MENGUJI EFEKTIVITAS JKN DAN RASIONALITAS DANA PENDAMPING APBD DALAM MEWUJUDKAN EFFECTIVE UNIVERSAL HEALTH COVERAGE DI KALIMANTAN SELATAN

Ahyar Wahyudi

doi:10.69957/praob.v6i05.1696

Authors

Ahyar Wahyudi Lembaga Akreditasi Fasilitas Kesehatan Indonesia

DOI:

https://doi.org/10.69957/praob.v6i05.1696

Keywords:

JKN, Universal Health Coverage, Effective Coverage, Dana Pendamping APBD, Active Coverage, Risk Pooling, Strategic Purchasing

Abstract

Capaian kepesertaan Jaminan Kesehatan Nasional (JKN) yang mendekati universal belum serta-merta menunjukkan tercapainya effective universal health coverage (UHC). Penelitian ini bertujuan menganalisis kesenjangan antara population coverage, active coverage, dan effective coverage, sekaligus menguji rasionalitas dana pendamping Anggaran Pendapatan dan Belanja Daerah (APBD) dalam memperkuat perlindungan kesehatan di Kalimantan Selatan. Penelitian menggunakan paradigma post-positivistik dengan pendekatan kuantitatif deskriptif-analitik dan policy analysis. Analisis dilakukan melalui coverage gap, activation rate, perbandingan antarwilayah, serta analisis cost-opportunity, yang kemudian diintegrasikan dengan perspektif financial protection, risk pooling, strategic purchasing, dan governance. Hasil menunjukkan bahwa tingginya population coverage belum identik dengan perlindungan efektif. Dari 4.324.807 peserta JKN, hanya 3.686.585 berstatus aktif, sehingga terdapat sekitar 638.222 peserta yang mengalami activation gap. Kondisi tersebut menunjukkan bahwa tantangan UHC telah bergeser dari ekspansi kepesertaan menuju kesinambungan perlindungan, pemanfaatan pelayanan, mutu, dan perlindungan finansial. Dana pendamping APBD memiliki legitimasi sebagai targeted safety net bagi kelompok yang benar-benar berada di luar perlindungan JKN, tetapi berisiko berubah menjadi parallel financing apabila digunakan untuk menutup persoalan klaim, administrasi, atau kelemahan provider. Penelitian merekomendasikan penerapan prinsip JKN First Policy, financial additionality, pemisahan fungsi pelayanan dan pengawasan, serta penguatan Dinas Kesehatan sebagai policy gatekeeper untuk memastikan APBD memperkuat, bukan menggantikan, JKN.

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