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Abstract

Palliative care services delivered through a home care scheme in Indonesia are not yet included in the National Health Insurance (JKN) benefit package. Through a bridging guarantee scheme, since 2020 the Regional Government of the Special Region of Yogyakarta (DIY) has provided this service to the local population in accordance with applicable regulations. Therefore, a basis for budget allocation that considers the regional conditions of DIY is required. This study employed a mixed-methods approach with an explanatory sequential design, beginning with a quantitative study to estimate the prevalence of the population requiring palliative care services as well as the unit cost using a time-driven activity-based costing (TDABC) approach. The qualitative study was conducted using purposive sampling of 14 respondents through in-depth interviews with healthcare workers, patients and their families, and policymakers, applying the Theoretical Framework of Acceptability (TFA). The estimated prevalence over five years (2025–2029) showed 145, 148, 151, 155, and 158 cases, respectively. The unit cost of palliative care services using the TDABC approach was IDR 3,396,787. The estimated budget for services over five years, after being multiplied by the number of cases, amounted to IDR 492,534,115; IDR 502,724,476; IDR 512,914,837; IDR 526,501,985; and IDR 536,692,346, respectively. Palliative care is a necessary service that provides significant benefits, particularly for poor and underprivileged populations. However, broader dissemination is needed, including clearer service standards and regulatory frameworks governing its implementation. Based on the financial capacity of the Regional Government of DIY, stakeholders need to prioritize eligible population groups as service beneficiaries, while also restructuring the existing service delivery system. This budget estimation is proposed as a basis for allocating funds to ensure the sustainability of palliative care services for poor and underprivileged populations in DIY.

References

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Bahasa Abstract

Layanan paliatif dengan skema home care di Indonesia belum termasuk dalam paket manfaat JKN. Melalui skema jaminan penyangga, sejak tahun 2020 Pemerintah Daerah DIY memberikan layanan ini kepada masyarakat DIY sesuai ketentuan yang berlaku. Oleh karena itu, diperlukan dasar alokasi anggaran yang mempertimbangkan kondisi wilayah DIY. Penelitian ini menggunakan metode campuran (mixed methods) dengan rancangan explanatory sequential, yang diawali dengan studi kuantitatif untuk mengestimasi prevalensi penduduk yang membutuhkan layanan paliatif serta unit cost menggunakan pendekatan time-driven activity-based costing (TDABC). Studi kualitatif dilakukan dengan teknik purposive sampling terhadap 14 responden melalui wawancara mendalam dengan tenaga kesehatan, pasien dan keluarga, serta pembuat kebijakan menggunakan pendekatan Theoretical Framework of Acceptability (TFA). Hasil estimasi prevalensi selama lima tahun (2025–2029) menunjukkan jumlah kasus sebanyak 145, 148, 151, 155, dan 158 orang. Unit cost layanan paliatif dengan pendekatan time-driven activity-based costing sebesar Rp3.396.787. Estimasi anggaran layanan selama lima tahun, setelah dikalikan dengan jumlah kasus, berturut-turut adalah sebesar Rp492.534.115; Rp502.724.476; Rp512.914.837; Rp526.501.985; dan Rp536.692.346. Pelayanan paliatif merupakan layanan yang dibutuhkan dan memberikan manfaat signifikan, khususnya bagi penduduk miskin dan tidak mampu. Namun, diperlukan sosialisasi yang lebih luas, termasuk kejelasan standar layanan dan regulasi yang mengatur pelaksanaannya. Berdasarkan kemampuan Pemerintah Daerah DIY, para pemangku kepentingan perlu memprioritaskan kelompok masyarakat yang memenuhi kriteria sebagai penerima layanan, sekaligus menata kembali sistem pelayanan yang telah berjalan saat ini. Estimasi anggaran ini disusun sebagai dasar pengalokasian anggaran untuk menjamin keberlangsungan layanan paliatif bagi penduduk miskin dan tidak mampu di DIY.

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