Topic C: The Medical Doctors Migration Policy
Facts and policies of foreign doctors in Thailand

13 Mei 2014

The first session was explained by Dr. Prasobsri Ungthavorm ,who share the experience and shape policy for foreign doctors in this white elephant country . Dr . Prasobsri start by telling doctors fundamental foreign policy establishment promoted in Thailand comes from the ASEAN declaration on August 8, 1967. Thailand has similarities with characteristics similar fate and between countries . This policy thus becomes the direction of solving the problem for ASEAN and Thailand in particular.

Problems in Thailand in general has similarities with problems in other developing countries. Shortage of health resources are very vulnerable place. In terms of health facilities, Thailand only has 926 government hospitals and 322 private hospitals , general practitioners and the ratio of only 1 : 4319 . Thailand aims at increasing doctors up to 1 : 2500. While the number of specialist physicians themselves only 34500.

Measures taken regarding the issue of Thailand is shaping policy universal health coverage ( UHC ) started in 2002 which has a principle of justice, equity, and has a better quality. Newborns can immediately be covered by the government. This program aims at the improvement of health services, especially in rural and remote areas. The second policy is taken form the center of medical education with the goal of increasing the quantity of health personnel through scholarship programs, public and private cooperation, the addition of specialists, to bring in experts from abroad. The third policy is the policy of accelerating the establishment of the ASEAN community study in 2015. Policy aims to solve the problem of shortage of doctors in Thailand to bring in doctors from abroa .

Dr . Prasobsri added challenges to be faced in the next era of the free market is the increasingly complex problems of disease and high mortality rates. So this policy as one of the solutions to anticipate this. Networking between the countries will work together to be an important key for the program to be on target and allows the doctor to move to the country.

Facts and policies of foreign doctors in Indonesia

Prof. Dr. Med Trihanggono Achmad, Association of Indonesian Medical Education School

Prof. Dr. Med Trihanggono Achmad, Association of Indonesian Medical Education School opportunity in the second session on this topic to explain the policy and the situation in Indonesia related to foreign policy in Indonesian doctor and situations regarding physician needs in Indonesia.

Prof. Dr. Med Trihanggono Achmad, Association of Indonesian Medical Education School start talks on Indonesian policy for foreign doctors are specified on the doctors who have a similar level of education equivalent undergraduate and graduate school education. In addition, doctors are divided over the classification of doctors and dentists where doctors from outside Indonesia and ASEAN countries.

Multi recognition arrangement ( MRA ) in Indonesia is not much different from what is in Thailand and Malaysia. If in Malaysia and Thailand have the MRA group distinguishes dentists and general practitioners, in Indonesia two into one group. In addition , Prof. . Dr . Med Trihanggono Achmad, Association of Indonesian Medical Education School noted the role and duties of the board in Indonesia through Legislation Number 29 of 2004.

Indonesia also has implemented a policy mode 4 , which emphasizes the need for setting back the domestic rules. This policy needs to be reviewed because of the problems idi Indonesia is not the amount of force the doctor. Doctors had a considerable proportion, but has not spread to the needs in the area .

Facts and policies of foreign doctors in Malaysia

S The last session on the topic of physician migration policy presented by Dato ' Seri Dr . Noor Hisham bin Abdullah as a representative of the board of health of Malaysia's policy . Hisham explained overview of the situation regarding the movement of doctors in Malaysia.

According to Hisham, the number of doctors in Malaysia is not a problem anymore, because countries such as Vietnam, the Philippines, Myanmar, Indonesia, and Egypt contribute to the availability of doctors in this country . Breakthrough owned by the Malaysian government in power sufficient for the doctor to send them to the citizens of certain countries before returning to Malaysia to serve.

Hisham in his views on physician migration policy in 2015 knew this explains the real needs to be met is perepatan of medical education itself. Countries that accelerate development of medical school, will be able to meet the minimal needs of the country are still going to doctors.

Reporter: Faisal Mansur

Topic D:
The Impact of Doctor Migration on Medical Doctors Education
and Residency (medical specialists) Training

13 May 2014

This session was given by representatives from Indonesia and Thailand. Health education in the future should be improved in order to support the ability of health professionals to face the challenges of an increasingly complex future. This was stated by dr . Ova Emilia , M.Med . Ed.Sp.OG ( K ) , PhD in the last session of the first day of the event Postgraduate Forum on May 13, 2014. Specified future not only of the exact path. According to dr . Ova , many ways you can do to improve the competence of health personnel, among others, not only related to education alone but also related to the real world. The first way is Practice based Learning and Improvement. These competencies to improve the ability to fix an error, use of technology in decision making, knowing the areas that must be improved to be more enhanced insight, skill, attitud, and maintenance processes.

The second point is a Systems Based Practice , the goal of competence is the ability to understand, access, and resource and support system for service. Understanding the advantages and disadvantages of a system and trying to find a way out in order to improve services. Using the evidence and common purpose in the prevention, diagnosis and action . Establish good cooperation with colleague health professionals to better serve patients facing complex systems.

Additionally dr . Ova Emilia , M.Med . Ed.Sp.OG ( K ), PhD states that there is a form of training in the future must be obtained by a doctor: to develop the ability to understand the needs of the patient's physician, the clarity of duties / work area general practitioners and specialists, Continue professional development (CPD) is a requirement importantly, the achievement of broader expectations for the training phase of postgraduate ( master general abilities such as leadership, communication, orientation on quality and patient; adapt themselves to work in teams ; quality training) . Application of a new form of training will bring pressure from within and outside the educational environment. Limited resources, must bring in new teachers, need a great effort to change the old express their views is the pressure of the educational environment. External pressures include enjoy unlimited time because they have to share the work time, changes in services, the demand of safety service that is currently booming, increased productivity and great complexity of an increase in knowledge.

Wanicha Cheungkongkeuw (Thailand)

Lack of health workers in Asia , especially Southeast Asia threatens to hamper the effectiveness of health care quality health announced by the government in each country . This was disclosed by Wanicha Chuenkongkaew . the Postgraduate Forum , WHO estimates that the ratio of physicians to population if less than 2.3 health workers per 1000 population effectiveness of health care will not be achieved. In comparison with developed countries like the U.S. which touched 12.3 Southeast Asia only touched 1.6 .

The cause of the lack of health workers due to several reasons, among others: the low level of acceptance and the high cost of education, less follows a curriculum, financing is not smooth, career uncertain, troubled institutions, the investment is not in place, and organizers are questionable accreditation. In response to this kind of thing then formed a forum of health education reforms in many countries, especially in Asia so that the education system in this area can be improved. Then in 2011 formed the Asia-Pacific Network on Health Professional Education Reform ( ANHER ) .

Wachita on this occasion expressed ANHER goal is to create and strengthen cooperation regarding the region 's health education professionals. Besides increasing the knowledge of health professionals in order to quickly respond to problems in the health system that is always changing and growing. Successful reform of health education to be relevant to the health system and in accordance with social needs in each country.

In order for the above purpose is achieved ANHER implement several attempts, among other things, the first to use a general rule in the survey analysis of the situation. Then, share experiences on effective innovation and improvement of training is getting better in every country. Finally, we should prioritize collaboration among the five countries, namely Bangladesh, China, India, Thailand, and Vietnam .

Reporter : Harumanto

Topik A: Health System and The Economic Development in
The Changing Disease Pattern in South East Asia

Panelis:

1. Prof Dr. Hari Kusnanto, Dr.PH
2. Prof. Dato' Dr. Syed Mohammed Aljunid, MD, MSc, PhD, FAMM, DSNS
3. Prof. Barbara McPake, BA, PhD

Moderator: Prof. Dr. Supasit Pannarunothai, DTM&H, MSc, PhD

Prof, Supasit explain that, this forum was a collaboration from three countries, Thailand, Malaysia and Indonesia about knowledge dissemination.

Prof. Dr. Hari Kusnanto, Dr.PH

"The Epidemiology in South-East Asia Countries Indonesia: The epidemiology trends in SEA countries, the environmental issues and the needs for integration policy."

Today begins the presentation by Prof. Abdul Kusnanto with research citing Omran (1971), the three stages of modernization which are classified by cause of death: (1) Pestilence and famine; (2) receding pandemics; (3) degenaritve and man-made disease.

Hundreds of years ago the world was dominated by disease-related diseases such as diarrhea, pneumonia, malnutrition, tuberculosis and malaria, the disease has been reduced but still occurs in some parts of the world for some time. The story continues with a history of disease that had plagued the world like a plague and bulbonic pestis. The world is moving towards the direction of improvement that reduces the pandemic of these diseases. The improvement related to sanitation, personal hygiene, nutrition, antibiotics and the development of medical technology.

Shifting patterns of disease the world has shifted to the passage of time the diseases due to lifestyle such as diabetes, cardiovascular disease, and so on. Scientific articles by Olshanky and Ault (1986) also discussed, namely an explanation of the stages of human life expectancy and its threats as a result of his death, for example when a human life expectancy in the range of 30 years, the pattern of deaths from Pestilence and famine, while when the life expectancy in the range 70 years the mortality patterns ranging predominantly degenerative diseases.

Presentation of the movement continued life expectancy of Southeast Asian countries, where there is a demonstrated consistency and there that show upward movement. This was followed by an explanation of the actions of health interventions that need to be done, has shown benefit, and that cannot be used anymore.

At the end of the presentation, Prof. Hari Kusnanto explain the premature coefficient and life expectancy. Day explains some related studies and the positions of the countries of Southeast Asia related to it.

Prof. Dato' Dr. Syed Mohammed Aljunid, MD, MSc, PhD, FAMM, DSNS

"The Increased Socio-economic status, the needs for universal health coverage and medical industry development."

Presentation of Prof. Syed Aljunid describes how he observed UHC applications globally, which 192 countries have UHC implementation issues . He began with an explanation of what is UHC, in which he explains that the UHC is a society have equal access to health services. Then proceed with the three dimensional aspects of UHC and also aspects that affect UHC.

UHC three important aspects, among others : effective and efficient services, prevent uncontrolled spending and everyone gets equal access. Keywords UHC is not only achievable but also achieve sustainability. In the ASEAN region, Prof. Aljunid explained that the significant growth in developing economies over the last 10 years, but there are still economic disparities between countries .

Prof . Aljunid also explain the disparity in health systems where high standards but low service provision . Then also discussed the development of private health care providers.

Health-related industries are also discussed, where they play an important role in achieving UHC, for example, the discussion of UHC in positioning the private sector in SHI schemes, such as hospitals and private clinics that continue to grow with the profit motive.

Discussion on state expenditures for health are also being targeted by Prof. Aljunid, especially how different inter regional in the world, for example the difference between developed countries and developing countries.

In conclusion UHC is the target set by developing countries, health reform is still needed to achieve UHC and health financing is an important aspect of the UHC.

Prof. Barbara McPake, BA, PhD

"The tiers health care system: is it global phenomenon?"

The presentation begins with an explanation that health systems in low-income countries are generally fragmented and terstrata, while various sub populations using various kinds of access also to reach health care providers. More typical is the individual health care provider usually run more than one place of practice and health care providers in developing countries varies from very simple to modern. He also explained with examples, example in the target market of health services in Zambia,

Prof. Barbara continued the presentation by discussing a book that explores the issue of private health care providers. There are several categories including, among others : ( 1 ) involve the private sector with very minimal formal profit to moderate; ( 2 ) more portions for the formal and informal private sector in primary care, while the tertiary service sector dominated by the public; ( 3 ) significant involvement of hospital formal private hospitals; ( 4 ) the public sector to encourage private sector development.

Furthermore, Prof. . Barbara also discussed the issue of dual practice based schemes ' outside ' ( apart from the private practice of public practice ), ' beside ' ( eg Maputo central hospital there are special clinics that provide private services ) , ' inside ' ( private practice in public facilities ) , and ' integrated ' ( private practice integrated public facilities ) .

Discussion Session

Laksono Trisnantoro

In Jakarta, UHC good for society but not good for the people of Papua. Do we need to postpone the UHC to achieve equality of health service providers in both areas?

Then the second, Prof Syed Aljunid mention there stagnation in private healthcare providers, while private hospitals in Malaysia many target markets of Indonesian society, how did he respond?

Barbara

The idea of following the money, especially at State facilities health facilities is uneven, in fact not only in Indonesia. Obviously Indonesia needs acceleration sacret budget for health care, especially in remote areas.

Syed Al Junid

The private sector in Malaysia is different from Indonesia and Thailand. In Malaysia are not allowed to dual practice, should choose to work in the public or private sector. There is a target market, namely the rich, the second they are not satisfied with the health services provided by the government, and the latter targeting for medical tourism. They have to work hard and compete in quality and efficiency. One of the reasons is the material for cheaper production from Indonesia, who made a private hospital in Malaysia to compete, related to Malaysia very competitive prices.

Prof. Supasit

Inviting Wanichai to talk about the situation at the Siriraj hospital.

Prof. Wanichai

Siriraj Hospital is an academic hospital to Mahidol University. Siriraj Hospital also has private services where the profit generated divided to serve those who are poor in the public service. While the share of health care workers as well.

Prof. Supasit

What about the quality of the data generated from the ASEAN region ?

Prof. Hari Kusnanto

We have a problem related to the data, since the Suharto era, for example, different data regarding universal coverage for the immunization program. Statistical data are generally derived from the Central Statistics Agency (BPS) and Susenas. With UHC, Hari hopes of the poor can also enjoy the health services. There are a lot of issues, not only in Indonesia, such as in the U.S. there is the issue of restrictions on the use of certain anti-hypertensive drugs. If it's done well in Indonesia is also very possible. My hope, the poor can also pursue a life expectancy .

Prof. Syed Aljunid

When we have reached UHC , what could be developed further? Growing problem in Malaysia today are chronic diseases are not contagious, for example, how to control diabetes. Other issues associated with information and IT use in the development of health services. We already have a blueprint of telemedicine has not been achieved yet.

Noraita, Farmasis, Malaysia

I had to buy Imodium in Indonesia, and to my amazement it costs around $ 1, it was sold per tablet and the price is much cheaper in Malaysia. We are in Malaysia have a generic drug policies that should exist in every pharmacy. We also do not have a dispensing separation, while in Indonesia and Thailand there , can tell the experience in Indonesia and Thailand?

Prof. Supasit

We also still have a problem with dispensing as Indonesia and Malaysia.

Reporter : Nandy Wilasto

Opening: Dean of Faculty Medicine, GMU

13 Mei 2014

This forum launched by Dean of Faculty Medicine, GMU, Prof. Dr. dr. Teguh Aryandono, Sp.BO (K). He highlighted the relationship between the recent findings in epidemiology and the future challenges in health sector. The challenges would be varied among ASEAN countries. Moreover, with the different international regulation on health personnels distribution, which have an important role in affecting the development of health systems and human health resource management. Therefore the postgraduate forum is very important as a media to share recent knowledge on health sectors, in particular: epidemiological transition, doctor supply, doctor migration, and various topics on health systems.

Reporter: Digna Purwaningrum

Indonesia Health System Discussion Series

  Introduction

Indonesia health system is embarking on a very important phase with the implementation of the National Health Insurance System, the forthcoming agenda to revise the decentralization law and its impact to health sector, the increasing incidence of communicable and non-communicable diseases as well as automobile accidents and the growing population. On the other hand, government changes will take place in the upcoming presidential and legislative election, which would affect the long-term health planning at every level of the government.

As an effort to obtain inputs for future health policy development the Center for Health Policy and Management UGM holds a series of seminar as follow:

April 11th 2014, Jogjakarta : Decentralization Policy Reform
April 17th 2014, Jakarta : Health Financing Reform
April 23rd 2014, Jogjakarta : Hospital Organization Reform
April 29th 2014, Jakarta : Health Workforce Education Reform
May 7th and 12th 2014, Jakarta : How health system scenario would be in the context of health equity?

  The discussion series aim to:

1. Discuss health sector reform situation to feed into the development of the Indonesian Health System in Transition report
2. Obtain inputs for future policy analysis and projection

May 12th 2014, in Jakarta: What is the future scenario for Indonesian health system to achieve health equity?

Topics:

1. Will Indonesia achieve more efficient and equitable health system?
2. Socioeconomic inequity: will it be resolved?
3. Geographical inequity: will it be resolved?
4. Is Indonesia equipped to fund for JKN? Can Indonesia control unhealthy behavior? Can Indonesia control corruption and fraud in the health sector?

Presenter:

Prof. dr. Laksono Trisnantoro, MSc, PhD (PKMK Universitas Gadjah Mada)

Invitations:

1. APO Manila
2. WHO Indonesia
3. World Bank Indonesia
4. UNICEF Indonesia
5. DFAT – Indonesia

Venue:

Ubud Room 3rd Floor Gran Melia Hotel, Jl. HR. Rasuna Said Kav. X-0
Kuningan, Jakarta

Time:

May 12th 2014, 9 AM – 12 PM WIB

Pusat Kebijakan dan Manajemen Kesehatan
Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

Menyelenggarakan

Diskusi Kebijakan Kesehatan

Skenario Sistem Kesehatan Indonesia Masa Depan
untuk Pencapaian Kesetaraan Kesehatan

Rabu, 7 Mei 2014
Gedung Granadi Kuningan Jakarta
Pukul 10.00 – 12.30

  PENGANTAR

Saat ini sistem kesehatan Indonesia memasuki masa penting dengan berjalannya Sistem Jaminan Kesehatan Nasional (JKN), adanya rencana perubahan UU desentralisasi dan dampaknya untuk sektor kesehatan, meningkatnya beban penyakit menular, tidak menular, dan kecelakaan serta jumlah penduduk yang semakin banyak. Disamping itu dengan akan bergantinya pemerintahan sebagai hasil pemilihan umum, berbagai rencana jangka menengah di bidang kesehatan di berbagai level pemerintah akan diperbaharui.

Dalam berbagai studi terlihat bahwa di Indonesia ada kesenjangan luar biasa dalam penyebaran tenaga dokter dan fasilitas kesehatan. Hal ini dapat mengancam tercapainya tujuan Universal Health Coverage. Sementara itu Road Map pencapaian Universal Coverage mempunyai berbagai asumsi yang terlihat sulit didapatkan. Oleh karena itu disamping Road Map, ada beberapa skenario yang dapat terjadi di masa depan. Ada skenario optimis seperti yang ada di Road Map, dan ada skenario pesimis.

 TUJUAN DISKUSI

1. Membahas skenario sistem kesehatan di Indonesia untuk mencapai universal coverage.
2. Memprediksi kemampuan fiskal Indonesia dalam pembiayaan kesehatan.

  JADWAL KEGIATAN

Rabu, 7 Mei 2014

  PESERTA

Peserta yang diharapkan menghadiri seminar ini adalah perwakilan dari Kemenkes, Ditjen Dikti, AIPKI, IDI, ARSADA, ADINKES, PERSI, BPJS, Fakultas Kedokteran, Dinas Kesehatan, dan setiap pihak yang berkecimpung dalam pembuatan kebijakan kesehatan. Seminar ini bersifat bebas biaya dan limited seat sehingga sangat diharapkan untuk mendaftar terlebih dahulu kepada pengelola. Kami juga tidak menanggung transport dan akomadasi para peserta.

  PENDAFTARAN DAN INFORMASI

Pusat Kebijakan dan Manajemen Kesehatan Fakultas Kedokteran UGM
Sdri. Intan Farida Yasmin/ Hendriana Anggi
Gdg. IKM Sayap UtaraLt. 2, Jl. Farmako Sekip Utara Yogyakarta 55281
Telp.: +62274 – 549425
Mobile: (Intan Farida Yasmin: +628129017065),
(Hendriana Anggi: +6281227938882)
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.; This email address is being protected from spambots. You need JavaScript enabled to view it.
Web: www.kebijakankesehatanindonesia.net 

Reportase

Sesi 2. Ideologi UU Pendidikan Kedokteran dan
reformasi apa yang ingin dicapai

Sesi kedua dibuka oleh Prof. Laksono Trisnantoro, PhD menyampaikan terkait ideologi UU Pendidikan Kedokteran. Pendidikan kedokteran di Indonesia bersifat konservatif, sulit diubah, sangat dipengaruhi ikatan profesi. Ikatan dokter di Indonesia berbeda dengan yg diterapkan di Amerika Serikat dan Australia. Di Indonesia, tidak ada pemisah antara kolegium (AIPKI) dengan asosiasi profesi (IDI) yang membuat IDI seakan mempunyai kekuasaan yang besar dan cenderung monopoli pengaturan dokter di Indonesia. Kekuasaan tanpa check and balance system ini akan merugikan bangsa. Tujuan UU Dikdok adalah mengatur pendidikan kedokteran, meskipun belum berjalan dengan baik karena belum didukung oleh PP dan peraturan yang di bawahnya, namun diharapkan dapat memberikan kejelasan dan membawa pada peningkatan sistem kesehatan di Indonesia. Belum ada kurikulum yang mengarahkan distribusi dokter ke daerah rural. Arah kurikulum FK ini harus diperjelas sehingga lulusan dokternya pun siap menjadi peneliti, atau dokter di rural area, atau bersaing di internasional.

Pembahas pertama dari sesi ini adalah Prof. dr. Med. Tri Hanggono Achmad selaku ketua AIPKI. Beliau menyampaikan bahwa UU Dikdok ditujukan untuk menyuplai dokter ke seluruh wilayah Indonesia yang penentuan jumlahnya harus melibatkan Kemenkes. Langkah nyata dari tuntutan perbaikan sistem pendidikan kedokteran adalah dengan health system approach Medical Education (Health-Same) sebagai pencapaian akhir pendidikan kedokteran. Kunci untuk reformasi ini ada tiga aspek yaitu:

1. tranformative learning, yang berarti reformasi kurikulum
2. interdependent education, yang berarti reformasi institusi

Penerapan Health-Same ini berarti fakultas kedokteran bertanggung jawab dalam peningkatan sistem kesehatan di wilayah tersebut. Jika mampu, maka dapat membantu peningkatan kesehatan di wilayah lain yang belum ada FK-nya. Pendidikan kedokteran sebaiknya tidak hanya berhenti setelah lulus dari FK, melainkan terus setelah program internship. Diharapkan post internship, para dokter dievaluasi kembali untuk menyaring apakah menjadi dokter layanan primer, spesialis atau arah lainnya.

Tanggapan Prof. Tri Hanggono, tantangan yang pasti diatasi adalah pengelolaan institusi Fakultas Kedokteran serta meningkatkan peran FK tersebut untuk menguatkan sistem kesehatan karena kebanyakan institusi yang sudah punya basi internal yang kuat hanya memikirikan kemajuannya sendiri tapi kurang memikirkan daerah lain. Hal yang sedang diusahakan adalah program intership yang berdasarkan pada kebutuhan wilayah dan bukan untuk seluruh wilayah.

Hal ini serupa dengan pendapat dari dr. Purwadi yang menyampaikan bahwa perlu ada tujuan jelas dari setiap FK yang didirikan di setiap wilayah dan bukan saja hanya berorientasi materi saja. Outcome dari lulusan FK ini diharapkan bukan hanya IPK tapi kontribusinya terhadap penguatan sistem kesehatan setempat.

Dr. Hermanto dari Unair mempertanyakan tentang kurikulum rural medicine untuk Indonesia apa? Apakah sudah ada assessment-nya atau hanya karena mengikuti globalisasi saja? Tanggapan Prof. Laksono terhadap pertanyaan ini adalah bahwa assessment sudah ada dari data nakes yang sangat timpang sekali di rural area. Dr. Hermanto menegaskan bahwa maksud kurikulum rural medicine ini bukan merombak kurikulum yang sudah berjalan di daerah maju, namun untuk FK yang berada di daerah rural seperti di Papua atau daerah terpencil lainnya. Harapannya, FK di daerah rural mampu menerapkan kurikulum yang sesuai dengan kondisi kesehatan wilayahnya dan bukan bukan mengimpor kurikulum FK lain. Alasannya, karena akan sangat tidak cocok jika misal kurikulum dari FK UGM diterapkan di Univ. Cenderawasih karena perbedaan masalah kesehatan dan juga fasilitas kesehatannya.

Sesi terakhir yang membahas tentang kesiapan Fakultas Kedokteran untuk reformasi menghadirkan dosen perwakilan beberapa Fakultas Kedokteran, yaitu dr. Hendro Wartatmo Sp.B-KBD dan dr. Purwadi Sp.BA. Dalam sesi ini dibahas bahwa harus ada dedinisi operasional siapa saja dosen klinis (dosen klinis) tersebut dan juga siknkronisasi antara UU dikdok dengan UU guru dan dosen. Selain itu, perlu pasal khusus mengenai wahan pendidikan di RPP tentang dosklin. Peraturan ini pun juga harus diperjelas agar penafsiran tidak subyektif dan apakah berlaku untuk FK swasta dan FK di bawah kementerian lain juga.

Reportase:

Diskusi Kebijakan Kesehatan Keempat:
Reformasi Tenaga Kesehatan

Sesi1.

Diskusi keempat ini bertemakan Reformasi Tenaga Kesehatan dan dihadiri oleh Tim dari PKMK UGM yang terdiri dari Prof. Dr. dr. Laksono Trisnantoro M.Sc, Ph.D, dr. Andreas Meliala, M.Kes, dr. Mushtofa Kamal dan mengundang kosultan WHO, perwakilan dari World Bank, Badan PPSDM, Ketua AIPKI, dan dosen dari FK di Indonesia. Pemateri pertama ialah dr. Andreasta Meliala yang menyampaikan bahwa banyak teori yang menyebabkan maldistribusi ini, seperti pembiayaan SDM, fasilitas kesehatan dan sosial yang kurang mendukung, ada halangan untuk penempatan ke daerah tersebut misal karena tidak ada permintaan dokter di tempat tersebut. Masalah-masalah tersebut berdampak terhadap tidak tercapainya universal coverage, dan juga semakin menciptakan iklim kompetisi Indonesia di Asia.

Ada beberapa skenario dalam pencapaian universal coverage, yang pertama adalah dengan asumsi adanya ketersediaan SDM yang memadai di daerah yang buruk diikuti dengan ada fasilitas yang mendukung. Skenario yang lain adalah daerah yang buruk bisa mengejar namun tidak bisa menyamai peningkatan kemajuan daerah yang baik yang berarti asas penyamarataan tidak tercapai. Kenyataannya adalah kemenkes tidak mampu membiayai pembangunan kesehatan di daerah terpencil. Dampak dalam kompetisi pasar internasional, Indonesia semakin kurang berpartisipasi dalam pelayanan medis internasional dan malah menjadi konsumen negara lain. Adanya kekurangan SDM ini kemungkinan malah menarik dokter dari luar negeri untuk membantu pelayanan kesehatan di Indonesia.

Pembahas pertama dalam sesi ini adalah dr. Untung Suseno, M.Kes selaku Kepala Badan PPSDMK. Beliau menyampaikan kenyataan sekarang ini Indonesia kekurangan dokter. Dengan program JKN, sangat daharapkan dokter pelayanan primer bisa mengelola dana kapitasi secara efektif dan efisien. Kurang ratanya persebarana dokter spesialis di daerah salah satunya karena pengaturan tersebut sangat tergantung dengan universitas (university based) dan kolegium dokter spesialis sehingga kolegium sebaiknya bersifat independen dan tidak dipengaruhi politik. Mengenai alokasi dana dari BPJS harus disesuaikan dengan kapadatan PBI setiap daerah. Hal yang harus diperjelas dari sistem JKN ini adalah define universal coverage yang ingin dicapai.

Materi dilanjutkan oleh dr. Puti Marzoeki dari World Bank yang menyampaikan bahwa inti dari setiap permasalahan kesehatan harus dikembalikan ke dasar dalam pembuatan kebijakan tersebut. Semakin tinggi demand diharapkan supply akan mengikuti. Namun ada variabel lain, yaitu bahwa semakin tinggi gaji yang diberikan maka akan menarik semakin banyak supply (SDM), sayangnya hanya sedikit yang bisa memberikan gaji besar tersebut.

Pembicara berikutnya adalah perwakilan dari WHO yang disampaikan oleh Haroen Hartiah. Beliau menyampaikan isu-isu yang di-highlight terkait SDM kesehatan selain aspek kualitas dan kuantitas serta distribusi dokter dan tenaga kesehatan (nakes) lainnya adalah kompetensi klinis dan critical thinking dari SDM tersebut. Ada aturan dari WHO yaitu Global Code of International yang mengatur negara pengirim dan negara penerima tenaga kesehatan terkait semakin tingginya iklim kompetisi internasional terhadap tenaga medis. Sementara mengenai universal coverage, harus ada peningkatan kurikulum nakes terkait dengan pelayanan di masyarakat dan juga ada interprofesional education untuk mendukung pencapaian universal coverage tersebut.

DISKUSI

Dr. Mulyo dari RSSA Anwar mengusulkan untuk sister hospital sebaiknya dibuat grup misal untuk Indonesia timur disuplai dari Unair dan unibraw yang menugaskan residen ke daerah tersebut. Sementara Dr. Purwadi Sp.BA berpendapat bahwa tidak ada keseimbangan antara supply dan demand terkait nakes dikarenakan tidak ada koordinasi/komunikasi antara institusi pendidikan (produsen) dengan Kemenkes (user). Harapannya WHO dapat memfasilitasi antara produsen dengan konsumen sesuai dengan EBM internasional.

Prof. Laksono menanggapi bahwa residen seharusnya diperhitungkan sebagai suplai SDM nakes spesialis yang sesuai dengan kompetensinya sehingga dapat mengurangi maldistribusi tenaga spesialis. Mengenai perubahan UU, harus ada evidence terlebih dahulu sebelum bisa mengusulkan untuk perubahan.

Dr. Untung menambahkan bahwa usulan untuk meningkatkan pendapatan dokter PTT membutuhkan perjuangan karena seringnya ditolak oleh pemerintah pusat. Mengenai kekurangan nakes, harus ada peraturan jelas dari kemenkes mengenai jumlah peserta pendidikan nakes yang dibutuhkan sehingga kekurangan dapat diatasi.