Titip Pesan Buat ARSADA Terkait Program JKN

Berikut beberapa pokok pemikiran saya yang mudah-mudahan bisa disampaikan dalam rapat ARSADA besok. Menyimak persoalan-persoalan terkini terkait Program JKN, maka saya dapat memberikan beberapa update informasi di lapangan sebagai berikut.

Masalah yang pertama adalah tentang ketersediaan obat-obatan bagi peserta JKN. Ada beberapa fakta di lapangan yang saya cermati, yaitu :

  1. Keluhan-keluhan masyarakat sekarang sudah mulai mengerucut ke masalah penyediaan obat yang melibatkan pihak eksternal di luar sistem JKN. Keluhan masyarakat terkait layanan faskes sudah mulai berkurang, begitu juga keluhan terhadap adanya iur biaya sudah relatif tidak “seramai” dulu lagi.
  2. Isu utama saat ini adalah adanya keluhan JKN yang harus merogoh kocek nya untuk membeli obat-obatan yang konon katanya tidak tersedia di e-katalog sehingga IFRS ataupun apotek jejaring BPJS harus membeli obat dengan harga reguler yang lebih tinggi dari harga e-katalog.
  3. Kondisi ketersediaan obat yang masuk dalam e-katalog di pabrikan saat ini semakin parah. Sistem e-katalog yang hanya ada satu pabrikan/prinsipal untuk satu jenis obat sangat aneh dan riskan sehingga sangat wajar apabila pada akhirnya pabrikan tersebut “melambaikan tangan ke kamera” alias menyerah menerima pesanan yang begitu membludak dan jauh dari perkiraan mereka sendiri.
  4. Jika membandingkan dengan 4 bulan pertama pelaksanaan JKN (Januari – April) dimana DPHO warisan ASKES masih bisa dipergunakan sebagai acuan, maka kita dapat melihat bahwa persoalan obat-obatan relatif tidak begitu mengemuka dan dapat diatasi. Namun sejak DPHO sudah tidak boleh dipergunakan lagi maka kita melihat bahwa persoalan ketersediaan obat menjadi masalah yang sangat dominan dan menjadi sebagian besar keluhan masyarakat.
  5. DPHO yang masih mencantumkan 3 – 4 prinsipal/pabrikan untuk satu jenis obat ternyata jauh lebih baik daripada e-katalog karena ada pilihan untuk membeli dari prinsipal lain ketika sebuah prinsipal tidak dapat melayani.

Kenapa persoalan ini terjadi ? Menurut hemat saya adalah karena LKPP yang menjadi si “Raja Tega” dalam memangkas harga obat-obatan sampai-sampai margin yang ada hanya cukup untuk mengantar obat oleh distibutor/PBF ke faskes ataupun Apotek jejaring. Sampai ada selorohan begini dari distributor/PBF : “Silahkan beli dengan harga e-katalog tapi kami tidak bisa mengantar, kami hanya akan buka “lapak” di depan kantor dan dipersilahkan faskes atau apotek untuk mengambil sendiri obatnya di lapak depan kantor kami”.

Dari gambaran ini maka sudah sangat jelas begitu kelimpungannya mereka para distributor/PBF dengan harga e-katalog. Celakanya kontrak payung antara LKPP dilakukan BUKAN dengan distributor/PBF akan tetapi dengan prinsipal/produsen/pabrikan. Dan jika kita cermati maka kebanyakn prinsipal/produsen obat adalah perusahaan “baru kemarin sore” dan belum memiliki nama besar ataupun jam terbang tinggi di kancah penyediaan obat-obatan, namun kemudian mereka menyatakan sanggup ikat kontrak dengan LKPP dan celakanya hanya mereka yang sanggup sehingga untuk 1 jenis obat hanya ada 1 prinsipal/produsen. Ini sangat rawan terjadi masalah.

Rekomendasi dari saya adalah :

  1. Mohon ARSADA memberi tekanan kepada Direktorat Jendral Bina Kefarmasian dan Alat Kesehatan Kemenkes agar melakukan evaluasi terhadap seluruh kontrak payung antara LKPP dengan prinsipal/produsen obat. Mohon agar LKPP melakukan evaluasi tehadap harga-harga obat dalam e-katalog karena ini menyangkut pelayanan kepada peserta JKN. Janganlah terlalu “ganas” memangkas harga obat-obatan dalam situasi dan kondisi negara Indonesia yang masih belum ideal seperti saat ini.
  2. ARSADA bisa memberikan saran kepada Kemenkes agar memperbolehkan penggunaan DPHO lagi sebagai alternatif kedua selain e-katalog. Dan jika memungkinkan maka harga obat-obatan standar diatur dan dikendalikan oleh Kemenkes melalui Direktorat Jendral terkait dan jangan dilepaskan begitu saja prinsipal/produsen obat untuk “berperang” sendirian dengan LKPP.

Jadi kesimpulannya, masalah ini sudah jelas dan ibarat penyakit maka diagnosa nya sudah tegak, tinggal mau diselesaikan atau tidak, mau diobati atau tidak.

Masalah yang kedua adalah : Pemahaman tentang kriteria penyakit yang konon katanya ada 144 jenis penyakit yang TIDAK BOLEH dirujuk mohon untuk diperjelas lagi. Sekiranya ARSADA bisa memberi masukan kepada Kemenkes agar mengeluarkan aturan yang tegas dan baku terkait hal ini dengan tetap merujuk pada pokok-pokok pikiran Konsil Kedokteran Indonesia (KKI) yang tegas menyatakan bahwa 144 penyakit tersebut adalah digunakan sebagai acuan target kompetensi minimal yang harus menjadi dasar penyusunan kurikulum standar pendidikan kedokteran di Indonesia dan BUKAN menjadi dasar pemahaman bahwa ke 144 penyakit tersebut TIDAK BOLEH DIRUJUK ke faskes 2.

Masalah yang ketiga adalah : Masih adanya perbedaan jam buka pelayanan FKTP karena perbedaan jenis FKTP (Klinik 24 Jam, Dokter Praktek Mandiri dan Puskesmas). Hal ini rawan menimbulkan komplain dari peserta yang kebetulan FKTP nya tidak melakukan pelayanan 24 jam karena jika memerlukan pelayanan yang diluar jam buka pelayanan maka tidak bisa, sementara peserta yang lain bisa karena kebetulan FKTP nya adalah klinik 24 jam. Di beberapa cabang pada akhirnya mengeluarkan kebijakan “lokal” yang memperbolehkan pasien dengan kasus seperti ini untuk berkunjung ke IGD meskipun tidak termasuk dalam kriteria emergensi.

Rekomendasi : Kemenkes perlu meninjau ulang aturan tentang kredensieling faskes khususnya FKTP. Perlu disusun standar baku jam buka pelayanan bagi FKTP.

Masalah ke-empat : Persoalan RAYONISASI FKRTL sepertinya terlalu kaku karena masalah jenjang rujukan dari RS Rujukan Kab/Kota, Rujukan Regional, Rujukan Propinsi dan Rujukan Nasional belumlah berjalan seperti kondisi ideal. RS Kelas C dan B yang masih dalam satu level yaitu layanan sekunder menjadi agak bias dan gamang di lapangan. Mohon untuk memberi masukan kepada Kemenkes agar persoalan Rayonisasi FKRTL ini untuk dievaluasi dan diperbaiki lagi.

Masalah yang kelima adalah : Sekiranya ARSADA bisa memberi masukan kepada DJSN agar menjadi Steering Comitte (SC) kepada BPJSK dalam hal perumusan metodologi SOSIALISASI dan PUBLIKASI program JKN kepada BPJSK. Masalah sosialisasi masih belum efektive dan berhasil guna. Perlu mencari metode-metode alternatif dalam sosialisasi program JKN kepada masyarakat. Mungkin perlu menggandeng dan melibatkan media secara lebih massive dan juga beberapa lembaga swadaya masyarakat yang memiliki jaringan sampai ke masyarakat pada tingkat paling bawah.

Masalah terakhir adalah masalah klasik…. tentang tarif INA CBGs. Mohon ARSADA bisa memberi penekanan lebih kepada NCC Kemenkes agar revisi tarif INA CBGs bisa diterbitkan selambat-lambatnya akhir triwulan pertama Tahun 2016 (Sekitar bulan Maret atau April) dan mohon untuk tarif-tarif yang memerlukan pelayanan di ruang critical care (ICU, PICU, NICU, ICCU) agar betul-betul dipertimbangkan untuk dinaikkan sampai dengan batas angka kewajaran. Tarif Kapitasi FKTP seyogyanya juga naik seiring dengan kenaikan tarif INA CBGs, sebuah kondisi dilematis memang tapi menurut saya harus tetap dilakukan.

Demikian beberapa pemikiran saya yang mungkin bisa menjadi bahan pengayaan dalam rapat ARSADA. Mohon maaf jika masih banyak hal yang belum disampaikan, tapi persoalan-persoalan pokok sepertinya sudah hampir semua saya sampaikan. Terutama masalah ketersediaan obat-obatan mohon untuk diselesaika secepatnya (cito).

Mohon juga ditanyakan juga tentang progres distribusi kartu peserta dalam bentuk kartu KIS. Berdasarkan informasi yang saya peroleh, distibusi KIS dilakukan serentak di seluruh Indonesia dimulai pada bulan Mei kemarin, namun anehnya sampai sekarang saya belum melihat progres yang siginfikan. Apakah saya yang kurang informasi atau bagaimana.

Demikian dan terimakasih atas kesempatan yang diberikan kepada saya untuk menyampaikan usulan-usulan tersebut diatas. Semoga menjadi bahan masukan yang positif dalam rangka terus melakukan perbaikan program JKN ke depan.

Amien YRA.

Salam

Tri Muhammad Hani
RSUD Bayu Asih Purwakarta
Jl. Veteran No. 39 Kabupaten Purwakarta – Jawa Barat

 

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