transport is the dominant factor affecting the utilization
of health services. The total population and population density also shows that the

Sleman district has a population of greater and greater density, it makes access easier in
Sleman compared to South Halmahera.

METHODS
This type of research is an analytic study. The study design was cross-sectional. The
research data is taken from quantitative data. This research was conducted in Sleman
District Health Office and South Halmahera District Health Office. Research was
conducted for 2 months which in October and November 2015.
The subject of this study is all of Sleman District Health Center and South
Halmahera Health Center. The data is taken from secondary data from the Department
of Health in Sleman and South Halmahera. Instruments in this study is the tabulation of
data. Data collection is done by making the data available health care in Sleman District
Health Office and South Halmahera District Health Office. Data analysis was performed
by presenting data in tables and statistical test free comparison that Mann Whitney U
Test using MINITAB Trial Version 17. The analysis is conducted to determine
differences in health care utilization and actual cost among health centers in Sleman
compared with health center in South Halmahera.

RESULTS
1. Regional Characteristics
a. Geographically, Sleman the mainland districts because the whole district
consists of the mainland. All health centers in Sleman is a health center with
the usual criteria. All health centers in Sleman can be accessed by participants
JKN through the land.
b. Geographically, South Halmahera islands including the district because the
area is dominated by oceans. Settlements in South Halmahera District almost
all located in coastal areas. Therefore, the most important transportation once
commonly used are the boats and the public. Health centers in South
Halmahera District there are health centers with the usual criteria, remote and
isolated. South Halmahera District including disadvantaged areas.

2. Human Resources Health

All health centers in Sleman has a number of general practitioners more than
two people, while in South Halmahera District seventeen percent of general
practitioners who have more than two people. Health centers in Sleman there are
eight percent who do not have a dentist, while health centers in South Halmahera
District as much as 87 percent who do not have a dentist.
3. Utilization of Health Services Health Center
There is a difference between PHC utilization ratio compared Sleman South
Halmahera. Sleman utilization ratio is higher than the ratio of utilization of
South Halmahera. There is a significant difference (p <0.05) utilization ratio
between health centers in Sleman than in South Halmahera District Health
Center.
4. Actual Cost Health Care
The actual costs in Sleman district health center is smaller than the actual costs
in South Halmahera District Health Center. There is a significant difference (p
<0.05) actual cost between health centers in Sleman in comparison with clinics
in South Halmahera.

DISCUSSION

Based on this research indicates that the South Halmahera District as an area with a
geography that consists of the ocean and has a large area when compared to Sleman so
South Halmahera District has health care utilization lower than Sleman. Means of
transport is the dominant factor affecting society in accessing health services.3
The most important factor of geography is the time necessary to the health facility
so that the condition relating to the geographical distance of residence to health care,
transportation, road infrastructure, climate and natural conditions. Distance and time
have a significant impact on the health utilization.4 Means of transport services relating
to the utilization of health services where limiting factor especially poor people can not
come to health facilities due to difficult transportation and costs to be incurred.5
The proximity distance or speed of travel time between the residential community to
the location of health facilities significant effect on the provision of health services.
Citizens residing in villages close to the location of health facilities, have a higher level

of access to health services than citizens who live in villages far to the location of health
facilities. Similarly, citizens residing in villages who quickly reach the health facilities,
have a higher level of access to health services than citizens who live in villages are
slow to reach the health facility.6
Based on this research indicates that the South Halmahera District as an area with a
number of health human resources that bit has a low utilization of health services. The
number of doctors who make fewer queue becomes long. It also keeps the doctor is
difficult to find because of the amount of rare that people have to travel a distance that
jauh.7 distances to reach a doctor making costs incurred in traveling to be expensive so
that people choose a doctor who is closer or treat yourself.8 Distances distant and
expensive transportation costs greatly influence the election by the public health
facilities, although health insurance can increase the likelihood of communities in
reaching the health.9 Small number of doctors and dentists can reduce the benefit
package provided by the Health BPJS thus hindering the public in obtaining health
services.2

CONCLUSION AND RECOMMENDATIONS

South Halmahera District as an area with difficult geographic conditions have a low
utilization of health services so that access to healthcare is difficult. Instead Sleman as a
region with a convenient geographic conditions have a higher utilization of health
services so that access to health care is easily done. South Halmahera District has a
number of health human resources that bit has a low utilization of health services so that
access to healthcare is difficult. Instead Sleman health human resources that many have
high utilization of health services so that access to health care is easily done.
The government is expected to do business even distribution of health services,
develop means of transport to facilitate access to health, and gave dissemination to the
public in order to take advantage of the ownership of health insurance, especially in
areas with difficult geographical conditions. BPJS apply compensation in areas with
difficult geographical conditions in which compensation has been governed by the
applicable regulations.

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