Analisis kebijakan jaminan kesehatan kota Bengkulu dalam upaya efisiensi dan efektifitas pelayanan di puskesmas

Background. Mayor of Bengkulu Regulation Number 13 Year 2012 on The Implementation Guidelines for State Health Insurance Assistance Costs (Jamkeskot) in Bengkulu city is managed by the Secretariate of the Government of Community Welfare Section in Bengkulu. The cost of referral health care in Provincial General Hospital could be made more efficient by optimizing the role of community health centers as a curative, preventive and promotive health services. It is hoped to reduce the number of visits for treatment and referral to hospital. The purpose of this study is to analyze the City Health Insurance policies in an effort to improve the efficiency and effectiveness of primary health care and public health efforts to reduce the number of visits for treatment and referral to hospital. Method: The type of research is non-experimental research, or also called qualitative research. It is an exploratory research to find a new role of the city government and Administering Agency to improve the efficiency and effectiveness of health services at the health center. Unit of Analysis: 1) Community Health Center Unit 20, 2) organizing: PT. Askes 2 person and Community Welfare section 2 person, 3) the City: Head of the Community Welfare Section 1 person, Bengkulu City Health Office 2 person. Data is collected using interview using questionnaire as the instrument, and documents review. Results: Bengkulu Jamkeskot policies have not applied the principle of insurance in which the organizers serves to control the quality and cost of health care provided in both basic services/primary and referral services. Most of the health centers tend to refer patients (67%) that are still within their authorization to provide care. The reason being: the health centers have limited equipment and drugs, and some patients demanded to be referred due to perceived bad quality of service at the health centers. The Community Welfare section has not coordinated with the City Health Office to conduct training for the health center in an effort to increase the effectiveness of services. Recommendation: The City Government is to establish a team to conduct technical guidance supervision to health centers to ensure that the health centers play the role of gatekeeper and only refer patients that need complex care, providing medical equipment and drugs to the health centers with proposed funding from Bengkulu City budget and provincial budget. The Health Centers are to provide routine counseling on healthy behavior and IEC on nutrition and hygiene to every posyandu. The City Health Office provides technical guidance in drafting POA for promotive and preventive activities to have more focus in efforts to control the causes of disease. Improve policy management of Jamkeskot by submitting the management to an administering body, so that the Jamkeskot can apply the insurance principles where the strong help the weak, the healthy help the sick, the rich help the poor; and also can control the quality and cost of service.