IMPLEMENTASI FUNGSI POKOK PELAYANAN PRIMER PUSKESMAS SEBAGAI GATEKEEPER DALAM PROGRAM JKN (STUDI DI PUSKESMAS JUWANA KABUPATEN PATI)

*Ainur Rahma -  , Indonesia
Septo Pawelas Arso -  , Indonesia
Anneke Suparwati -  , Indonesia
Received: 15 Jun 2016; Published: 13 Dec 2017.
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Section: Administrasi dan Kebijakan Kesehatan
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Abstract
The National Health Insurance (NHI) program which embracing the principles of Managed Care, focuses on the health care needs of first level Health Care Provider, where the first level Health Care Provider have an important role because as the main gate of patients who need health care utilization (Gatekeeper), so hoppefully most of health services finished at primary level. Primary Health Center (PHC) as first level health facilitation have strategic role and advantages for supporting the implementation of NHI compared to family doctors and private clinics because it has two functions, that are the function of organizing Primary Health Efforts and Individual Health Efforts. Where the principal function of Individual Health Efforts in NHI as gatekeeper are strengthening the function of first contact care, continuity care, comprehensive care, and coordination care. The purpose of this study was to analyze implementation of 4 primary care principal function of PHC as gatekeeper in NHI program in Juwana PHC, Pati, guidelines with “Manual Pelaksanaan JKN-BPJS Kesehatan” and performance indicators "Quality Indicators 9". This research was carried out to the stakeholders that related with the implementation of primary care principal functions in Juwana PHC, there are five main informants. Triangulation informant is the Head of Primary Health Care Management Unit from BPJS and Head of Basic Health Efforts and Referral Unit from Dinas Kesehatan Kabupaten Pati. The research used qualitative methods of collecting data through in-depth interviews. The results showed that the implementation of the primary care principal functions of Juwana PHC is 70% in accordance with the Guidelines for the ‘Manual Pelaksanaan JKN-BPJS Kesehatan’. While based on 3 indicators fromQI9assessmentin terms ofcommitmentof servicefor the determination ofperformance-basedcapitationnorm, PHCJuwanaonlyget acapitationRp. 4500.00on January-March 2015.
Keywords
National Health Insurance,Gatekeeper, Juwana Primary Health Center, Primary Care Functions

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