Volume 5, No. July 7, 2024
p ISSN 2723-6927-e ISSN 2723-4339
The Implementation of National Health Insurance Policy in Rural Health Center
Hendi Mulyadi 1, Arif Budy Darmawan 2,
Nani Yulyani 3, Endang
Sutrisno 4*, Ipik Permana 5
Gunung
Jati Swadaya University, Cirebon, West
Java, Indonesia 1*2345
Email : endang.sutrisno@ugj.ac.id
4*, ipikpermana@ugj.ac.id 5
ABSTRACT
Society
will not be separated from health, therefore life in society will not run well
if it is not supported by good health facilities with government support. So the government's efforts to improve health facilities are
by launching National Health Insurance and a national health program. This
research aims to find out more about the implementation of national health
insurance service policies in rural health centers. Meanwhile, the research
method used is qualitative with descriptive analysis, the data collection
method is direct interviews, then in-depth observation and is complemented by
literature study. The subjects were people who took part in the JKN program
whose facilities were at the village health center. The results of the research
are that the implementation of the national health insurance service policy in
the village has not been optimal, so there is still a lot of need to improve
it. The number of human resources in health workers needs to be increased,
facilities are still limited, not all poor people use JKN. Rural health centers
still really need to intensify the socialization of free health, because there
are still many who don't know the information. This can be used as banner media
on strategic roads and supplemented with outreach on the JKN service program to
any remote village.
Keywords : JKN Policy; Service Quality; Rural Health Center; HR gap.
INTRODUCTION
1945
Constitution article 28 H paragraph
(1) that "Everyone has the right live
a prosperous life physically and mentally, located stay, And get environment life Which Good And Healthy
as well as entitled obtain service health" And article 28 H
paragraph (3) which contains "Every person entitled
on guarantee social Which possible
development himself in a way
intact as man Which with dignity (Saputra
et al., 2020) .
The
JKN (National Health Insurance) program is a program that the community has
been waiting for, this program is an idea from the Indonesian government in
providing health services to the community of all classes as a whole. (Pertiwi & Gurning, 2023) .
This program was published in 2014, the contents of this program include basic
services, specialist services, with assistance to the community regarding the
heavy burden of accessing health services (Puspitorini, 2022) .
After the emergence of this program, the burden of spending on obtaining health
services became lighter for the community. The principle of this program is to
help each other, meaning those who are healthy help those who are sick and help
the less fortunate, this program seeks to create comprehensive access to health
for all society (Rumbekwan, 2022) .
Since
the beginning of the government implementing the JKN (BPJS Health) program,
many people have been helped, although the implementation of this program has
not been optimal (Darmawan,
2019) . Implementation of JKN in
Community Health Centers also presents its own challenges, especially in terms
of limited health human resources (Purwaningsih,
2023) . Therefore, the government is
paying intense attention to improving the quality and quantity of health and
services at Community Health Centers through various training programs and the
provision of medical equipment (Pratama
et al., 2020) . Apart from that, an
efficient and effective referral system is also very important to ensure that
patients who need more in-depth care can be quickly transferred to a health
center with better and more complete facilities (Pertiwi
& Gurning, 2023) .
In
this case, the most basic public service policy accepted by the community is
the service carried out by the community health center which is the front guard
in providing health services to the community (Kasenda
et al., 2022; Laksana & Meirinawati, 2023; Pariantini et al., 2023) . Problems that occur in community
health centers in adopting policies to address the
quality of services at community
health centers by creating three
levels of policy problems are as follows, the first
is an easy
problem (well-structured), the
second is a moderate problem (moderately-structured),
and the third
is a serious problem (ill-structured) (Pradana, 2016) . These problems are adjusted according to their level of complexity, meaning how much
the problem requires other parties. A serious problem is a problem where the decision
making is totally intransitive, where the decision at
each moment is not arbitrarily determined by one
party, but rather by means
of discussion by all parties
involved. Meanwhile, easy and moderate
problems have transitive meaning, and these problems
rarely occur in institutions in complex environments (Prihantini, 2015) .
This research is relevant to the
results of research conducted by Rosmawati (2018) explaining that the reality is related to the
implementation of the National Health Insurance Policy (JKN) at the Sigi
District Health Service. Then, as explained by Van Metter and Carl Van Horn,
they describe policies related to the size and direction of the policy,
resources, criteria used, the character of the users, methods of talking
between the organization and the users, as well as the economic, social and
political environment. The research in question has the result that the
implementation of the national health insurance program at the Sigi District
Health Service has not been appropriate and optimal in all aspects, this is due
to the number of resources not being in accordance with needs, and the
characteristics of human resources not being in accordance with needs, as well
as Insufficient health equipment supplies, so that the patient or person
visiting and the existing place and equipment is not balanced. The risk is that
the national health insurance service is not optimal, which is far from what
everyone expects.
So, community health
centers located in rural areas face
their own challenges, especially related to accessibility, far from residential
areas, lack of infrastructure, making it difficult for people to get health
services. In addition, rural health centers often lack medical personnel who
are needed to facilitate the best possible health services, indicating a lack
of utilization of existing facilities at rural health centers. Nevertheless,
rural health centers play an important role in providing basic and preventive
health services to communities in remote areas (Engdila, 2021) .
Referring
to the statement above, the implementation of government policy in
Improving the quality of health services in rural
community health centers must be in line with the expectations of people in
rural areas, different from the quality of community health services in urban
areas. Realizing this, how can the implementation of Health Insurance service policies at rural health
centers be implemented according to community expectations
? Some of the problems that
arise occur in rural health centers,
accessibility is far from residential
areas, lack of information, incomplete infrastructure, lack of human resources
who must apply the same
policy regulations.
METHOD STUDY
The
method used in this research is qualitative, with a descriptive type and data
analysis using qualitative descriptive. According to the opinion expressed by Harahap (2020) ,
qualitative is a deductive type of analysis used in social research, different
from quantitative which uses an inductive analysis model. In qualitative
research, you must be able to develop theory using various methods such as
interviews, observation and documentation. Qualitative can find theories
according to data collection in the field and existing social phenomena.
RESULTS DISCUSSION
Based on observations
at rural health centers regarding the National Health Insurance policy and can be
analyzed with the data obtained, the
implementation of the JKN service policy at rural
health centers has several significant challenges that influence its success.
Based on the results of our research, it shows that although there has been an
increase in community access to basic health services, there are also obstacles
in terms of limited human resources and inadequate infrastructure. Supporting
factors in this implementation include active participation from local
governments and local communities, but the main challenges remain centered on
the availability and equitable distribution of resources.
Implementation of health service policies often faces complex
challenges and requires a deep understanding of existing realities and
dynamics. The following are some common problems that often arise: namely
limited resources such as limited funds, inadequate health facilities, and a
shortage of medical personnel are the main obstacles in providing quality
health services. For example, remote areas often face challenges in providing
adequate access to health services, with long distances and limited access to
transportation being major barriers for residents to access necessary medical
care. That the results of the policy monitoring stage must involve regular data collection to monitor policy
implementation. This includes checking whether the program has been implemented
according to the set schedule, and whether initial achievements are in line
with the set targets. Therefore, the results of policy monitoring observations from the private sector and non-governmental
organizations are also strategies that can be implemented to improve the
quality of health services in rural areas. This
partnership can help overcome state budget and resource constraints and bring
innovation and efficiency to health service delivery. Public service policy
theory supports this collaborative approach and emphasizes the importance of
multistakeholder participation in effective policy development and implementation.
Thus, the combination of benefits for medical personnel, improved health
services and cooperation between various sectors can be a comprehensive
solution to the shortage of medical personnel and improve the quality of health
services in rural areas.
In addition, the
quality of health services can vary significantly from one place to another.
Some Community Health Centers may experience difficulties in meeting
established health service standards, whether due to a lack of adequate
infrastructure, a lack of trained medical personnel, or managerial problems in
managing health facilities.
Leadership and
management aspects also play a crucial role in the success of policy
implementation. The level of commitment and ability of local leaders to manage
and coordinate various health initiatives can influence the overall
effectiveness of policy implementation. Active community participation in
supporting and implementing policies is also important to ensure widespread and
sustainable adoption of proposed health programs. In addition, challenges in
terms of infrastructure such as unstable electricity, inaccessible
transportation, and limitations in information and communication technology
often slow down or even hinder the effective delivery of health services.
Frequent policy
changes or political uncertainty can disrupt the continuity of health policy
implementation in the field. Changes in priorities or policy direction can
create confusion and complicate long-term planning to improve public health. In
facing these various problems, it is important for the government, health
institutions, society and the private sector to work together collaboratively.
A holistic, evidence-based approach and a strong commitment to improving
infrastructure, increasing accessibility, and improving the quality of health
services are the keys to achieving the common goal of improving overall public
health.
Law Number 25 of 2019 concerning Public Services is important for
establishing a strong legal foundation in an effort to improve the quality of
public services in Indonesia, ensuring that services are better, more efficient
and more responsive to community needs. This law also aims to increase public
trust in the government and public institutions in providing services that meet
their expectations and needs. That the results of the
policy evaluation stage of the evaluation process are carried out to evaluate
the impact of the policy on the target population. This evaluation can include
analysis of the effectiveness, efficiency, and social and economic impacts of
the policy. This evaluation helps to assess whether the objectives of the
national health insurance service policy in rural health centers have been
achieved properly. Therefore, the results of policy evaluation observations
must be collaborative between the government, health
institutions, society and the private sector to work together optimally.
Addressing education about JKN in the community requires a
structured and sustainable approach.
The priority is an intensive multi-stakeholder training campaign so that
messages about the
benefits and operational methods of JKN can be communicated effectively.
Regional governments can collaborate with local health centers and village
health cadres to carry out direct activities in villages. Social media can be
used to disseminate information widely and quickly, while posyandu's
direct efforts can provide more detailed and interactive explanations to the
community. Collaboration with them can ensure that the information conveyed is
more easily accepted and understood by the wider community. Apart from
education, it is necessary to simplify the JKN administration system to reduce
complexity and speed up the service process. The development of an integrated
information technology system between Community Health Centers and BPJS Health
can be an effective solution in speeding up the administrative process and
minimizing complicated bureaucracy. An integrated system allows patient data
and health information to be accessed easily and quickly, thus speeding up the
registration process, claims and other services.
To improve service quality, it is also
important to train Puskesmas administrative staff in the effective
use of information
technology and administrative management. With adequate knowledge
and skills, administrators can manage the system
more efficiently, provide faster and more accurate
services, and reduce administrative errors which often
become obstacles in the service process.
Overall, the combination of intensive and continuous
training and simplifying the administration system through information technology can significantly increase public understanding and access to
JKN. These steps are in line with the
political theory of public services
which emphasizes the importance of public education,
administrative efficiency, and the use
of technology in improving the quality
of public services.
It's needed too standardization of health services across all community health centers to eliminate
service inconsistencies. Regional governments
must set minimum service standards that must be met by each community health
center and carry out regular monitoring and evaluation to ensure compliance
with these standards.
Through a comprehensive evaluation of the implementation of JKN
service policies in rural health centers, related parties can identify
strengths, weaknesses and areas that need to be improved to increase the
effectiveness and positive impact of this program for rural communities.
CONCLUSION
In the context
of JKN health services in rural community health centers,
William N Dun's theory highlights the importance of policy legitimacy to be
accepted by local communities and other related parties. Apart from that,
resource mobilization which includes financial aspects, human resources and
health infrastructure is also key in ensuring policies can run well.
Good
arrangements from local governments and effective coordination between various
related institutions (such as BPJS Health, Health Services, and community
health centers) are needed to support efficient
operationalization of policies in the field. Finally, effective policy
operationalization will ensure quality and affordable health services for rural
communities, in line with the objectives of the JKN program.
By adopting an
approach that is in accordance with the above theory, it can be hoped that the
implementation of the JKN service policy in rural health centers
can successfully achieve the stated goals, namely increasing the accessibility,
quality and sustainability of health services for the entire population of
Indonesia, including those in rural areas.
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Copyright Holder: Hendi Mulyadi, Arif Budy
Darmawan, Nani Yulyani, Endang Sutrisno, Ipik Permana (2024) |
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