SISTEM PELAYAN KESEHATAN DI INDONESIA

Oleh:

Siti Masfiah, SKM, M.Kes, M.A

Kesehatan Masyarakat UNSOED

OUTLINE
Definisi Pelayanan Kesehatan Jenis Pelayanan Kesehatan Sistem Pelayanan Kesehatan di Indonesia

Stratifikasi Pelayanan Kesehatan

Masalah Pelayanan Kesehatan di Indonesia

DEFINISI PELAYAN KESEHATAN

Prof. Dr. Soekidjo Notoatmojo:

Sub sistem Yankes tujuan utamanya adalah pelayanan preventif dan promotif dengan sasaran masyarakat.
Levey & Loomba (1973): Upaya yang diselenggarakan sendiri/bersama dalam suatu organisasi untuk memelihara dan meningkatkan kesehatan, mencegah dan menyembuhkan penyakit serta memulihkan kesehatan perorangan, keluarga, kelompok atau masyarakat. Acuan Depkes RI (2009)

JENIS PELAYANAN KESEHATAN

Pelayanan Kedokteran:

Medical Services
Solo prectice/bersama-sama Tujuan: menyembuhkan penyakit, memulihkan kesehatan Sasaran: perorangan dan keluarga Pelayanan kesehatan Masyarakat Public health services Pengorganisasian secara bersama-sama Tujuan: memelihara dan meningkatkan kesehatan, mencegah penyakit Sasaran: kelompok, masyarakat

LEVELS OF PREVENTION

Onset of Disease Exposure Early Detection

Onset of Signs/ Symptoms

D1. Cure D2. Control C

D3. Disability

D4. Death
Primary Prevention Secondary Prevention Tertiary Prevention

Preclinical
Copyright 2008, The Johns Hopkins University and Henry Taylor

Clinical

MEDICAL VS PUBLIC HEALTH SERIVCES MEDICINE AND PUBLIC HEALTH

DEATH SICK/ILL
APPROACH : CURATIVE MEDICINE/DOCTOR TARGET : SICK PERSON INDIVIDUAL GOAL : CURED PERSON THROUGH : -TREATMENT/DRUG -TECHNOLOGY BASED MEDICAL SERVICES MEASUREMENT : INDICATORS -MORTALITY -MORBIDITY

ONSET Do not SICK

HEALTHY

APPROACH : PREVENTION PROMOTION

TARGET : UN-SICK PEOPLE/COMMUNITY GOAL : HEALTHY PEOPLE IN A HEALTHY ENVIRONMENT THROUGH : -HEALTHY PUBLIC POLICY -BEHAVIOR CHANGE -Preventive & Promotive based HEALTH SERVICES

MEASUREMENT : HEALTH INDICATORS -HDI ????? -QLI ??????

MEDICAL VS PUBLIC HEALTH SERIVCES MEDICINE AND PUBLIC HEALTH

DEATH SICK/ILL ONSET Do not SICK HEALTHY

DEATH

HEALTHY HEALTHY

DEATH

DEATH

HEALTHY

By DECREASING MORTALITY AND MORBIDITY MEANS INCREASING HEALTH ???

MEDICAL VS PUBLIC HEALTH SERIVCES MEDICINE AND PUBLIC HEALTH

DEATH SICK/ILL ONSET Do not SICK HEALTHY

Patient Practitioner Chief complaint History & Physical Laboratory tests Clinical Diagnosis Treatment plan Home monitoring and Follow-up visit

follow-up testing

A defined population A health system Community perceptions Professional opinions Epidemiologic analysis Community Diagnosis Interventions Monitoring efforts

Modification of all the above steps.

Sistem Pelayanan Kesehatan

Sistem : Tatanan, komponen, interaksi, interdependensi, tujuan
Proses Output

Input

Feed back

SYSTEM
Systems have structure, defined by parts and their

composition;
Systems have behavior, which involves inputs,

CARDIOVASCULAR SYSTEM

processing and outputs of material, energy or information;

Systems have interconnectivity: the various parts of

a system have functional as well as structural relationships between each other.

System(s) have by itself function(s) or group of

Functions

PUBLIC HEALTH SYSTEM

PUBLIC HEALTH SYSTEM

REGULATOR (Government)

HEALTH OF COMMUNITY PROVIDER PROVIDER PROVIDER CLIENTS CLIENTS CLIENTS

Services

PUBLIC HEALTH STRUCTURES

Public Health Structure

Four governmental levels : Local/District Health Office/Departments State / Province Health Office/Agency
Bureau for Public Health, Health Care Authority

Federal / National Government Ministry of Health, CDC, EPA, ? International Health Agencies WHO, UNICEF, etc

MINISTRY OF HEALTH FROM CENTRAL TO PERIPHERAL LEVEL

HEALTH DEPARTMENT (Depkes) Ministry of Health Central Level

Provinced Health Office (Dinkes) Provincial level

District Level Health Office District Level

Sub district Level Health Centre Village Level

Sub Health Centre (Pustu)

Village Midwife Clinic (Polindes)

Integrated Health Post(Posyandu)

REFERRAL SYSTEM
Public Health Unit Health Centre Unit

Health Department/Provinced Health Office (Depkes/DKP)

Health Foundation 3rd level

Central or Province Hospital

District Level Health Office

Health Foundation 2nd level

District/city Hospital, Clinic, Private Practitioner

Primary Health Care

Health Foundation Ist level

Primary Health Care, Midwife, General practitioner

Village Midwife Clinic & Integrated Health Post

Community
HOUSEHOLD

Village Midwife Clinic, Integrated Health Post & Village Health Post

Maximal Type of Regional Health Office Structure

Minimal Type of Regional Health Office Structure

Relationship Between Regional Health Office and other Department

Walikota/major BAPPEDA Private doctor/midwife BKKBN Private Hospital Province Health Office Regional Health office RSUD Posyandu (Integrated Service Post) Traditional medicine Regional Legislative council

central statistics agency

Public Works

POM Institution

Regional Health Laboratory

Primary Health Care

Department of Hygiene And funeral

Dispenda

Regional AIDS control

Industry and Trade Office

Tourism Agency

Non government Organization

Religion Office

PDAM

Social Office

Education Office

TYPES OF HEALTH WORKER (PP NO 32 TAHUN 1996 )

1) Health personnel consist of: a. medical personnel; b. nursing personnel; c. pharmacy personnel; d. community health workers; e. energy malnutrition; f. Therapy of physical strength; g. Technicians medical personnel. 2) Labor includes medical doctors and dentists 3) Labor nursing include nurses and midwives. 4) Energy pharmacy involves pharmacists, pharmaceutical analyst and assistant pharmacist. 5) Power epidemiology public health include health, medical entomologist, microbiologist health, health extension workers, health administrators and sanitarian. 6) Energy includes nutritionists and nutrition dietitian. 7) Power of therapy include physical therapist, speech therapist and Occupational Therapy . 8) Labor radiographer technician include medical, radioteraphist , dental technician, technician elektromedist, health analyst, refractionis optisien, otorik prosthetic, technicians transfusions and medical recorder.

PUBLIC HEALTH FINANCING

HEALTH FINANCING

There are generally five primary methods of funding health care systems:

direct or out- of- pocket payments, general taxation to the state, county or municipality, social health insurance, voluntary or private health insurance, and donations or community health insurance.

TERIMAKASIH