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Aksesibilitas Pelayanan Kesehatan di Indonesia

Authors:
  • National Research and Innovation Agency Republic of Indonesia (Badan Riset dan Inovasi Nasional)
  • The National Agency for Research and Innovation of The Republic of Indonesia

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Buku ini mencoba menelisik kesenjangan yang terjadi antara wilayah kabupaten dengan kota, dan antara wilayah miskin dan non miskin pada semua pelayanan kesehatan yang tersedia, baik tenaga maupun fasilitas pelayanan kesehatan. Hasilnya menunjukkan bahwa memang pada hampir semua kategori kesenjangan tersebut tengah terjadi. Kesenjangan tidak terjadi hanya pada sisi supply antara daerah miskin dan non miskin saja. Secara studi kasus, buku ini juga mengupas secara detail tentang aksesibilitas di Kabupaten Gresik dan Kabupaten Maluku Tenggara Barat. Sisi supply, barrier maupun demand, dibahas dengan melibatkan data laporan rutin, data survei Riskesdas dan Rifaskes serta pandangan dari para policy maker di tingkat kabupaten maupun dari para pelaku lapangan secara langsung.
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... Access to services in various areas and population groups is an unresolved issue [1][2][3]. Access area in the island is one of them [1,4]. Health services is closely related to access to health services. ...
... Access to services in various areas and population groups is an unresolved issue [1][2][3]. Access area in the island is one of them [1,4]. Health services is closely related to access to health services. ...
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The health services disparities is still felt by the community, especially those living in the archipelago where the situation and condition of availability and quality of health human resources are low. This study aims to explore public health services in the era of national health insurance in Satangnga Tanakeke, Takalar District, Indonesia. This research was conducted in the Maccini Baji Village of Satangnga Island, Mappakasunggu Sub-District, Takalar District. This research was a qualitative research with case study approach. There were 19 informants which consist of village secretary, village office staff, head of community health centers, head of community health sub-centers, midwife, community leader, pregnant mother and people who are using or have used health services. The selection of informants was done by purposive sampling. The results showed that the accessibility of public health services in Satangnga Island was concentrated in community health sub-centers, this was due to geographical access, the time and cost of transportation to health services access, such as community health centers and hospitals to be the main obstacle. Facilities and infrastructure in the health facility on the Satangnga Island were still felt inadequate and need government attention. Cultural and community financial condition did not affect the health services utilization.
... Bantuan sosial, atau yang kerap disebut juga sebagai bantuan publik, dapat berbentuk tunjangan uang, barang atau pelayanan sosial tanpa memperhatikan kontribusi atau premi dari penerima. Sedangkan asuransi sosial adalah jaminan yang hanya diberikan kepada para peserta sesuai dengan kontribusinya, yakni premi atau tabungan yang dibayarkan (Muchtar 2014, Laksono 2016. ...
... Dengan menggunakan analisis Aksesibilitas (Suharto 2013, Laksono 2016, Putri & Noer 2020, dapat dilihat bagaimana akses terhadap jaminan terhadap perempuan pemulung kepala keluarga. Pendekatan ini berfokus pada konsep kesesuaian antara kebutuhan pasien dan kemampuan sistem dalam memenuhi kebutuhan tersebut, antara lain: (1) ketersediaan, jumlah tenaga dokter dan pelayanan kesehatan lainnya, (2) aksesibilitas, kaitan secara geografis antara provider pelayanan dengan masyarakat sebagai pengguna, (3) akomodasi, sistem pelayanan kesehatan yang berkaitan dengan kemudahan pemanfaatan, (4) keterjangkauan, kemampuan finansial masyarakat untuk memanfaatkan pelayanan, dan (5) akseptabilitas, direpresentasikan dengan sikap pengguna terhadap pelayanan, dan sebaliknya. ...
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This paper focuses on the lives of women scavengers heads of households and how the state guarantees the fulfillment of the right to health. Women are relatively more vulnerable to various risks related to their life cycle and role in the family; thus, their access to health insurance is an obligation that must be met by the government. This paper has two objectives: to map social life and, at the same time, analyze the accessibility of the Healthy Indonesia National Health Insurance Card for female head of household scavengers in TPA Cipayung, Depok City. Using qualitative methods, and focusing on five dimensions of accessibility: availability, accessibility, accommodation, affordability, and acceptance, this study found that all health insurance arrangements are still very problematic. Even though these women scavengers are protected by JKN-KIS PBI, in reality, they are still challenging to get access to health services, ranging from the availability of doctors, the scarcity of drugs, to the discrimination of health services. This shows that they have not yet received full health insurance, which has a direct impact on the social and economic lives of the scavengers.
... Fakta empiris memang menunjukkan topografi Pegunungan Tengah yang ektrem, yang didominasi oleh wilayah yang masih belum tersentuh pembangunan, termasuk akses jalan yang masih minim (Ariwinanti et al., 2020;Laksono, Dewi and Wulandari, 2020;Wardoyo et al., 2020). Beberapa studi sebelumnya menginformasikan bahwa fasilitas pelayanan kesehatan, baik Puskesmas maupun Rumah Sakit, seringkali ditemukan kurang atau tidak tersedia pada wilayah-wilayah dengan akses fisik yang terbatas (Laksono et al., 2016;Soewondo et al., 2019;Laksono andWulandari, 2020, 2021). Laporan Survei Kesehatan Daerah Papua tahun 2006 menunjukkan bahwa barier geografis di daerah p e g u n u n g a n P a p u a m e m p e n g a r u h i l a j u pembangunan kesehatan di Tanah Papua, baik dalam aspek infrastruktur, sumber daya kesehatan, dan akses masyarakat terhadap layanan kesehatan (Dinas Kesehatan Provinsi Papua, 2006). ...
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Kesehatan ibu dan anak merupakan salah satu faktor yang mengindikasikan status kesehatan masyarakat di suatu wilayah. Studi ditujukan untuk menganalisis hubungan antara input tenaga bidan dan dokter pada kinerja pelayanan kesehatan ibu dan anak di Pulau Papua. Studi dilakukan dengan pendekatan analisis ekologi. Populasi studi adalah seluruh kabupaten/kota di Pulau Papua (42 kabupaten/kota). Selain input tenaga bidan dan tenaga dokter sebagai variabel independen, studi ini menganalisis K4, persalinan di fasilitas pelayanan kesehatan, dan KN1, sebagai variabel dependen. Analisis memanfaatkan scatter plot dengan garis fit linier sebagai penentu. Hasil studi menunjukkan variasi yang sangat tinggi antar kabupaten/kota, baik pada variabel input tenaga maupun pada kinerja kesehatan ibu dan anak. Secara spasial input tenaga bidan dan dokter yang paling rendah cenderung di wilayah Pegunungan Tengah. Semakin tinggi input tenaga bidan maupun tenaga dokter, semakin tinggi pula kinerja K4 di kabupaten/kota tersebut. Semakin tinggi input tenaga bidan maupun tenaga dokter, maka semakin tinggi pula kinerja persalinan di fasilitas pelayanan kesehatan di wilayah tersebut. Semakin tinggi input tenaga bidan maupun tenaga dokter, maka semakin tinggi pula kinerja KN1 di area tersebut. Lebih lanjut, input tenaga bidan memiliki efek yang lebih bermakna dibanding input tenaga dokter untuk seluruh kinerja kesehatan ibu dan anak. Studi menyimpulkan bahwa rentang input tenaga bidan dan dokter di Pulau Papua sangat lebar. Input tenaga bidan dan tenaga dokter berhubungan secara positif dengan kinerja pelayanan kesehatan ibu dan anak di Pulau Papua. K4 merupakan faktor yang paling kurang dilakukan, baik oleh tenaga bidan maupun tenaga dokter.
... Disparities as a result of this development also have an impact on the accessibility of health-care facilities. Regions with good economic movements tend to have good accessibility to health-care facilities [1]. For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy-makers [2]. ...
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BACKGROUND: The utilization of hospital services is a benchmark for the success of a health-care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities. Regions with good economic movements tend to have good accessibility to health-care facilities. For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy-makers.
... Berdasarkan teori tersebut yang dimaksud dengan aksesibilitas adalah suatu kemudahan untuk penyandang disabilitas yang digunakan untuk mewujudkan kesamaan kesempatan dalam seluruh aspek kehidupan termasuk kehidupan berpolitik. Aksesibilitas dilihat dari penyelenggaraan Pemilu 2019, akan digunakan teori Akesibilitas Pelayanan menurut Penchansky & Thomas (1984) (Laksono et al., 2016): ...
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Penelitian ini bertujuan untuk menganalisis aksesibilitas penyandang disabilitas dalam Pemilihan Umum 2019 di Kabupaten Sleman, Provinsi Daerah Istimewa Yogyakarta (DIY). Penelitian ini dikaji dengan menggunakan dimensi menurut Thomas dan Penchansky, yang terdiri dari dimensi aksesibilitas, akomodasi, ketersediaan, dan akseptabilitas. Penelitian ini merupakan penelitian deskriptif kualitatif dengan menggunakan tehnik wawancara dan dokumentasi untuk mengumpulkan data. Data yang ada dianalisis menggunakan tehnik analisis model interaktif dari Miles dan Huberman. Hasil penelitian menunjukkan bahwa Pemilihan Umum 2019 di Kabupaten Sleman belum aksesibel bagi penyandang disabilitas. Berdasar dimensi aksesibilitas, terdapat fakta bahwa Tempat Pemungutan Suara (TPS) yang disediakan oleh penyelenggara belum seluruhnya mudah diakses oleh penyandang disabilitas, seperti adanya tangga yang menyulitkan penyandang disabilitas untuk masuk ke TPS. Pada dimensi akomodasi, masih ada pelayanan petugas TPS yang belum ramah terhadap penyandang disabilitas. Berdasar dimensi ketersediaan, terdapat kendala ketersediaan material, machine, dan method sehingga tidak optimal dalam mengakomodasi hak-hak pemilih penyandang disabilitas. Pada dimensi akseptabilitas belum ramah bagi penyandang disabilitas, karena masih adanya persepsi yang kurang tepat dari sebagian masyarakat terhadap penyandang disabilitas. Penyelenggara Pemilihan Umum disarankan untuk lebih memperhatikan akses bagi penyandang disabilitas, khususnya mengenai keterjangkauan TPS, ketersediaan sarana dan prasarana, ketersediaan standar operasional prosedur (SOP) bagi penyandang disabilitas, keterampilan dan kesigapan petugas dalam menangani pemilih penyandang disabilitas, serta memperbaiki cara pandang masyarakat dalam memandang penyandang disabilitas.
... Disparities as a result of this development also have an impact on the accessibility of health care facilities. Regions with good economic movements tend to have good accessibility to health care facilities (1). For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy makers (2). ...
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Background. The utilization of hospital services is a benchmark for the success of a health care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities. Methods. Chi Square test was used to test dichotomy variables and t-tests were performed for analyzing the difference among continuous variables. These tests were employed to assess the hypothesis that there was significant regional difference in the access of health care in Indonesia. Estimation using multinomial logistic regression test was used to study the disparity between regions in hospital utilization. Results. The results of this study indicate that there were disparities between regions in Indonesia. In the inpatient category all regions have better utilization than the Papua region, except the Sumatra region. The highest disparity occurs between the Nusa Tenggara region and the Papua region. Possibility of utilizing hospital vs. inpatient facilities not using the hospital 1,439 times in adults in the Nusa Tenggara region compared to the Papua region (OR = 1,439; 95% CI = 1,271 - 1,629). In the category of outpatient utilization as well as hospitalization in hospitals, the Papua region has better hospital utilization compared to other regions. The greatest disparity with the Sumatra region (OR = 0.484; 95% CI = 0.392 - 0.597). Conclusion. In conclusion, there were disparities between regions in Indonesia even though the odds ratio for mortality between regions decreased compared to the previous period. Ethical Clearance. The 2013 RISKESDAS survey had ethical clearance that was approved by the national ethical committee in the NIHRD (ethic number: 01.1206.207). Informed consent was used during data collection, which considered aspects of data collection procedure, voluntary, and confidentiality.
... The results of this analysis indicate the possibility that although women in Indonesia perform antenatal care more frequently, experience complications during pregnancy, they may have a higher chance of experiencing neonatal death. Another possibility is the availability of health services which are still uneven in some parts of Indonesia 16 . The geographical condition of Indonesia, which has more than 16 thousand, could also be another factor affecting neonatal death 17,18 , including the still thick local cultural customs that make Indonesian women choose to give birth at a traditional birth attendant 19,20 . ...
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One factor that is thought to have a close relationship with neonatal deaths is parity. This is a problem for Indonesia which has the cultural characteristics of a large number of children is something positive. The study used the 2017 IDHS data. With stratification and multistage random sampling, 36,548 women aged 15-49 years with live births in the last 5 years were sampled. The final analyzed using a Binary Logistic Regression test. Multiparous women in Indonesia have a higher percentage of neonatal deaths than multiparous women. But the difference in parity between primiparous and multiparous was found not to be a predictor of neonatal death in Indonesia. Three other variables were found to be proven, predictors. Women who were not employed were 0.576 times more likely than women employed for neonatal death (OR 0.576; 95% CI 0.407-0.814). Women who did antenatal care ≥4 times were 2.332 times more likely than women who had ANC <4 times to experience neonatal death (OR 2.332; 95% CI 1.519-3.578). Women who did not experience a complication during delivery were 0.457 times more likely than women who had a complication during delivery for neonatal death (OR 0.457; 95% CI 0.317-0.659). The study concluded that parity was not a predictor of neonatal death in Indonesia. Other variables that were proven to be predictors are employment status, antenatal care, and complications during pregnancy.
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Latar belakang: Kesehatan ibu dan anak merupakan salah satu faktor yang mengindikasikan status kesehatan masyarakat di suatu wilayah. Studi ditujukan untuk menganalisis hubungan antara input tenaga bidan dan tenaga dokter pada kinerja pelayanan kesehatan ibu dan anak di Pulau Papua, Indonesia. Metode: Studi dilakukan dengan pendekatan analisis ekologi. Populasi studi adalah seluruh kabupaten/kota di Pulau Papua (42 kabupaten/kota). Selain input tenaga bidan dan tenaga dokter sebagai variabel independen, studi ini menganalisis kunjungan antenatal care ke-empat, persalinan di fasilitas pelayanan kesehatan, dan kunjungan neonatus pertama, sebagai variabel dependen. Analisis memanfaatkan scatter plot dengan garis fit linier sebagai penentu. Hasil: Hasil studi menunjukkan variasi yang sangat tinggi antar kabupaten/kota, baik pada variabel input tenaga maupun pada kinerja kesehatan ibu dan anak. Secara spasial input tenaga bidan dan dokter yang paling rendah cenderung ada di wilayah Pegunungan Tengah Papua. Semakin tinggi input tenaga bidan maupun tenaga dokter di suatu kabupaten/kota, maka semakin tinggi pula kinerja K4 di kabupaten/kota tersebut. Semakin tinggi input tenaga bidan maupun tenaga dokter di suatu wilayah, maka semakin tinggi pula kinerja persalinan di fasilitas pelayanan kesehatan di wilayah tersebut. Semakin tinggi input tenaga bidan maupun tenaga dokter di suatu area di Papua, maka semakin tinggi pula kinerja KN1 di area tersebut. Lebih lanjut, input tenaga bidan memiliki efek yang lebih bermakna dibanding input tenaga dokter untuk seluruh kinerja kesehatan ibu dan anak yang dianalisis. Kesimpulan: Studi menyimpulkan bahwa input tenaga bidan dan tenaga dokter berhubungan dengan kinerja pelayanan kesehatan ibu dan anak di Pulau Papua, Indonesia.
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Underlying the continuing emphasis on access by health services researchers and policymakers is the assumption that patients having poorer access will receive less than appropriate health care, other things being equal. However, recent research results typically have not supported this assumption, and the nature and importance of relationships between access and use still remain unclear. Most published studies have sought to define general relationships that are descriptive of the behavior of all patients in a population facing access problems. The authors use interview data to show that significant relationships between satisfaction with access and use of services can be found if segments of the population, homogeneous in terms of age, sex, or other characteristics, are considered separately. This approach is based on the assumption that dissatisfaction with a particular dimension of access may be salient for some groups of patients but not others, and it is consistent with the view that patients' beliefs and perceptions are important determinants of health behavior.
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Our objective was to evaluate 8 interpersonal and structural features of care as predictors of patients' voluntary disenrollment from their primary care physician's practice. We performed a longitudinal observational study in which participants completed a validated questionnaire at baseline (1996) and follow-up (1999). The questionnaire measured 4 elements of the quality of physician-patient relations (communication, interpersonal treatment, physician's knowledge of the patient, and patient trust) and 4 structural features of care (access, visit-based continuity, relationship duration, and integration of care). Study participants were insured adults who reported having a regular personal physician at baseline and who completed both baseline and follow-up questionnaires (n=4108). The outcome measured was voluntary disenrollment from the primary physician's practice between baseline and follow-up. One fifth of the patients voluntarily left their primary physician's practice during the study period. When tested independently, all 8 scales significantly predicted voluntary disenrollment (P <.001), with somewhat larger effects associated with the 4 relationship quality measures. In multivariable models, a composite relationship quality factor most strongly predicted voluntary disenrollment (odds ratio [OR]=1.6; P<.001), and the 2 continuity scales also significantly predicted disenrollment (OR=1.1; P<.05). Access and integration did not significantly predict disenrollment in the presence of these variables. These findings highlight the importance of relationship quality in determining patients' loyalty to a physician's practice. They suggest that in the race to the bottom line medical practices and health plans cannot afford to ignore that the essence of medical care involves the interaction of one human being with another.