PELAYANAN KESEHATAN IBU MELALUI PROGRAM JAMINAN KESEHATAN STUDI KASUS DI KABUPATEN GUNUNGKIDUL

Background: Conditions of increasing health care costs, pushing the problem of the high maternal mortality rate (MMR) is a priority concern both locally, nationally and globally. Indonesian government in 2011 to expand the target Jamkesmas through Jampersal program. Jampersal beneficiaries are all maternal who do not have health insurance. Gunungkidul district has implemented good programs Jamkesmas, Jampersal, and Jamkesta for pregnant women as a form of government commitment to improve maternal health care coverage. Objective: The purpose of this study examines the implementation of health insurance for pregnant women through 3 system based on insurance/health insurance is Jamkesmas, Jampersal and Jamkesta, conducted in primary care and is there an additional cost to use the service in the health insurance program. Method: The study used descriptive qualitative approach and case study design. Primary data were obtained from interview with purposively selected respondents and secondary data were documents or reports of the implementation of health insurance program for pregnant mothers at District of Gunung Kidul 2012. Result: Implementation of the program has not integrated financing and health services through the implementation of quality and cost control. Lack of action by eliminating barriers of health financing by providers, proven practices encountered additional costs, especially in service in the private sector, which is caused by higher real cost for its operation and prolonged reimbursements. Prospective Payment System has not been understood by providers so over utilization/over budget in insurance mechanisms can not be controlled. Conclusion: Implementation of the health insurance program for pregnant women only normative pattern of policy on social service programs specified. Implementation of the program increases people's access to health services, health insurance services proven to pregnant women has involved the role of the private sector is high. However, some efforts had to be made in improving mechanisms and management of claims and increasing accountability of provider performance by maximizing role of Health Office as regulator in supervision and monitoring of the provider