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BIODATA
Dr.Santoso Soeroso SpA(K), MARS Tempat & Tanggal lahir : Magelang, 22
September 1947 Alamat kantor : Komite Medik RS Pondok
Riwayat Pekerjaan :Wakil Dir. Medik & Keperawatan RS Dr.
Kariadi , Semarang (1990-1995)Wakil Dir. Umum & Keuangan RS Dr.
Kariadi, Semarang (1995-1998)Direktur RS Fatmawati (1998-2002)Direktur RSPI-Sulianti Saroso (2002-2007)Chief Operating Officer RS Puri Indah
(Pondok Indah Group)Ketua II Health Technology Asseessment
Alamat kantor : Komite Medik RS Pondok Indah, Jl. Metro Duta Kav UE, Jakarta Selatan
Pendidikan :Dokter (FK UNDIP 1973) Dokter Spesialis
Anak (FK UNDIP 1982), Research Fellow Pediatrc Cardiology, University of Lund, Sweden 1984-1985, Reseach Fellow Pediatric Cardiology , Tokyo Women Medical College, Japan, the Heart Institute of Japan, 1991-1992, SpA Konsultan 1992
MARS (FKM UI , 1996)Lemhannas KRA XXXIII (2000)
Ketua II Health Technology AsseessmentIndonesia (2003-2013)
Ketua Bidang Kredensial Komite Medik RS Pondok Indah
Anggota Institut Manajemen Rumah Sakit –PERSI
Kepala Divisi Penelitian dan Health Technology Assessment - PERSI (2009-sekaramg)
Sekretaris, Badan Pertimbangan PemgurusPusat IDAI (2012 – 2015)
SANTOSO SOEROSOKEPALA KOMPARTEMEN
PENELITIAN DAN HEALTH TECHNOLOGY ASSESSMENT PERSIHotel Peninsula, Jakarta , 3 Juli 2013
cx=-[
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MILLENIUM DEVELOPMENT GOALS
Jumlah kematian dalambulan
Region
IndonesiaSumatera Jawa-Bali Kalimantan Sulawesi IBT
Jumlah kematian 17 bulan 1738 3333 587 979 888 7524
Jumlah kematian 12 bulan 1227 2353 414 691 627 5311
MATERNAL MORTALITY RATIO
Jumlah lahir hidup 12 bulan 1.072.588 2.371.448 280.717 345.556 331.845 4.402.154
Uncorrected Maternal Mortality Ratio per 100.000 live birth
114 99 148 200 189 121
Maternal Mortality Ratio per 100.000 live
birth*262 227 340 459 434 278
18/12/2012 Determinan Kematian Maternal_kajian Litbangkes 6*setelah uncorrected MMR dikoreksi dengan completeness , yaitu dibagi = 0,4352
Proporsi kriteria PONEK RSU PEMERINTAH(Data Rifaskes 2011)
No Kriteria PONEKSumatera Jabal Kalimantan Sulawesi IBTN % N % N % N % n %
1 Kamar ops siap 24 jam
208 69.7 233 81.1 74 67.6 90 62.2 80 62.5
2 Tim siap ops 24 jam 208 70.2 233 84.1 74 63.5 90 45.6 80 62.53 Pelayanan darah 24
jam208 50.5 233 63.1 74 56.8 90 46.7 80 43.8
jam4 Laboratorium 24
jam208 61.1 233 75.1 74 63.5 90 52.2 80 52.5
5 Radiologi 24 jam 208 56.3 233 70.0 74 55.4 90 41.1 80 47.56 Farmasi dan alat
penunjang siap 24 jam
208 60.1 233 77.3 74 67.6 90 60.0 80 55.0
7 Ruang Pemulihan siap 24 jam
208 49.0 233 68.7 74 44.6 90 40.0 80 35.0
8 Unit Pelayanan darah 24 jam
208 43.3 233 37.8 74 47.3 90 44.4 80 36.3
9 Tim PONEK Esensial
208 38.5 233 57.1 74 24.3 90 34.4 80 42.5
18/12/2012 Determinan Kematian Maternal_kajian Litbangkes 7
KESIMPULANPada kajian ini diperoleh uncorredcted ratio kematian ibu.Pada kajian ini perlu dikoreksi dengan completeness sebesar0,4352; sehingga urutan MMR dari tertinggi sebagai berikut : Region Sulawesi (459/ 100.000 kelahiran hidup) Region IBT (434/100.000 kelahiran hidup) Region IBT (434/100.000 kelahiran hidup) Kalimantan (340/100.000 kelahiran hidup) Sumatera (261/100.000 kelahiran hidup) Jawa Bali (227/100.000 kelahiran hidup) Indonesia (278 /100.000 kelahiran hidup)Kajian ini menyimpulkan kematian ibu masih tinggi di Indonesia.
18/12/2012 Determinan Kematian Maternal_kajian Litbangkes 8
Population: Elderly Society in Thailand
600
800
1000
1200
1400
Po
pu
latio
n (
x 1
,000
)
Population - 67 millionTotal fertility rate: 1.6 (2009)
Life expectancy at birth:74 Years
0
200
400
600
0 20 40 60 80 100 Age
Po
pu
latio
n
Pop 2007 POP 2020
Source: Health Care Reform Project (2008)
74 Years
Under 5 Mortality: 14/ 1000 live births
Maternal mortality: 48/100,000 live births
9
How Pay for Health CareThe national health security program increased government budget
Thailand Spends a Relatively High Share of Government Spending on Health
Source: World Bank (2012) Government Spending and Central-Local Relations in Thailand’s Health Sector.Health, Nutrition and Population (HNP)
11
Thailand:Path to Universal Coverage
Source: National Statistic Office, the Health and Welfare Surveys in 1991, 1996, 2001 and 2003.
12
Impacts of Universal CoverageDecreasePoverty from Health Care Spending
Source: Limwattananon (2010): analysis of Socioeconomic Survey (various years)
2000280,000
Households
200888,000
Households
14
Distribution of Patients by Treatment Outcome
0%
20%
40%
60%
80%
100%
2003-4 2008-9 2003-4 2008-9 2003-4 2008-9
Hypertension Diabetic Hypercholesterol
No diag No trearment Uncontrol Control
ImproveHealth Outcome
Source: National Health Examination Survey 2003-2004 and 2008-2009
Social Sustainability:Legitimacy, People Satisfaction
15
Share of Total Spending Financed by Government Has Been Rising
Source: World Bank (2012) Government Spending and Central-Local Relations in Thailand’s Health Sector.Health, Nutrition and Population (HNP) Discussion Paper (Forth coming)
16
QUALITYHospital Accreditation
Voluntary program which is conducted by the Institute of Hospital Quality Improvement and Accreditation
Accredited Hospitals
100
150
200
250
Nu
mb
er o
f h
osp
ital
This Thai accreditation process is demanding from both public and private hospitals
0
50
100
1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er o
f h
osp
ital
Hospitals
18
Coverage of health facilitiesMainly under Ministry of Public Health (MOPH)
• Provinces (76) exclude Bangkok
– General/Regional hospitals 100%• Districts
– Community hospitals nearly 100%
Health Care Delivery Development
– Community hospitals nearly 100%• Subdistrict or Tambon
– Municipal health centres (214)– Tambon Health centres (9,738) nearly 100%
19
4
5
6
7
8
9%
in
com
e sp
ent
on
hea
lth
1992
2000
2002
2004
Dec
linin
g of
gapEQUITY
Income Spending on Health by Income Groups
Before UC
0
1
2
3
4
Decile
1
Decile
2
Decile
3
Decile
4
Decile
5
Decile
6
Decile
7
Decile
8
Decile
9
Decile
10
Income Deciles
% in
com
e sp
ent
on
hea
lth
20042006
Dec
linin
g of
gap
Poorest Richest
After UC
Source: Socio-Economic Survey 1992 - 2006 conducted by NSO.20
ACCESSIBILITY Increase utilization of out-patient and in-patient
Source: HISRO (2008)
21
Perkembangan RS di Indonesia
Number of private hospitals is increasing more than government ones.
Number of For-Profit Private-Hospital almost doubled in the last five years
Number of Non-For-Profit-Private Hospital almost remained the same
03 04 05 06 07 08Owner
03 04 05 06 07 08
For Profit Corporation
49 52 55 60 71 85
Non-Profit(Foundation)
530 538 538 538 539 539
Non-Profit (NGOs)
27 27 28 28 28 29
Total
606 617 621 626 638 653
Specialist distribution (KKI, 2008)
Jakarta: 24% of specialists, serves around 4% community in a relatively small area
• Provinces in Java: 49% of specialists, serves • Provinces in Java: 49% of specialists, serves around 53% community
• Rest of Indonesia: 27% of specialists, serves around 43% community in a very large area
Specialist distribution (KKI, 2008)Province Number % Cumulative People served Ratio
DKI Jakarta 2.890 23,92% 23,92% 8.814.000,00 1 : 3049
Jawa Timur 1.980 16,39% 40,30% 35.843.200,00 1 : 18102
Jawa Barat 1.881 15,57% 55,87% 40.445.400,00 1 : 21502
Jawa Tengah 1.231 10,19% 66,06% 32.119.400,00 1 : 26092
Sumatera Utara 617 5,11% 71,17% 12.760.700,00 1 : 20681
D.I.Jogjakarta 485 4,01% 75,18% 3.343.000,00 1 : 6892D.I.Jogjakarta 485 4,01% 75,18% 3.343.000,00 1 : 6892
Sulawesi Selatan 434 3,59% 78,77% 8.698.800,00 1 : 20043
Banten 352 2,91% 81,69% 9.836.100,00 1 : 27943
Bali 350 2,90% 84,58% 3.466.800,00 1 : 9905
Sumatera Selatan 216 1,79% 86,37% 6.976.100,00 1 : 32296
Kalimantan Timur 203 1,68% 88,05% 2.960.800,00 1 : 14585
Sulawesi Utara 173 1,43% 89,48% 2.196.700,00 1 : 12697
Sumatera Barat 167 1,38% 90,86% 4.453.700,00 1 : 26668
Propinsi Lainnya 1.104 9,14% 100,00% 52.990.200,00 1 : 47998
12083 100,00% 224.904.900,00 1 : 18613
Specialists Distribution (Pediatrics)
Data: IDAI (Pediatrician Association, 2006)
Jumlah Dokter Spesialis Obsetri dan Ginekologi
11
20
11
13
16
18
22
17
27
29
29
56
46
40
46
101
141
154
168
240
12
13
13
14
15
17
21
23
25
27
28
34
39
42
48
71
136
153
163
287
Sulteng
NAD
Jambi
Kalbar
Kepri
Kalsel
Kalt im
Lampung
Banten
Riau
DIY
Sumbar
Sumsel
Sulsel
Bali
Sumut
Jabar
Jateng
Jat im
DKI
Obstetric and Gynecologist
4
4
3
1
4
6
10
7
5
6
8
12
7
11
1
2
3
3
4
5
7
8
8
8
9
10
11
0 50 100 150 200 250 300 350
M alut
Papua Barat
Gorontalo
Sulbar
Babel
Bengkulu
Papua
NTT
Sultra
M aluku
NTB
Sulut
Kalteng
Sulteng
2006 2008
Typical graphic description of medical specialist distribution
Historical Facts , to answerwhy there is inequitable distribution of health
workforce and hospital
Indonesia is not a welfare state since the colonial era
Hospitals operate within market ideologyMedical Doctors (esp.colonial era
Indonesia has market based economy
Medical Doctors (esp.specialists) operates based on the fundamental demand and supply principles.
Adverse Effects of 30-baht UCin Thailand
Demanding huge governmental budgetExodus of doctors from government-run hospitals to
private sectorprivate sectorDouble standards of medication and treatmentWhen fully implemented: catalyzing family
breakdown due to more individualism in community
Poll on Current Health Care
Matichon, February 5, 2007 A survey report was conducted by the Office of Heath Systems Research Institute and ABAC Poll on 13, 497 people from September 1, 2006- October 31, 2006 : 1) 34% felt that the health care services provided by 1) 34% felt that the health care services provided by the government are inadequate. 2) 72.9% urge the government to solve the problem of over crowded tertiary care hospitals urgently. 3) 59.3% felt the government provided insufficient budget for public health;4) 87.1 % suggested the government to establish more health care centers.
Emerging Elements of Communitarian Health Care System
Decentralization of government administration: Establishment of Office of Heath Care Reform Local leaderships with established community centers Local leaderships with established community centers
(best practices): 1 baht a day for membership, huge fundraising and payment for illness
Local infrastructure: village banking system (micro-economics)
Culture has been the forgotten resource for health care reform in Thailand.
Culture of volunteer workers & culture of care in community should be promotedcommunity should be promoted
Government supports: knowledge, training, setting standards of activities and programs at the grass-roots and networking;
Aging population: quality older people Better selection of medical students, nurses, etc.
HEALTH CARE SYSTEM TRANSITION
Health care system transition from fee for service out of pocket or reimbursement to accountable prospective payment will eventually be tied to the prospective payment will eventually be tied to the quality and outcome of patient care , cost management and the overall population health. This evolution requires tight integration between all those who influence the continuum of patient care with doctor and hospital alignment being the primary component.
SUTOTO PERSI 35
36
Lanjutan…..
37
U.U B.P.J.S psl 10Membuat kesepakatan dengan Fasilitas
kesehatan mengenai besar pembayaranfasilitas kesehatan yg mengacu padafasilitas kesehatan yg mengacu padastandar tarif yg ditetapkan pemerintah
Membuat atau menghentikan kontrakkerja dengan fasilitas kesehatan
SUTOTO PERSI 40
Standar Tarif harus dalam hargakeekonomian, ada up dating. !!!
PERPRES 12 TH 2013 TTG JAMINAN KESEHATAN
Pasal 35 (1) Pemerintah dan Pemerintah Daerah bertanggung
jawab atas ketersediaan Fasilitas Kesehatan danpenyelenggaraan pelayanan kesehatan untukpenyelenggaraan pelayanan kesehatan untukpelaksanaan program Jaminan Kesehatan.
(2) Pemerintah dan Pemerintah Daerah dapatmemberikan kesempatan kepada swasta untuk berperanserta memenuhi ketersediaan Fasilitas Kesehatan danpenyelenggaraan pelayanan kesehatan.
41
PERPRES 12 TTG JAMINAN KESEHATANPasal 24
Peserta yang menginginkan kelas perawatanyang lebih tinggi dari pada haknya, dapatyang lebih tinggi dari pada haknya, dapatmeningkatkan haknya dengan mengikutiasuransi kesehatan tambahan, atau membayarsendiri selisih antara biaya yang dijamin olehBPJS Kesehatan dengan biaya yang harus dibayarakibat peningkatan kelas perawatan.
42
Supasit PannarunothaiCenter for Health Equity Monitoring Faculty of
Medicine, Naresuan University
Scope Equity trends in Thailand Benchmarks Phase I Objectives and methods for Phase II Quantitative data on equity in Thailand Qualitative data from focus group discussion Experiences learnt
Equity trends in ThailandThe Constitution
The Decentralization Act 2001Universal health coverage
Equity Efficiency
Social accountabilityQuality
Benchmarks of Fairness Phase I Scoring of Provincial Health Reforms
Benchmarks Phayao* Yasothon1 Intersectoral public health 1.8 2.02 Financial barriers to equitable access 2.6 2.23 Non-financial barriers to access 2.7 2.04 Comprehensiveness of benefits and tiering 1.4 2.14 Comprehensiveness of benefits and tiering 1.4 2.15 Equitable health financing 1.5 1.56 Efficacy, efficiency and quality of health care 2.1 2.07 Administrative efficiency 1.8 1.58 Democracy, accountability and empowerment 3.8 1.99 Patient and provider autonomy 1.6 0.8
Overall score 2.1 1.8Score from -5 to +5 with zero representing status quoThe overall score was made by implicit weightingPannarunothai and Srithamrongsawat (2000)
Lessons learnt from Phase I The benchmarks provided a comprehensive framework for
evaluation of health system.
It could be used as a tool for provincial health system development.development.
If combining with more objective data, the benchmarks should provide more accurate directions for developments.
Mettanando BhikkhuB.Sc., M.D. (Chulalongkorn), B.A.,MA. (Oxford),
Th.M. (Harvard), Ph.D. (Hamburg)Ethics Committee, Faculty of Medicine, Chulalongkorn University,
www.mettanando.com
Collaboration Among Health Care Professional, Civil Societies and Politicians:
Triangle that moves mountainAccumulation of Knowledge
Health Reform
Social Movement Political Linkage
Source: Dr. Prewase Wasi
49
Volunteer Recruitment
6 million Thai people registered with the Ministry of Culture as “Volunteers”
Volunteering at the grass-roots Volunteering at the grass-roots Promoted by Office of Health Care Reform Prof. Prawes Wasi (Guru of National Health Reform, Rural
Doctor Group) Volunteers are active in many areas of health care:
cancer, HIV/AIDS, etc.
Chalermpol CHAMCHAN
“Impacts and Constraints of Universal Coverage (UC) in Thailand’s Public Health
System”
24 June 2009 At Faculty of Economics, TU
Chalermpol CHAMCHAN
Doctor of Area Studies, Graduate School of Asian and African Area Studies (ASAFAS), Kyoto University
51
I. Background
The UC policy incorporated 1) Financial reforms with closed-end provider payment
method – the capitation method – and
2) Strengthened primary care network with more attention on health promotion and disease prevention works (PP) – a concept of “Primary Care Unit (PCU)” under “Contracted Unit of Primary Care” (CUP) structure.
Adequacy of the capitation rates and UC budget
“Adequacy” ---- survival of the health facility and its financing----enough and the hospital could survive, even with some financial deficits and debts.
However, “Adequacy” ---- in relation to assigned work tasks and expected outcomes by the NHSO, the MOPH and the patients----hardly enough and inadequate to have the facility achieving at the quality levels
Adequacy of the capitation rates and UC budget
“Investments” for long-term development and quality improvement of services provided ---- said to be forgotten, due to the limitations and inadequacy of the budget----affects not only the sustainability of the facilities themselves affects not only the sustainability of the facilities themselves but also of the whole health service provision system.
“Salary subtraction” of the UC budget at the national level & at the provincial level
“The co-payment”: The fixed 30 baht/visit
From PCUs to Secondary and Tertiary level hospitals
Failures of strategies to strengthen service provisions at primary care level, and health promotion and prevention (PP)---Failures of the SNS and KBKJ strategies
2. Linking consequences:
SNS and KBKJ strategies
From Secondary level hospitals to Tertiary level hospital
Over-referring of In-Patient cases
55
Backward from
Tertiary level hospitals to Secondary level hospitals Infeasible reallocations of health personnel from
provincial cities to rural districts
3. Secondary Constraints
provincial cities to rural districts
Secondary care level hospital to PCUs Infeasible strengthening primary care network
56
Workloads and Poor performances of
service provisions at the primary care level
Workloads and Poor
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
Primary Constraints at Facilities in Secondary
Infeasible to strengthen Primary
care network
Consequences of Failures at primary
care level
Consequences of Failures at primary
care level
Consequences of Failures at primary
care level
June At Faculty of Economics, TU 57
Workloads and Poor performances of service
provisions at the secondary care level
Workloads and Poor performances of service provisions at the primary
care level
Facilities in Secondary Care Level +
Impacts of the UC implementation
Primary Constraints at Facilities in Tertiary Care
Level +Impacts of the UC
implementation
1) Primary Constraints
Infeasible Reallocation of health personnel in
the province
3) Secondary Constraints
Consequences of Over-referring of In-Patient cases
2) Linking Consequences
Consequences of Over-referring of In-Patient cases
Consequences of Over-referring of In-Patient cases
2) Linking Consequences2) Linking Consequences
“…where shortages (and inequitable distributions) of health workforces are still prevalence in many areas and sufficient budget funding are not yet 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
58
Thailand’s health system has achieved intermediate goal but not yet the final one of the UC policy.
(1) Assuring universal
and comprehens
(2) Ensuring adequate
and
(3) Increasing
the effectivenes
ConclusionsConclusions
‘Universal inclusion’ is to be achieved, but “Universal access” is still not ensured that it is equitable to
all insured population UC system is insufficiently provided with health resources,
and as a result ineffectively functioning and vulnerable59
ive health insurance coverage.
comprehensive health insurance coverage.
equitable access to needed health
service.
and equitable access to needed health
service.
s and sustainability of health
system
effectiveness and
sustainability of health
system
Source: Docteur et al. 2003Source: Docteur et al. 2003
To empower Primary Care Unit (PCU) and enhance its staffs
To put forward a concrete agenda to relieve shortages of health workforce and its misdistribution nationwide
Policy SuggestionsPolicy Suggestions
misdistribution nationwide To adjust financing mechanism of UC in
term of fund sourcing and budget managements
To promote better community participation and patients’ responsibilities
60