ek.kes pembiayaan ronnie
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ek.kes pembiayan ronnieTRANSCRIPT
Ekonomi KesehatanRonnie Rivany
Pokok Bahasan.3.1PEMBIAYAAN KESEHATAN
(Umum)
Health Care Financing
• BIAYA KESEHATAN ADALAH SEMUA BIAYA YANG DIKELUARKAN OLEH PEMERINTAH, SWASTA DAN MASYARAKATYANG SECARA EXPLISIT / NON DITUJUKAN UNTUK MEMPERBAIKI KEADAAN KESEHATAN
Health Care Financing (1.1)• WHO,1978
Sumber pembiayaan kesehatan berasal dari dua sumber
– Public (and Quasi Public) sources• General tax revenues• Deficit financing• Earmarked taxes• Social insurance• Local tax revenues• State-run lotteries & betting
Health Care Financing (1.2)
• WHO,1978– Private sources
• Private health insurance• Employer-financed services• Charitable and voluntary contributions• Community self-help and fund-raising• Private household expenditure
Health Care Financing (2.1)
• Zchock,1979Sumber pembiayaan kesehatan berasal dari
dua sumber – Public & Quasi Public sources
• General Tax Revenues• Deficit Financing• Sales Tax Revenues• Social Insurance• Lotteries & Betting
Health Care Financing (2.2)
• Zchock,1979– Private sources
• Direct Employer Financing• Private Health Insurance• Charitable Contributions• Direct Household Expenditure• Communal Self-Help
Health Care Financing (3.1)• Lee & Mills,1983
Sumber pembiayaan kesehatan berasal dari empat sumber– I. Government
• A. Ministry of– Health– Social Security– Local Government– Transport & Communications– Agriculture– Rural Development– Industry Trade /Employment– Mine– Water Resources– Public Works– Education– Interior– Foreign Affair– Justice and Police– Defence
Health Care Financing (3.2)• Lee & Mills,1983
– B. Local Government• Regional• District• Municipalities• Village councils
– C. Other public agencies• Public Utilities• Nationalized industries• Compulsary health insurance
Health Care Financing (3.3)
• Lee & Mills,1983– II. Religious organizations &
domestic charities• A. Religious organizations/missions• B. Domestic charities and voluntary
bodies
Health Care Financing (3.4)
• Lee & Mills,1983– III. Private
• A. Private industry• B. Direct payments for
– In patient / out patient ( fees for services)– Private practitioners– Services abroad– Private dental services– Others private health services– Private purchases ( medicines, first-aid )– Transport required to use health services
Health Care Financing (3.5)
• Lee & Mills,1983– IV. External Sources
• Foreign aid and Technical Co-operation– Bilateral Government– Multilateral Government– Private
Health Care Financing (3.6)
• Lee & Mills,1983– Aplikasi at local level
• Individuals• Communities• Local insurance schemes• Local industry or agricultural enterprises or
co-operatives• Charity/religious missions• State or regional revenues• Central government revenues, and• External assistance
HEALTH CARE FINANCING.4Ministry Of Health RI
• Routine (DIK)• Development (DIP)• BLN (Foreign Aid)• OPRS• SBBO• INPRES
Health Care Financing (4.1)
• Gani.A,2001–I.Pemerintah
• Pemerintah Pusat: APBN, “JPSBK”, JPSBBM,Bantuan & Pinjaman LN
• Pemerintah Propinsi : APBD Prop• Pemerintah Daerah :APBD Daerah,
Penerimaan fungsional kesehatan– Dinas Kesehatan– BKKBN– Dinas Diknas– dll
Health Care Financing (4.2)
• Gani.A,2001– II.Non Pemerintah
• Out of pocket• Perusahaan• Asuransi Kesehatan
Indikator Kesehatan Beberapa Negara (191 Negara)
WHO:World Health Report 2000Negara IMR MMR MR
BalitaGNP/Kap (US$)
Biaya kes/kap(US$)
Urutan biaya kes
Malaysia 8 39 9 3.400 110 93
Thailand 26 44 30 1.960 133 64
Philipina 31 170 42 1.020 40 124
Indonesia 45 390 52 580 16 154
Vietnam 31 160 160 370 17 182
Myanmar 79 230 230 220 100 136
Srilangka 17 60 19 820 25 138
India 70 418 98 450 23 133
Deskripsi Alokasi Biaya pra krisis (2,5% Anggaran Kes Pemerintah)
GNP/kap 16 US$
Pem = 4 US$(25%) Masy =12 US$ (75%)
RT = 6 US$ As = 0.5 US$PT = 1.5 US$
Biaya kesehatan per kapita/th (US$), 1998/1999( Gani,A. 2001)
Propinsi Pemerintah Masyarakat Total
Aceh 0.75 2.30 3.05
Sumatra Utara 1.60 3.40 5.00
Sumatra Selatan 0.90 2.20 3.10
Sulawesi Tenggara
2.22 1.80 4.02
Nusa Tenggara Timur
2.20 2.20 4.40
Jawa Barat 1.71 4.89 6.60
Biaya kesehatan per kapita(US$) beberapa daerah 1999/00(Gani,A. 2001)
Kabupaten/Kota Pemerintah Masyarakat Total
Kab. Tangerang 0.77 3.74 4.51
Kota Bandar Lampung
1.60 7.53 9.13
Kab.Buton 0.41 1.26 1.67
Kota Kendari 0.71 2.52 3.23
Kab.Gresik 0.70 5.99 6.68
Kab.OKU 0.54 2.84 3.38
Kab.Lahat 0.84 1.43 2.27
Kab.Belitung 1.86 2.16 3.84
Kota Palembang 0.79 4.73 5.52
Kab.Dairi 2.94 4.79 7.73
Kab.Karo 5.76 4.71 10.47
Kota Medan 1.19 7.60 8.79
Government Health Expenditure (Rp billions) 1995/99( Rivany,R. 2001)
Sources 95/96 96/97 97/98 98/99
Routine (DIK) 633,886 733,912 1,034,134 1,150,572
Develop(DIP)
441,840 506,067 687,183 536,273
BLN(foreign aid)
237,490 365,649 201,149 545,778
OPRS 54,896 59,706 60,000 31,500
SBBO 38,000 49,500 55,000 55,000
INPRES 421,000 519,701 607,772 570,900
Total 1,827,112 2,234,535 2,645,238 2,890,023
Implkasi Alternatif Sistem Pembiayaan Kesehatan(Gani,A. 2001)
Activity Equity Quality Eficiency Sustainability TotalMobilisasi
•Subsidi•Out of pocket
•Price adjust•Prepayment
•Social charity•Private firms•Debt finance
Utilisasi•Fee for services
•Capitation•Budget
Implkasi Alternatif Sistem Pembiayaan Kesehatan(Gani,A. 2001)
Activity Equity Quality Eficiency Sustainability TotalMobilisasi
•Subsidi ***** * *** *** 12•Out of pocket * ** ** **** 9
•Price adjust ** ***** *** *** 13•Prepayment **** *** ***** ***** 17
•Social charity ***** * ** * 9•Private firms * **** *** ** 10•Debt finance * * * * 4
Utilisasi•Fee for services * **** * ** 8
•Capitation *** *** ***** ***** 16•Budget *** ** ***** **** 14
Ekonomi KesehatanRonnie Rivany
Pokok Bahasan.3.2PEMBIAYAAN KESEHATAN
(Rumah Sakit)
Public Hospital Financing (1.1)Sumber Pemasukan
Jumlah/2000 Jumlah/2001 Jumlah/2002
1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..
Public Hospital Financing (1.2)Sumber Pengeluaran
Jumlah/2000 Jumlah/2001 Jumlah/2002
1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..
Private Hospital Financing (2.1)Sumber Pemasukan
Jumlah/2000 Jumlah/2001 Jumlah/2002
1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..
Private Hospital Financing (2.2)Sumber Pengeluaran
Jumlah/2000 Jumlah/2001 Jumlah/2002
1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..
DISKUSI KELOMPOK• Tabel 1 & 2
– Jelaskan tanggapan kelompok terhadap pola Pembiayaan Kesehatan th 89/90 dengan trendnya di thn 94/95
• Tabel 3 & 4– Jelaskan tanggapan kelompok terhadap
pola Health Expenditure th 84/85 – 89/90 – 94/95
• Tabel 5– Jelaskan tanggapan kelompok terhadap
Pembiayaan Kesehatan Berdasarkan Sumber Dana thn 84/85 – 94/95