Ek.kes Pembiayaan Ronnie

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


• Zchock,1979Sumber pembiayaan kesehatan berasal dari

dua sumber – Public & Quasi Public sources

• General Tax Revenues• Deficit Financing• Sales Tax Revenues• Social Insurance• Lotteries & Betting


• 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


• Lee & Mills,1983– II. Religious organizations &

domestic charities• A. Religious organizations/missions• B. Domestic charities and voluntary

bodies


• 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


• Lee & Mills,1983– IV. External Sources

• Foreign aid and Technical Co-operation– Bilateral Government– Multilateral Government– Private


• 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


• 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


• 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


1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..

Private Hospital Financing (2.1)Sumber Pemasukan


1…………..2………….3…………..4…………..5………….6………….7………….8…………9…………..

Private Hospital Financing (2.2)Sumber Pengeluaran


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

Documents

Ek.kes Pembiayaan Ronnie