(R)UU Keperawatan Di Era Sistem Kesehatan Nasional Dan Peta Jalan Program JKN

Introduction : Beberapa waktu yang lalu cukup ramai diberitakan oleh media cetak dan online bahwa RUU Keperawatan telah disahkan oleh DPR melalui Sidang Paripurna Hari Jum’at tanggal 12 September 2014. Sebuah media online pada hari Minggu 14/9/2014 menulis judul berita : “RUU Keperawatan Sudah Rampung, Kini Perawat Bisa Buka Praktik Sendiri”. Pun begitu dari sebuah media cetak pada hari Senin 15/9/2014 yang menurunkan berita berjudul “RUU Keperawatan Selesai, Perawat Bisa Buka Praktek”.

Menarik untuk kita diskusikan karena beberapa pertanyaan mendasar seperti : (1). Dimana posisi UU Keperawatan ini dalam program besar pemerintah yaitu Sistem Jaminan Sosial Nasional (SJSN) melalui program JKN yang sudah dirintis di awal tahun ini oleh BPJS Kesehatan ?? dan (2). Apakah kontribusi dari undang-undang ini dalam rencana jangka panjang pemerintah menuju Universal Health Coverage atau jaminan kesehatan semesta pada tahun 2019 nanti sebagaimana telah digariskan dalam peta jalan (road map) JKN 2012 – 2019 ??

Discussion : Secara garis besar UU Keperawatan ini mengatur tentang lingkup praktik keperawatan, Konsil Keperawatan, standar pendidikan profesi, pendidikan berkelanjutan, registrasi tenaga perawat dan penyelenggaraan praktik keperawatan. Sehingga templateatau outline memang sama persis dengan UU Praktik Kedokteran Nomor 29 Tahun 2004.

Bagian yang menarik adalah BAB VIII tentang Penyelenggaraan Praktik Keperawatan terutama pada Pasal 48 yang mengatur tentang Praktik Mandiri perawat. Pasal 37 sampai Pasal 47 mengatur praktik keperawatan secara komprehensif yaitu menyangkut kewenangan perawat, hak dan kewajiban pasien, pengungkapan rahasia pasien serta hak dan kewajiban perawat dalam konteks kerja perawat yang bekerja di fasilitas kesehatan maupun mandiri.

Pasal 48 tentang Praktik Mandiri adalah yang paling menarik karena penulis mencoba memasukkan spirit dari substansi pasal ini ibarat sebuah kepingan “puzzle” dalam kerangka besar sistem JKN di Indonesia melalui BPJS Kesehatan. Pasal 48 Ayat (1) berbunyi : “Praktik mandiri dapat dilakukan secara perorangan dan atau berkelompok”. Sedangkan Ayat (2) berbunyi : “Perawat dalam melakukan praktik mandiri sekurang-kurangnya memenuhi persyaratan : (a) Memiliki tempat praktik yang memenuhi persyaratan kesehatan; dan (b) Memiliki perlengkapan untuk tindakan asuhan keperawatan di luar institusi pelayanan kesehatan termasuk kunjungan rumah.” Makna dari pasal ini sangat jelas bahwa perawat diperbolehkan baik secara sendiri ataupun berkelompok untuk melakukan praktik pelayanan asuhan keperawatan bahkan di luar fasilitas kesehatan termasuk kunjungan rumah (home visite).

Point of View JKN : Pertama, Undang-Undang Nomor 24 Tahun 2011 tentang BPJS menegaskan bahwa salah satu prinsip JKN adalah kepesertaannya yang bersifat WAJIB dan telah digariskan sesuai peta jalan JKN bahwa pada tahun 2019 seluruh warga negara Indonesia termasuk warga negara asing yang bekerja di Indonesia lebih dari 6 bulan HARUS menjadi peserta BPJS. Inilah yang disebut dengan jaminan kesehatan semesta atauUniversal Health Coverage (UHC) sesuai dengan komitmen global yang telah ditetapkan olehWorld Health Assembly (WHA) pada konferensi di Jenewa tahun 2005.

Kedua, unsur-unsur penyelenggara JKN sebagaimana diatur dalam Pedoman Pelaksanaan JKN (PMK No. 28Tahun 2014) adalah : (1). Regulator (pemerintah melalui kementerian); (2). Peserta JKN yaitu seluruh rakyat Indonesia termasuk pegawai asing yang bekerja minimal 6 bulan; (3). Pemberi pelayanan kesehatan yaitu Fasilitas Kesehatan Tingkat Pertama (FKTP) dan Fasilitas Kesehatan Tingkat Lanjutan (FKTL) dan terakhir adalah (4). Badan penyelenggara yaitu BPJS.

Ketiga, Pasal 36 Perpres Nomor 12 tahun 2013 tentang Jaminan Kesehatan menyebutkan bahwa penyelenggara pelayanan kesehatan meliputi semua Fasilitas Kesehatan yang menjalin kerjasama dengan BPJS Kesehatan atau pada keadaan tertentu (kegawatdaruratan medik atau darurat medik) dapat dilakukan oleh fasilitas kesehatan yang tidak bekerja sama dengan BPJS Kesehatan. Fasilitas Kesehatan Tingkat Pertama (FKTP) yang dimaksud dalam PMK No. 28 Tahun 2014 tentang Pedoman Pelaksanaan JKN adalah : Puskesmas atau yang setara, Praktik Dokter, Praktik Dokter Gigi, Klinik Pratama atau yang setara dan RS Kelas D atau yang setara. Sedangkan Fasilitas Kesehatan Tingkat Lanjutan (FKTL) adalah Klinik Utama atau yang setara, Rumah Sakit Umum dan Rumah Sakit Khusus.

Ke-empat, manfaat jaminan kesehatan sebagaimana disebutkan pada Pasal 20 Perpres No. 12 Tahun 2013 adalah manfaat medis berupa pelayanan kesehatan yang komprehensif (promotif, preventif, kuratif dan rehabilitatif) sesuai dengan indikasi medis yang tidak terikat dengan besaran iuran yang dibayarkan; dan manfaat non-medis meliputi akomodasi dan ambulan. Pelayanan kesehatan meliputi pelayanan kesehatan Rawat Jalan Tingkat Pertama (RJTP) dan Rawat Inap Tingkat Pertama (RITP), pelayanan kesehatan Rawat Jalan Tingkat Lanjutan (RJTL), Rawat Inap Tingkat Lanjutan (RITL), pelayanan gawat darurat dan pelayanan kesehatan lain yang ditetapkan oleh menteri.

Brief Summary : Program JKN akan diikuti oleh seluruh rakyat Indonesia pada tahun 2019 yang akan dilayani oleh fasilitas kesehatan yang telah bekerjasama dengan BPJS dengan memberikan manfaat medis dan non-medis yang bersifat komprehensif. Sehingga tidak terdapat celah atau peluang untuk melaksanakan praktik mandiri pelayanan asuhan keperawatan karena“puzzle-puzzle” itu sudah tersusun dengan rapi dan terstruktur dalam membentuk frame atau kerangka Jaminan KesehatanNasional (JKN) dalam peta jalan JKN 2012-2019.

Conclussion : (R)UU Keperawatan penting dalam konteks mengatur perawat professional yang memiliki 3 aspek yaitu (1). Kompetensi (skill, knowledge and attitude) melalui pengaturan tentang standar pendidikan profesi dan pendidikan berkelanjutan; (2). Sertifikasimelalui pengaturan tata cara registrasi dan penerbitan STR Perawat dan terakhir adalah (3).Licensi melalui pengaturan tata cara penerbitan Surat Ijin Praktik Perawat (SIPP). Ketiga komponen ini memang sangat penting untuk menjamin profesionalisme dan legalitas tenaga perawat yang bekerja pada sarana fasilitas kesehatan baik pada FKTP (Puskesmas dan Klinik) ataupun FKTL (Rumah Sakit).

Namun (R)UU Keperawatan menjadi kehilangan urgensi nya pada BAB dan Pasal yang mengatur tentang praktik keperawatan mandiri. Karena jelas dalam kerangka sistem JKN maka tenaga perawat bukanlah komponen dari sistem tersebut, akan tetapi menjadi sub-component dari komponen Fasilitas Kesehatan Tingkat Pertama atau Lanjutan. Artinya, tenaga perawat hanya bisa menjalankan praktik pelayanan asuhan keperawatan ketika ber-kolaborasi atau ber-affiliasi dengan tenaga kesehatan medis (dokter) dalam sebuah lingkup yang disebut Fasilitas Kesehatan (Faskes) baik FKTP ataupun FKTL.

Jadi, QuoVadis (R)UU Keperawatan ?? Semoga ini bukanlah sekedar “hadiah alakadarnya” terakhir dari para wakil rakyat kita (DPR) yang sebentar lagi akan berakhir masa tugasnya. Sekian.

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