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Abstract

Bengkulu is one of the provinces in Indonesia where SC rate has increased significantly over the last five years after the implementation of JKN. Previous studies into SC trend in Indonesia indicate that both overutilization and underutilization of SC exist reflected inequality. SC is a public health concern since it absorbs a huge amount of JKN funds and is indicated to contribute to the BPJS deficit. This study evaluates the achievement of the SC case equity target in Bengkulu Province based on the 2014- 2019 JKN roadmap. Combining qualitative and quantitative approaches, analyzing secondary data from the BPJS routine data and government survey (SUSENAS) as well as interview with Local government and BPJS staff. This study found that despite the increase in coverage of JKN memberships, gap exists in the provision of health professionals, doctors and obstetrician distribution likely affected the utilization of SC. Currently, SC is enjoyed mostly by women residing in Bengkulu city and dominated by PPU and PBPU segment, which are 39 and 45% respectively. Improved monitoring and realization of compensation policy to provide equal distribution of doctors and obstetricians either by BPJS or local government.

Bahasa Abstract

Bengkulu adalah salah satu provinsi di Indonesia yang dalam 5 tahun terakhir sejak implementasi JKN tercatat mengalami peningkatan proporsi persalinan lewat operasi Caesar. Sementara, BPJS Kesehatan melaksanakan fungsi pembiayaan dalam pelayanan kesehatan JKN. Tujuan penelitian ini adalah mengevaluasi capaian sasaran equity kasus SC di Provinsi Bengkulu berdasarkan peta jalan JKN 2014-2019. Metode yang digunakan adalah mix method yakni kuantitatif dan kualitatif dengan cara analisis data JKN dan SUSENAS serta wawancara pihak BPJS Kesehatan dan Dinas Kesehatan. Hasil penelitian menunjukkan bahwa tata kelola program JKN di Provinsi Bengkulu sudah cukup baik dalam aspek capaian kepesertaan. Namun, pada pemerataan pelayanan dibutuhkan keterbukaan dan sinergitas program dan kebijakan antara pemerintah daerah dan BPJS Kesehatan. Layanan SC di Provinsi Bengkulu belum merata dan berkeadilan. Utilisasi layanan operasi caesar lebih banyak dinikmati oleh peserta JKN yang tinggal di Kota Bengkulu dan didominasi segmen kepesertaan mampu yakni PPU (39%) dan PBPU (45%). Pengawasan layanan SC perlu dilakukan secara cermat. Selain itu, pemenuhan kebijakan kompensasi pelayanan SC perlu diupayakan bagi wilayah faskes tidak memadai oleh BPJS Kesehatan maupun Pemerintah Provinsi Bengkulu.

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