5.Panel4 PPT Budi Aji UNSOED
Creating the right to access to
quality health care for the
poor: A case study at a
restructured hospital with noclass wards policy in Indonesia
Presented by:
Dr.sc.hum. Budi Aji, SKM, M.Sc.
3rd Indonesian Health Economics Association
(InaHEA) Congress
Yogyakarta, 28-30 July 2016
1
This research was supported by
the World Health Organization
(WHO) Geneva
Gender, Equity and Human Rights
under Grant HQGER1408785
Year 2015
School of Public Health
Faculty of Health Sciences
Jenderal Soedirman
University
World Health Organization
Gender, Equity and Human
Rights Switzerland
2
Overview
•
•
•
•
•
Background
Purpose of the study
Research methods
Results and discussion
Policy recommendation & future
research
3
Background
Health services gap
3rd class ward “free“: for
poor people
VIP class “private“ : in the
capital city
4
Background
Challange toward increasing access to quality
hospital care for the poor
• Policy innovation to create hospital
without class ward is implemented at
Wates Hospital in the District of
Kulonprogo-Yogyakarta
• Admission rate among the poor increased from 39.60%
in 2011 to 43.42% in 2012 and 56.35% in 2013
• Significant for future model/design for hospital system
in Indonesia?
5
Study objectives
• To gain a better understanding of the
experience of the poor and non-poor patients
after the implementation of no-class wards
policy.
• To gain a better understanding of hospital
behavior towards the treatment patients under
no-class wards policy.
• To determine the possible impact of no-ward
class policy on the poor and non-poor patients
with respect to the government and hospital
commitments to enhance nondiscrimination in
provision and quality of care.
• To formulate recommendations for the
6
Research methods
Theoretical framework
Restructu
red
hospital
with noclass
wards
policy
Addressin
g the full
scope of
impacts
Healthcare
users (the poor
and non-poor
patients)
Internal
hospital
management
Healthcare
professionals
Other
stakeholders
(local
government
agencies)
Adopting 6
areas of
interest of the
accessibility to
quality
healthcare:
- Nondiscriminatio
n
- Physical
accessibility
- Economic
accessibility
- Information
accessibility
- Prompt
attention
- Adequate
treatment
Evaluation of
impact that is
guided by
human rights
considerations
7
Research methods
Study design, sites & informants
• Research design: qualitative study
• Study sited: District of Kulonprogo,
Yogyakarta, Indonesia, especially at Wates
Hospital
• The data collections in 3 phases:
– First: in-depth interviews with 19 patients or
their family members (carers)
– Second: in-depth interviews with 3 stakeholders
– Third: FGD with hospital professionals
8
Research methods
Data management & analysis
• Qualitative study:
– In-depth & FGDs
– Data analysis: thematic framework
analysis
– Sorting and coding: Qualitative software
MAXQDA 11
9
Research methods
Ethical considerations
• Ethical issues: informed consent,
confidentiality of information,
voluntary participation and response
to health emergencies while carrying
out interviews
• Full ethical review: ethical
committee, local government
approval
10
Results & dicussion
Study results & discussion
11
Conclusion
Conclusion
No-class ward policy at Wates Hospital had
effectively reduced the experiences of
patients on discriminatory treatment as well
as improved quality of services.
The policy had an impact on increasing
hospital utilization significantly among both
the poor and non-poor patients that support
the success of the UHC program
The policy had also improved the assurance
of quality of services through building a
trustful relationship; patient empowerment
and right; and developing clinical pathways.
12
Policy recommendations & future research
Policy replication becomes an important
issue to scale up the policy to other
hospitals in the different regions in
Indonesia.
Future research needs to expand on our
work to compare the implementation of
no-class wards policy in other hospitals in
different regions in Indonesia considering
different local context.
13
Thank you
14
quality health care for the
poor: A case study at a
restructured hospital with noclass wards policy in Indonesia
Presented by:
Dr.sc.hum. Budi Aji, SKM, M.Sc.
3rd Indonesian Health Economics Association
(InaHEA) Congress
Yogyakarta, 28-30 July 2016
1
This research was supported by
the World Health Organization
(WHO) Geneva
Gender, Equity and Human Rights
under Grant HQGER1408785
Year 2015
School of Public Health
Faculty of Health Sciences
Jenderal Soedirman
University
World Health Organization
Gender, Equity and Human
Rights Switzerland
2
Overview
•
•
•
•
•
Background
Purpose of the study
Research methods
Results and discussion
Policy recommendation & future
research
3
Background
Health services gap
3rd class ward “free“: for
poor people
VIP class “private“ : in the
capital city
4
Background
Challange toward increasing access to quality
hospital care for the poor
• Policy innovation to create hospital
without class ward is implemented at
Wates Hospital in the District of
Kulonprogo-Yogyakarta
• Admission rate among the poor increased from 39.60%
in 2011 to 43.42% in 2012 and 56.35% in 2013
• Significant for future model/design for hospital system
in Indonesia?
5
Study objectives
• To gain a better understanding of the
experience of the poor and non-poor patients
after the implementation of no-class wards
policy.
• To gain a better understanding of hospital
behavior towards the treatment patients under
no-class wards policy.
• To determine the possible impact of no-ward
class policy on the poor and non-poor patients
with respect to the government and hospital
commitments to enhance nondiscrimination in
provision and quality of care.
• To formulate recommendations for the
6
Research methods
Theoretical framework
Restructu
red
hospital
with noclass
wards
policy
Addressin
g the full
scope of
impacts
Healthcare
users (the poor
and non-poor
patients)
Internal
hospital
management
Healthcare
professionals
Other
stakeholders
(local
government
agencies)
Adopting 6
areas of
interest of the
accessibility to
quality
healthcare:
- Nondiscriminatio
n
- Physical
accessibility
- Economic
accessibility
- Information
accessibility
- Prompt
attention
- Adequate
treatment
Evaluation of
impact that is
guided by
human rights
considerations
7
Research methods
Study design, sites & informants
• Research design: qualitative study
• Study sited: District of Kulonprogo,
Yogyakarta, Indonesia, especially at Wates
Hospital
• The data collections in 3 phases:
– First: in-depth interviews with 19 patients or
their family members (carers)
– Second: in-depth interviews with 3 stakeholders
– Third: FGD with hospital professionals
8
Research methods
Data management & analysis
• Qualitative study:
– In-depth & FGDs
– Data analysis: thematic framework
analysis
– Sorting and coding: Qualitative software
MAXQDA 11
9
Research methods
Ethical considerations
• Ethical issues: informed consent,
confidentiality of information,
voluntary participation and response
to health emergencies while carrying
out interviews
• Full ethical review: ethical
committee, local government
approval
10
Results & dicussion
Study results & discussion
11
Conclusion
Conclusion
No-class ward policy at Wates Hospital had
effectively reduced the experiences of
patients on discriminatory treatment as well
as improved quality of services.
The policy had an impact on increasing
hospital utilization significantly among both
the poor and non-poor patients that support
the success of the UHC program
The policy had also improved the assurance
of quality of services through building a
trustful relationship; patient empowerment
and right; and developing clinical pathways.
12
Policy recommendations & future research
Policy replication becomes an important
issue to scale up the policy to other
hospitals in the different regions in
Indonesia.
Future research needs to expand on our
work to compare the implementation of
no-class wards policy in other hospitals in
different regions in Indonesia considering
different local context.
13
Thank you
14