PANDANGAN IKATAN DOKTER ANAK TERHADAP SISTEM RUJUKAN DALAM
PANDANGAN IKATAN DOKTER
ANAK INDONESIA (IDAI) TERHADAP
SISTEM RUJUKAN KESEHATAN
DALAM ERA JKN
YOGYAKARTA , 24 MARET 2016
MILLENIUM DEVELOPMENT GOALS
Specialists Distribution (Pediatrics)
Data: IDAI (Pediatrician Association,
2006)
Obstetric
and Gynecologist
Jumlah Dokter Spesialis
Obsetri dan Ginekologi
DKI
240
287
163168
Jatim
153
154
Jateng
136
141
Jabar
71
Sumut
101
48
46
Bali
42
40
39 46
Sulsel
Sumsel
34
Sumbar
56
28
29
27
29
25
27
17 23
21
22
17
18
15
16
14
13
DIY
Riau
Banten
Lampung
Kaltim
Kalsel
Kepri
Kalbar
13
11
13
Jambi
NAD
Kalteng
20
12
11
11
Sulteng
7
10
12
Sulut
9
8
8
6
NTB
M aluku
Sultra
8
5
78
7
NTT
Papua
10
56
4
4
13
Bengkulu
Babel
Sulbar
3
3
2
4
1
4
Gorontalo
Papua Barat
M alut
0
50
100
150
200
2006
250
300
2008
Typical graphic description of medical specialist distribution
350
SUTOTO PERSI
10
11
Lanjutan…..
12
Figure 6 Systematic Constraints and Cyclic Consequences in Public Health Service
System at the Provincial Level
Primary Constraints at
Facilities in Primary Care
Level +
Impacts of the UC
implementation
Workloads and Poor
performances of
service provisions at
the primary care level
Consequences of
Failures at primary
care level
Infeasible to
strengthen Primary
care network
Primary Constraints at
Facilities in Secondary
Care Level +
Impacts of the UC
implementation
Workloads and Poor
performances of service
provisions at the secondary
care level
Consequences of
Over-referring of
In-Patient cases
Infeasible Reallocation
of health personnel in
the province
Primary Constraints at
Facilities in Tertiary Care
Level +
Impacts of the UC
implementation
24 June 2009
1) Primary Constraints
Workloads and Poor
performances of service
provisions at the primary
care level
At Faculty of Economics, TU
2) Linking Consequences
3) Secondary Constraints
15
Conclusions
Thaila d s health syste has achieved intermediate goal but
not yet the final one of the UC policy.
(1) Assuring universal
and comprehensive
health insurance
coverage.
(2) Ensuring
adequate and
equitable access to
needed health service.
(3) Increasing the
effectiveness and
sustainability of
health system
Source: Docteur et al. 2003
• U ive sal i lusio is to e a hieved, ut
• U ive sal a ess is still ot e su ed that it is e uita le to
all insured population
• UC system is insufficiently provided with health resources,
and as a result ineffectively functioning and vulnerable
16
• “…where shortages (and inequitable
distributions) of health workforces are
still prevalence in many areas and
sufficient budget funding are not yet
acquired, the public health care system
(and UC) as a whole is vulnerable and
might not be sustainable in the long-run
17
ANAK INDONESIA (IDAI) TERHADAP
SISTEM RUJUKAN KESEHATAN
DALAM ERA JKN
YOGYAKARTA , 24 MARET 2016
MILLENIUM DEVELOPMENT GOALS
Specialists Distribution (Pediatrics)
Data: IDAI (Pediatrician Association,
2006)
Obstetric
and Gynecologist
Jumlah Dokter Spesialis
Obsetri dan Ginekologi
DKI
240
287
163168
Jatim
153
154
Jateng
136
141
Jabar
71
Sumut
101
48
46
Bali
42
40
39 46
Sulsel
Sumsel
34
Sumbar
56
28
29
27
29
25
27
17 23
21
22
17
18
15
16
14
13
DIY
Riau
Banten
Lampung
Kaltim
Kalsel
Kepri
Kalbar
13
11
13
Jambi
NAD
Kalteng
20
12
11
11
Sulteng
7
10
12
Sulut
9
8
8
6
NTB
M aluku
Sultra
8
5
78
7
NTT
Papua
10
56
4
4
13
Bengkulu
Babel
Sulbar
3
3
2
4
1
4
Gorontalo
Papua Barat
M alut
0
50
100
150
200
2006
250
300
2008
Typical graphic description of medical specialist distribution
350
SUTOTO PERSI
10
11
Lanjutan…..
12
Figure 6 Systematic Constraints and Cyclic Consequences in Public Health Service
System at the Provincial Level
Primary Constraints at
Facilities in Primary Care
Level +
Impacts of the UC
implementation
Workloads and Poor
performances of
service provisions at
the primary care level
Consequences of
Failures at primary
care level
Infeasible to
strengthen Primary
care network
Primary Constraints at
Facilities in Secondary
Care Level +
Impacts of the UC
implementation
Workloads and Poor
performances of service
provisions at the secondary
care level
Consequences of
Over-referring of
In-Patient cases
Infeasible Reallocation
of health personnel in
the province
Primary Constraints at
Facilities in Tertiary Care
Level +
Impacts of the UC
implementation
24 June 2009
1) Primary Constraints
Workloads and Poor
performances of service
provisions at the primary
care level
At Faculty of Economics, TU
2) Linking Consequences
3) Secondary Constraints
15
Conclusions
Thaila d s health syste has achieved intermediate goal but
not yet the final one of the UC policy.
(1) Assuring universal
and comprehensive
health insurance
coverage.
(2) Ensuring
adequate and
equitable access to
needed health service.
(3) Increasing the
effectiveness and
sustainability of
health system
Source: Docteur et al. 2003
• U ive sal i lusio is to e a hieved, ut
• U ive sal a ess is still ot e su ed that it is e uita le to
all insured population
• UC system is insufficiently provided with health resources,
and as a result ineffectively functioning and vulnerable
16
• “…where shortages (and inequitable
distributions) of health workforces are
still prevalence in many areas and
sufficient budget funding are not yet
acquired, the public health care system
(and UC) as a whole is vulnerable and
might not be sustainable in the long-run
17