Oleh: Zairil
ABSTRAK
Latar
Belakang: Kesehatan adalah hak fundamental setiap
warga. Asuransi kesehatan masyarakat miskin (Askeskin) bertujuan untuk
meningkatkan akses pelayanan kesehatan masyarakat miskin yang masih rendah.
Utilisasi persalinan oleh tenaga kesehatan bagi ibu miskin di Kecamatan Nan
Sabaris Kabupaten Padang Pariaman tahun 2006 relatif masih rendah yakni 68,2%. Keberhasilan
program Askeskin dalam peningkatan utilisasi
persalinan ditolong oleh tenaga kesehatan bagi ibu miskin ditentukan
dengan indikator cakupan yakni 90%.
Tujuan penelitian ini adalah untuk
mengukur hubungan kepemilikan askeskin dengan utilisasi persalinan oleh tenaga
kesehatan.
Metode:
Rancangan penelitian ini case controlstudydengan populasi ibu miskin yang
melahirkan periode Januari 2006 - Juli 2007. Besar sampel 140 orang terdiri
dari 70 ibu bersalinditolong oleh dukun bayi (kasus) dan 70 ibu bersalin
ditolong oleh tenaga kesehatan (kontrol). Teknik sampling secara simple random
sampling. Variabel bebas yakni kepemilikan askeskin dan variabel terikat adalah
utilisasi persalinan oleh tenaga kesehatan.Variabel luar meliputi umur,
pendidikan, pengetahuan ibu tentang
paket pelayanan askeskin, sikap/pandangan terhadap pelayanan kesehatan, jarak
ke fasilitas pelayanan kesehatan dan
sarana transportasi. Analisis data
secara univariabel dan bivariabel denganuji statistik chi square.
Analisis pemodelan multivariabel dengan uji statistik regresi logistik untuk
mengukur hubungan kepemilikan askeskin dengan utilisasi persalinan oleh
tenaga kesehatan dengan mengendalikan
beberapa variabel luar. Keeratan hubunganvariabel diukur dengan nilai rasio
odds dengan tingkat kepercayaan (IK) 95% dan α = 0,05.
Hasil:
Analisis multivariabel dengan uji regresi logistik menunjukan bahwa ada hubungan yang signifikan
antara kepemilikan askeskin dengan utilisasi persalinan oleh tenaga kesehatan pada ibu miskin (p<0,05). Keeratan hubungan dengan
nilai rasio odds= 6,43 (95% IK: 2,79 –14,79) setelah variabel pendidikan
dikendalikan pada tingkat analisis.
Kesimpulan:
Ada hubungan antara kepemilikan askeskin dengan utilisasi persalinan oleh
tenaga kesehatan. Probabilitas persalinan ibu miskin dengan pertolongan dukun
bayi pada ibu yang tidak memiliki
askeskin yakni 6 kali lebih tinggi dibanding persalinan ibu miskin yang tidak memiliki askeskin dengan
pertolongan tenaga kesehatan. Disarankan program askeskin sebaiknya tetap
dilanjutkan dan sosialisasi askeskin perlu langsung kepada masyarakat miskin
yang menjadi sasaran terkait dengan pendistribusian dan penggunaan kartu
askeskin serta sosialisasi
tentang paket pelayanan kesehatan.
Kata
Kunci: Asuransi kesehatan, Utilisasi,
Persalinan, Tenaga Kesehatan
ABSTRACT
Background:
Health is a basic human right. Health insurance for poor community aims to increase
access to health service by poor community. The utilization of childbirth
service provided by health professionals among poor
mothers at Subdistrict of Nan Sabaris, District of Padang Pariaman in
2006 was relatively low (68.2%). Meanwhile the success of health insurance
program for poor community is indicated by coverage of childbirth service
assisted by health professionals for poor mothers as much as 90%.
Objective:The study aimed to assess the
effect of health insurance
for poor community to the
utilization of childbirth assisted by health professionals.
Method:This
was a case control study using the population of poor mothers who gave birth
during January 2006 –July 2007. There were 140 samples consisting of 70 mothers
assisted by traditional childbirth attendants (as cases) and 70 mothers assisted
by health professionals(as control). Samples were chosen using simple random
sampling technique. The independent variable was ownership of health insurance for
poor community and the dependent
variable was the utilization of childbirth
service provided by health professionals. External variables consisted of age,
education, knowledge of mothers about service package of health insurance for poor
community, attitude/view about health service, distance to health service facilities and transportation
facilities. Data analysis used univariable and bivariable technique with chi
square statistical test.
Model analysis used multivariable technique with logistic regression
statistical test to measure the relationship between ownership of health
insurance for poor community and the
utilization of childbirth provided by health professionals by controlling some
external variables. Closeness of the relationship between variables was
measured using odds ratio (OR) with CI 95% and α= 0.05.
Result:
The result of multivariable analysis using logistic regression test showed that
there was significant relationship between ownership of health insurance for poor community and the utilization of
childbirth provided by health professionals among poor mothers (p<0.05).
Closeness of the relationship indicated OR= 6.43, CI 95%= 2.79 –14.79 after
variable of education was controlled at the analysis level.
Conclusion:
There was relationship between ownership of health insurance for poor community
and the utilization of childbirth
provided by health professionals.The probability of childbirth provided by
traditional childbirth attendants being utilized by poor mothers who are not
covered by health insurance was 6 times higher than poor mothers who are not
covered by health insurance gave birth
with health professionals.The
program of health insurance
for poor community should be continued
and wider socialization should be made directly to poor community as target through
the distribution and utilization
of health insurance as well as socialization
on health service packages.
Keywords:
health insurance, utilization, childbith, health professionals
BAB
I : PENDAHULUAN
A. Latar Belakang
B. Perumusan Masalah
C. Tujuan Penelitian
D. Manfaat Penelitian
E. Keaslian Penelitian
BAB
II : TINJAUAN PUSTAKA
A. Pelayanan Persalinan
B. Utilisasi Pelayanan Kesehatan
C. Sistem Pembiayaan Kesehatan
D. Landasan Teori
E. Kerangka Konsep
F. Hipotesis Penelitian
BAB
III : METODE PENELITIAN
A. Jenis dan Rancangan Penelitian
B. Populasi dan Subyek Penelitian
C. Sampel dan Teknik Sampling
D. Tempat dan Waktu
E. Variabel dan Definisi
Operasional
F. Instrumen Penelitian
G. Cara Pengumpulan Data
H. Analisis Hasil
I. Jalannya Penelitian
J. Kesulitan Penelitian
K. Kelemahan Penelitian
BAB
IV : HASIL PENELITIAN DAN PEMBAHASAN
A. Hasil Penelitian
B. Pembahasan
BAB
V : KESIMPULAN DAN SARAN
A. Kesimpulan
B. Saran
DAFTAR
PUSTAKA
LAMPIRAN
