Sistem Jaminan Kesehatan

Nasional
UU no 40 tahun 2004 tentang SJSN
 UU no 40 tahun 2004 tentang SJSN :
9 Prinsip SJSN
1. Kegotong-royongan
2. Nirlaba
3. Keterbukaan
4. Kehati-hatian
5. Akuntabilitas
6. Portabilitas
7. Kepesertaan bersifat wajib
8. Dana amanat
9. Hasil pengelolaan dana jaminan sosial dipergunakan
seluruhnya untuk pengembangan program dan untuk
sebesar-besarnya kepentingan peserta
UU No 40 tahun 2004 tentang SJSn
UU no 40 tahun 2004 tentang SJSN
 Prinsip ekuitas
• Prinsip ekuitas adalah kesamaan dalam
memperoleh pelayanan kesehatan sesuai
dengan kebutuhan medis yang tidak terkait
dengan besaran iuran yang telah dibayarkan
• Prinsip ini diwujudkan dengan pembayaran
iuran sebesar prosentase tertentu dari upah
bagi yang memiliki penghasilan dan
pemerintah membayarkan iuran bagi mereka
yang tidak mampu
UU no 40 tahun 2004 tentang SJSN
UU no 24 tahun 2011 tentang BPJS
UU no 24 tahun 2011 tentang BPJS
 Why prospective ?
• Dapat mengendalikan biaya kesehatan
• Mendorong pelayanan kesehatan tetap
bermutu sesuai standar
• Membatasi pelayanan kesehatan yang tidak
diperlukan
• Mempermudah administrasi klaim
• Mendorong provider untuk melakukan cost
containment
The role of pharmacy in public health includes:
1) Access to medications
2) Assuring safe &
effective medications
3) Safely using/discarding
medications
 Access to Medicine
• The large of the worlds population that does not
benefit from simple, safe, effective
pharmaceutical and the millions of children and
adults who die each year from common condition
that can be prevented or treated with modern
medicines, signal a fundamental failure of health
care system
• Those who have access to essential medicines
often receive the wrong medicines, the wrong
dosage or a quantity insufficient for their need
 Why worry about medicines ?
• Medicines save lives and improve health
• Medicines promote trust and participation in
health services
• Medicines are costly
• Medicines are different from another
consumer product
• Substantive improvements in the supply and
use of medicines are possible
 Medicines are different from other
consumer product
• The consumer does not chose a medicines. It is
prescribed by a clinician or recomended by
pharmacy staff
• Even when consumer chose the medicines he or she
is not trained to judge it appropriateness, safety,
quality of value for money
• Neither the average medical practicioner nor the
average pharmacist is equipped to independenly
access the quality, safety or efficacy of each new
medicines
 Medicines are different from other
consumer product
• Fear or illnes can lead patients to demand costly
medicines from health workers or to buy such
medicines for themeselves when cheaper medicines
or no medicines would achieve the same result
• The consumer often cannot judge the likely
consequences of not obtaining a needed medicines.
This problem is most troublesome when the decision
maker is a parent and the patient is a child.
 Selection

Management support
1. Planing and administration
2. Organization and
Use management
Procurement
3. Information management
4. Human resources
management

Distribution

Policy, law and regulation

 Increasing access framework (source CPM/MSH 2011)
Strategies to
increase access
Availability Education
Accessibility • Supply of product • Patient
• Location of product and services consultating
and services • Demenad for product • Social marketing
• Location of users and services Management
• Business
management
Safe I efficacious I Cost effective I Quality • Financial
Medical product and services management
Regulation
• Standards
Acceptability
Affordability development
• Characteristics of
• Prices of product and • Task shifting
product and services
services Economic
• Attitudes and
• Ability to pay • Insurance plan
expectations of users
• Pooled
procurement
 Four dimension acces to essential medicines

• Availability defined by the relationship between the type and

quantity of product or service needed, and the type and
quantity peoduct or service provided.
• Affordability defined by the relationship between prices of
the product or services and the users ability to pay for them
• Accessibility defined by the relationship between the location
of the product or service and the location of eventual user of
the product and service
• Acceptability (satisfaction) defined by the relationship
between the user’s attitude and expectation about the
product and service and the actual characteristics the
products and services
 Cross cutting
• Quality of product and services an essensial
componen of access cutting across all the
dimension, but which specially applies to
product in terms of their safety, efficacy and
cost effectiveness
 E-Procurement,
E- Purchasing, E-Catalogue

Perpres No 16 Tahun 2018

Pengadaan Barang/Jasa Pemerintah
Permenkes No 48 Tahun 2013
Petunjuk Pelaksanaan Pengadaan Obat dengan
Prosedur E-purchasing Berdasarkan E-catalogue
Permenkes no 63 Tahun 2014
Pengadaan Obat Berdasarkan Katalogue Elektronik
Kepmenkes No 659 Tahun 2017
Formularium Nasional
Permenkes No 58 tahun 2014
Standar pelayanan kefarmasian di rumah sakit
Peraturan Presiden no 12 tahun 2013
Jaminan Kesehatan
 Tujuan Penerapan E-Procurement
1. Meningkatkan tranparansi / keterbukaan
dalam proses pengadaan barang/jasa
2. Meningkatkan persaingan yang sehat dalam
rangka penyediaan pelayanan publik dan
penyelenggaraan pemerintahan yang baik
3. Meningkatkan efektifitas dan efisiensi dalam
pengelolaan barang/jasa pemerintah
 E-Procurement
• Pengadaan secara elektronik atau E-
procurement adalah pengadaan Barang/Jasa
yang dilaksanakan dengan menggunakan
teknologi informasi dan transaksi elektronik
sesuai dengan ketentuan peraturan perundang-
undangan
 E-Purchasing
• E-Purcashing adalah tata cara pembelian
Barang/jasa melalui E-catalogue
 E-Catalogue
• Katalog Elektronik atau E-Catalogue adalah
sistem informasi elektronik yang memuat daftar,
jenis, spesifikasi teknis dan harga barang
tertentu dari berbagai penyedia barang/jasa
pemerintah
• Disusun dari FORNAS
 E-Tendering
• E-tendering adalah tata cara pemilihan
penyedia barang/jasa yang dilakukan secara
terbuka dan dapat diikuti oleh semua penyedia
barang/jasa yang terdaftar pada sistem
pengadaan secara elektronik dengan cara
menyampaikan 1 (satu) kali penawaran dalam
waktu yang ditentukan