Session Objective
Discuss the model for achieving fair financing scheme Discuss the problem of health financing scheme in Indonesia Discuss the concept and role of health service management Discuss the concept and method for managing quality
Organization as a System
INPUT PROBLEM, RESOURCES & CAPABILITIES PROCESS MANAGEMENT FUNCTION OUTPUT/OUTCOME
QUALITY
External Env.
FAIR FINANCING
Why, Objective, Concept & Model
New Term
Peran Kasir Peran pemerintah dalam sistem kenaikan harga obat
USA Problem
Expensive Business oriented, commercialism Difficult claim bureaucration Selective health problem coverage Low Governance = corruption, law enforcement
Why
Managed by private company aimed to gain more benefit
Differences
Government control Insurance awareness Difficult claim due to limited budget
WHY INSURANCE?
SPORADIC HEALTH EVENT & NEED
CATASTROPHIC AND EXTREMELY EXPENSIVE Financing Scheme POOR PEOPLE-HEALTHACCESS Accessibility, Equity, Quality, Solidarity
OBJECTIVE
Risk Spreading
Collecting
FINANCIAL SOURCES
Gov, Comm., Private, Fund
Allocating
Health Service
Spending
Health Cost
Ease of Operation
User Involvement
Consumer
Provider
Tax/Premi
Govt. /Prof
Regulation
Claim
Coverage
Payment
Purchaser
Responsiveness
Financing
Penggalian
Alokasi
Belanja
UKM
UKP
Miskin
Mampu
Masy
Pem
Wajib
A P Public-Private Mix
Sukarela
Quality?
The final outcome of management
Productivity
Good Service
Efficient
Client quality: what client and carriers want from the services (individuals and population) Professional quality: whether the service meets need as defined by professional, provider and referrers and whether it correctly carried out techniques and procedure which are believe to be necessary to meet client needs. Management quality: the most efficient and productivity use of resources within limit and directives set by higher authorities/purchaser
fully meeting requirement or the need of those who need the service most at the lowest cost.
TQM/QMS
QUALITY ASSURANCE
QUALITY CONTROL
INSPECTION
DESIGN
PRODUCTION
PRODUCT
CUSTOMER
Quality Management
Coordinate activities to direct and control an organization with regard to quality Components:
Quality planning Quality control Quality assurance Quality improvement
QP:
Focused on setting quality objectives and specifying necessary operational processes and related resources to fulfill quality objectives
QC:
Focused on fulfilling quality requirements
QA:
Focused on providing confidence that quality requirement will be fulfilled
QI:
Focused on improving capacity for continuous performance improvement
CHECK
DO PLAN
QUALITY TOOLS
A method to identify the quality problem (chance for improvement), develop the quality action plan, carried out the plan, guarantee the performance Type:
Statistical Process Control Problem analysis: Fishbone, process flowchart Quality Task Force