KnE Life Sciences | The 2nd International Meeting of Public Health 2016 | pages: 391–400

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1. Introduction

Health financing is one of the subsystems in the national health system where there is an attempt of the costing, allocating, and purchasing, which are integrated and support each other in the implementation of health development. Sources of health financing come from Government and Non-Government. The mandate of the Health Legislation Number 36/2009 states that the Government health budget in the province and district is allocated a minimum of 10% (ten percent) of the allocation and budget of the areas outside of the salary. Financing the health budget appropriations are used to finance the Efforts of a public health program (PHE/UKM), individual health program Effort (IHE/UKP) and Supporting Efforts (health systems strengthening/PSK). The third program should be comprehensive and mutual support. The health system is composed of regulatory, governance, human resources health, drugs, health equipment, financing, and health facilities.

In fact, in the year 2015, 20.36 trillion of 51.28 trillion (39.7%) Health Fund from the Ministry Health Budget were used to JKN program. Permenkes 741/2008 mentioned that the Minimum Service Standard (SPM) was the Health benchmarks the performance of district/city governments in the health field, where 14 of the 18 indicators were derived from the activities of UKM. The health service financing in Depok came from government budget either national or regional. With the greater number of the budget earmarked for UKM, it would hopefully improve the performance of health services.

The synergy of the Central and Local governments in addressing the adequacy of allocation of health financing is indispensable. It is arranged in Kepmenkes 04/2003 in which the Health Accounts (HA) should be developed so that it will retrieve the image of the situation at the level of central funding through the National Health Accounts (NHA), the level of the province through the Provincial Health accounts (PHA) and district/city levels through the District Health accounts (DHA).

This research aimed to describe how to allocate Depok health budget could increase the performance targets of the health office. The benefits of this research was as inputs and the basis for developing a health financing system in the Depok city.

2. Methods

This research was an observational study using secondary data collected between 2013 – 2015. Secondary data consisted of the allocation of the budget and coverage of minimum service standard Depok District Health Office in 2013 up to 2015.

The data was analyzed by doing the univariate and bivariate analysis. Univariate analysis was done to get the information about the financial reports and coverage of minimum service standard in the District Health Office in Depok from 2013 to 2015. Bivariate analysis was done using the correlation test to get the information between the independent variable and the dependent variable. The independent variable was the percentage of budget allocation activities of UKM and the dependent variable was Depok health service performance in between 2013 – 2015.

3. Results

The data came from a report on the realization of financial reports and coverage of minimum service Standards (SPM) Depok Health Office. Budget allocation data was further subdivided into:

Based on the source of the budget:

  • District Budget Plan (APBD)

  • Non-APBD, consisting of:

Table 1

The Health Budget distribution according to budget in Depok 2013-2015.


Type of Budget 2013 2014 2015
District Budget Plan 92.142.884.276 166.554.021.845 137.499.473.638
Per c entage 79.08 72.19 63.60
NON District Budget Plan:
Provincial Budget Plan 6.107.249.000 5.000.000.000 4.352.386.200
Health Operational Assistance 2.758.800.000 2.950.800.000 3.015.000.000
National Healthcare Fund 6.547.993.860 31.415.508.000 49.494.419.048
Tax Smoking Fund 1.414.228.279 19.880.782.762 17.930.170.000
Fund For Tax and Tobacco Results 1.600.000.000 920.239.000 3.630.702.012
Physical Specific Allocation Fund 5.944.183.100 3.991.180.000 260.261.500
Total Non District Budget Plan 24.372.454.239 64.158.509.762 78.682.938.760
Percentage 20.92 27.81 36.40
Total Budget 116.515.338.515 230.712.531.607 216.182.412.398
Total District Budget Plan 2.358.440.280.976.00 2.669.550.591.184.90 3.163.054.626.434.42
% District Budget Plan 3.91 6.24 4.35
% Non District Budget Plan 1.03 2.40 2.49
% Total Budget 4.94 8.64 6.83

From the table above, it could be seen that most of the budget financing was still a financed by APBD, but there was a trend of reducing APBD because of health budget from the Central Government as the Health Operational Assistance, National Healthcare Fund, Fund For Tax and Tobacco Results, and Smoking Tax Fund.

Based on the program of financing of health care, sorted based on the title of the activity:

  • Public health Efforts (UKM) included community empowerment activities.

  • Individual health Efforts (UKP) included the National Healthcare Fund financing, facilitation of Jamkesda, drugs and supporting services.

  • Health system support (PSK) which included the Management, Facilitation, Infrastructure, and health equipment

Table 2

The distribution of the budget Based on Financing health services in Depok 2013-2015.


Program 2013 2014 2015
Budget % Budget % Budget %
UKM 14.416.372.979 12.18 34.920.411.112 15.14 37.954.895.162 17.56
UKP 75.580.049.646 63.83 132.494.523.836 57.43 108.440.784.117 50.16
PSK 28.404.649.769 23.99 63.297.596.659 27.44 69.786.733.119 32.28
TOTAL 118.401.072.394 100 230.712.531.607 100 216.182.412.398 100
Figure 1

Health service Budget trends Depok 2013-2015.

fig-1.jpg

From the table and the figure above, it showed that the Depok Health office was working to increase financing for public health efforts and supporting health systems.

Depok Health Office oversaw 35 Primary Health Care Provider (Puskesmas) as the cutting edge of service and activities program. The performance of the health service, referring to the 18 indicators of Minimum Service Standard (SPM) The coverage of activities of the District Health Offices was shown in the following table:

Table 3

Coverage of SPM and the Performance of the Depok Health Office 2013-2015.


Type of Health Services Indicator TARGET COVERAGE PERFORMANCE (%)
(%) 2013 (%) 2014 (%) 2015 (%) 2013 (%) 2014 (%) 2015 (%)
Primary Health care Visit Pregnant Women K4 95 91.55 93.3 9.34 96.37 98.21 99.31
Handling The Complications The Mother 80 100 100 100 100 100 100
Delivery by trained health personnel in PHC 90 99.65 99.77 92.88 100 100 100
Service Of Parturition (KF3) 90 84.52 83.75 88.75 93.91 93.06 98.61
Handling Of Neonatal Complications 80 13.94 21.06 12.1 17.43 26.33 15.13
Visit Baby Coverage 90 97.24 94.25 100 100 100 100
UCI of Village 100 100 100 100 100 100 100
Childhood Services 90 76.86 96.99 96.94 85.4 100 100
The granting of poor child MPASI 6-24 months 100 8.45 37.78 7.43 8.45 37.78 7.43
Stunting nutrition treatments 100 100 100 100 100 100 100
Elementary School Children's Screening 100 91.93 93.19 93.26 91.93 93.19 93.26
Active FP (KB) Participants 70 76.46 75.68 74.29 100 100 100
The discovery and treatment of Sufferers:
a. AFP rate/100,000 under 15 yo 2/100.000 1.527 0.561 1.659 76.35 56.1 82.95
b. Pneumonia Toddler 100 19.09 15.01 10.50 19.09 15.01 10.5
c. New TB Patients BTA (+) 100 55.49 45.53 53.77 55.49 45.53 53.77
d. Sufferers DBD yg handled 100 100 100 100 100 100 100
e. Diarrhea Sufferers 100 74.55 79.95 84.75 74.55 79.95 84.75
Referral Health Services Poor primary health services 100 21.87 23.72 47.57 21.87 23.72 47.57
Referral health services to the poor 100 100 100 100 100 100 100
Emergency level 1 services by the district hospital 100 100 100 100 100 100 100
Epidemiological investigation of the Outbreak and countermeasures The Investigation of the Outbreak village conducted epidemiological act < 24 hours 100 100 100 100 100 100 100
Health promotion and community empowerment Active Village Preparedness 80 100 100 100 100 100 100
79.13 80.40 81.51

From the table above, it was shown that the performance of the Depok Health Office increased from 79.13 in 2013 to 81.51% by 2015.

Bivariate analysis between independent and dependent variable was done using the correlation test and the result was further explained on the table below:

Table 4

Correlation between Percentage of budget allocation activities of UKM and Depok Health Office performance in 2013 – 2015.


Independent Variable <Dependent Variable (Depok Health Office performance 2013 – 2015)
r p-value
Percentage of budget allocation activities of UKM 0.998 0.038*

The result showed that therevwas a significant positive relationship between the percentage of budget allocation activities of UKM and Depok Health Office performance with r = 0.998 (strong correlation) and p-value = 0.038. Therefore, this research showed that the higher the percentage of the budget allocation for the UKM, the performance of the Health Office was reached.

4. Discussions

Health office as organizer of health at the district/city level has benchmark performance called Minimum Service Standards (SPM). The performance of a health program is determined by the adequacy of operational budget and budget activities directly.

These studies and a researched by Wuri (2012) only looked at the allocation of Depok government budget in health services, amounting to 6.83% for the health service, but had not seen a quantity 10% according to the recommendation of Health Legislation. Health budget was not limited in the District health office, but it was divided into the other government offices (OPD) such as RSUD, BPMK, and other offices.

Based on the source of the budget, although the amount of funding provided to the District Health Office was increasing, the channeling of funds from the Central and provincial governments made the Depok Government turned out to reduce the percentage of the amount of the budget of APBD from 70.08% in 2013 to 63.60% in 2015. An earmarked tax such as smoking tax, and DBHCT in which 50% of the appropriations, should be in the health sector. Adding JKN fund was the reason to reduction health budget inAPBD. This was related to the realization of the budget while the total number of human resources in the health service was very restricted to carry out program activities. (Suhandi Lubis 2013, Gani 2007)

From the above research, propensity for physical financing was still considerable, shown by 30% of the budget allocation was in supporting efforts (health systems strengthening) because of the needs of infrastructure and health equipment. UKP financing still absorbed over 50% of the budget. Non APBD fundings werer utilized for activities that were able to leverage the program's coverage into UKM, from about 12% to 18% of the budget as it was evidenced by the increase in the coverage of the indicators contained in the SPM reaching 81.51% of the targets to be achieved. Although Siti Sundari (2006) said that budget allocation was unenforceable because UKM and UKP was an inseparable or continuum program, a commitment to increase the budget for financing the activities of UKM could improve the performance of the district health office.

This research was observational research. Limitations of this research data were taken from budget allocation and just sort of activity-based budgeting program of Depok Health Office. Depok Government had not used the method of DHA (District Health Accounts) in drawing up health financing policy. The existence of this research might be the basic interests to develop DHA in Depok, so it could be known whether the costs were already allocated effectively and efficiently.

5. Conclusions

It could be concluded that to raise the performance of the required health service, the budgets should be sufficient to finance health programs. The performance of the health service could be seen from the coverage of the achievement of a minimum service Standards (SPM). The existence of a commitment to increase UKM financing was proven to be able to raise the coverage of indicators of SPM.

Suggestions

  • District Health Office should socialize Primary Health Care Provider (Puskesmas) how to make financial planning based on SPM so that the performance of the District Health Office could increase.

  • The Government of Depok City should develop health-based planning of DHA (District Health accounts) so that the allocation of funding could be effective and efficient.

Acknowledgments

Authors thank to Depok health Office particularly PEP and finance department, Bappeda Depok for the provision of data, Narita as data analysts, friends in magister FKM University Indonesia FKM, my families and my best friend who has been giving good support material as well as immaterial so that this paper can be realized.

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