USULAN TARIF PAKET PERSALINAN NORMAL PADA PELAYANAN KESEHATAN PRIMER DI KABUPATEN JEMBRANA

Background: One objective of the fifth Millennium Development Goals is to improve maternal health. Jembrana is a district at the Province of Bali that has serious attention to maternal health through the program of Jembrana Health Insurance (JHI). This scheme covers health service for mothers that comprises normal delivery, antenatal care and family planning. The service that had increasing claims every year is normal delivery service. Limited budget demands efficiency of resources, thus it is necessary to study unit cost, identify the cost needed particularly normal delivery service. Objective: To identify the difference in resources used to produce normal delivery service, calculate unit cost with Activity Based Costing (ABC) method, specify the amount of tariff and descriptive the perception of stakeholders about tariff of normal delivery JHI. Method: The study used a case study design. Analysis unit are private practice midwives and community health centers. Selection criteria of private practice midwives based on the utilization of normal delivery and community health centers based on category of health center, i.e. inpatient/primary health center. Subject of the study were midwives, head of health centers, director JHI management council and head of medical service department of Jembrana District of Health Office. Result: Differing activities in normal delivery affected the amount of cost that had to be paid. Difference in the use of drugs, usable medical materials and medical devices at the community health center was 143,868, at private practice midwives was 147,136 whereas based on the standard of normal delivery was 136,983. The difference was caused by activities outside the standard, i.e. activities of multiple palpation and use of drugs. Elimination of non value added activity would save 9.8% from direct tracing. The amount of cost directly involved and overhead would affect unit cost and amount of tariff. Conclusion and Suggestion: Activitydifferences will affect the resources used such as medical personnel, drugs, usable medical materials, accommodation and overhead. Unit cost at the community health center 259.341 and private practice midwives 210.346, which indicated that the higher unit cost in community health center. Tariff proposition was still 500.000 both in community health center and private practice midwives with the policy of improving the community health center services. JHI program effectiveness is the role of various parties, both the local government as policy makers in setting the of subsidy, JHI Management Council to seek tariffs on basis of unit cost and health provider to provide good service and cost efficiency. G9vernment allocated a budget to improve community health center services that increase the utilization or reconsider use of normal deliveries in community health centers