SISTEM dan

MODEL
Pembiayaan
Kesehatan

Muhammad Fuad Iqbal,

AMd.,RMIK.,SKM.,M.K.M
 TABLE OF CONTENTS

01 02
Revenue Collection Pooling Mechanism

03 04
Allocation Mechanism Purchasing Mechanism
 Pembiayaan kesehatan merupakan dasar dari
kemampuan sistem kesehatan suatu negara untuk
memelihara dan meningkatkan kesejahteraan
penduduknya. Dana/uang yang terkumpul
digunakan untuk menyelenggarakan pelayanan
kesehatan seperti membayar para tenaga kesehatan,
obat-obatan dan juga membiayai kegiatan-kegiatan
yang bersifat promotif dan preventif.
universal health coverage (UHC) yaitu pembiayaan kesehatan untuk
memberikan perlindungan resiko keuangan penduduk yang artinya
adalah pembiayaan kesehatan juga digunakan untuk membantu
masyarakat mendapatkan pelayanan kesehatan akibat menderita suatu
penyakit tanpa harus mengalami resiko finansial yang berakibat
kemiskinan.
Revenue Collection /
Pengumpulan dana

Revenue collection adalah cara sistem kesehatan

mengumpulkan uang dari rumah tangga, bisnis, dan
sumber-sumber eksternal
Kriteria pengumpulan dana kesehatan (IMF)

1. Adekuat dan stabil: pembiayaan yang

dikumpulkan dalam junglah yang cukup, stabil
dan cenderung untuk meningkat.
2. Efisien: pembiayaan perlu meminimalkan
gangguan terhadap stabilitas ekonomi.
3. Ekuitas: pembiayaan dikumpulkan secara adil
pada berbagia kelompok tingkat pendaptan.
Kriteria pengumpulan dana kesehatan (IMF)

4. Mudah dikumpulkan: pembiayaan mudah untuk

dikumpulkan dan diproses.

5. Dapat diterima secara politis: perlu adanya

transparansi, difusi yang luas dan kejelasan
tentang penggunaan pembiayaan.
Sumber Pembiayaan Kesehatan

 Perusahaan, firma dan pemberi kerja

 Individu, rumah tangga dan pekerja
 Organisasi non pemerintah dan
Yayasan internasional dan domestic
 Perusahaan dan pemerintah
internasional
 Mekanisme pengumpulan dana

1. Pajak langsung dan tidak langsung

Pajak langsung adalah pajak yang bebannya harus ditanggung
sendiri oleh wajib pajak yang bersangkutan dan tidak dapat
dialihkan kepada pihak lain.

Yang termasuk dalam pajak langsung adalah Pajak penghasilan

(PPh), Pajak Bumi dan Bangunan (PBB) dan Pajak Kendaraan
Bermotor.
 Mekanisme pengumpulan dana
Pajak tidak langsung adalah pajak yang bebannya dapat
dialihkan atau digeser kepada pihak lain. Dengan kata lain,
pembayarannya dapat diwakilkan kepada pihak lain.
Adapun contoh dari pajak tidak langsung adalah Pajak
Pertambahan Nilai (PPN), Pajak bea masuk dan Pajak
ekspor
2. Asuransi Kesehatan Wajib, Sosial dan Swasta
 Asuransi kesehatan wajib merupakan pajak penghasilan yang dipungut oleh
Pemerintah, yg dikumpulkan oleh badan independen atau semi-independen
pemerintah.
 Asuransi kesehatan sosial berkaitan dengan pendapatan dan pembagian
antara pekerja dan pemberi kerja. kontribusi dapat bersumber dari pekerja
mandiri dimana besaran premi dihitung berdasarkan pendapatan ataupun
tarif tertentu.
 Asuransi kesehatan swasta dibayarkan oleh individu, ataupun pembagian
antara pemberi kerja dan pekerja atau dibayarkan secara penuh oleh
pemberi kerja. besaran premi pada umumnya ditetapkan berdasarkan risiko
kesehatan tiap individu, penilaian pada kelompok tertentu maupun secara
lokasi geografis teretentu maupun penilaian risiko pada suatu perusahaan
tertentu.
 Pooling/Risk Pooling

Risk pooling/pengumpulan risiko mengacu pada pengumpulan dan

pengelolaan sumber daya keuangan sehingga risiko finansial individu yang
besar dan tidak dapat diprediksi menjadi dapat diprediksi dan
didistribusikan di antara semua anggota kelompok.

Sasaran : Risk Subsidy, Equity Subsidy

 Alternatif bentuk organisasi untuk pengumpulan risiko dan
pembiayaan pelayanan kesehatan:
1. Kementerian Keseahtan
2. badan penyelenggara jaminan jaminan sosial
3. asuransi kesehatan swasta
4. asuransi kesehatan berbasis komunitas.
Allocation Mechanism

Mekanisme pengalokasian anggaran untuk kesehatan

1. Apa yang diperlukan
2. Bagaimana prosesnya
3. Untuk siapa
Pembelanjaan (Purchasing)

Pembelanjaan kesehatan berkaitan dengan

kelompok mana yang akan mendapatkan manfaat,
dalam bentuk pelayanan apa/manfaat yang
diberikan, siapa yang akan menyelenggarakan
layanan kesehatan, bagaimana mekanisme
pembayaran serta harga pembiayaan pelayanan
kesehatan yang dibeli.
 Jenis Pembelanjaan

Pasif
dilakukan dengan melakukan
pembayaran sesuai dengan
tagihan yang diberikan.
Strategic
pencarian terus menerus metode pembelian
dan penyedia layanan kesehatan secara
optimal yakni dengan mempertimbangkan
paket manfaat yang perlu disediakan,
bagaimana dan dari siapa layanan tersebut
dibeli.
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Venus is the second planet Despite being red, Mars is a
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Earth is where we all Mars is actually a
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Neptune is far from Venus has a beautiful Jupiter is the biggest
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Mercury is the closest Despite being red, Mars is
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Mercury is the closest Mars is actually a very
planet from the Sun cold place in the System

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Venus is the second planet Saturn is composed of
from the Sun hydrogen and helium
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Mercury is the closest planet to the

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