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MOHAMAD REZA AFFANDI

SARJANA - Pendidikan Dokter

Asal Perguruan TinggiUniversitas Airlangga
Nama ProdiPendidikan Dokter
JenjangSARJANA
Semester6
Judul Karya TulisKontrol Kualitas Sistem Pelayanan Diabetes Melitus Berbasis Pay-for-performance: Menuju Strategi Komprehensif Menghadapi Penyakit Katastropik di Indonesia
Topik Karya TulisKesehatan Masyarakat
Bidang Karya TulisIPA

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Ringkasan KTICatastrophic disease, especially diabetes mellitus, is known as a disease that extorts high volume of patients, high cost of treatment, and high risk of mortality so that it burdens the state both economically and socially. In Indonesia, one of the causes of increasing budget deficits of the Social Security Agency for Health (BPJS Kesehatan) from 2014 to 2017 is the cost spent for caring the diabetes and its complications. In fact, 90% of diabetes belong to type 2 diabetes mellitus that can actually be prevented through lifestyle intervention. In this regard, the government has established three main programs for the prevention of diabetes mellitus in Indonesia, namely Posbindu PTM focusing on screening and education; Prolanis focusing on diabetes patient management; and a healthy living campaign called CERDIK and PATUH. However, if the program is not well implemented, then the prevalence, the complications, and then the maintenance costs will continue to increase, and thus become a burden for the government. Therefore, the author proposes a system of pay-for-performance as a quality control for diabetes mellitus services in Indonesia.

The pay-for-performance (P4P) system is defined as a system used to provide incentives to physicians and health care provider organizations to achieve improved performance by increasing quality of care or by reducing costs. In addition, the rewards and compliments in the form of incentives are also comparable with the given targets that should be achieved including (1) The goals of Sustainable Development Goals, Universal Health Coverage, and the strategic plan of Ministry of Health to improve the health care quality of non-communicable diseases, particularly diabetes with clear and measurable objectives; (2) Lifestyle intervention such as changing individual or community lifestyle; and (3) Achieving good glycemic control or tackling the clinical inertia which cover factors including physician, patient, and service system that contribute to the inadequate therapy in diabetes patients. Related to the clinical inertia, the most important factor is the physicians which is mostly due to the lack of adherence to the guidelines published by Indonesian society of endocrinologist.

Based on the diabetes mellitus problems analysis in Indonesia, the author proposes three comprehensive strategic plans to solve the problem of diabetes as the catastrophic disease in Indonesia. The first plan is designing and implementing P4P to improve the quality of diabetes care. The objectives of P4P in diabetes care is to control quality of primary and secondary prevention programs such as diabetes risk factor screening, HbA1c monitoring, or referring to the expertise under the diabetes management guidelines. Therefore, the domains, performance indicators, and the size of incentives can be determined later based on the objectives and discussions involving parties such as physicians and health workers, endocrinologists, BPJS-K representatives, and the Minister of Health. However, based on The Regulations of the Minister of Health the Republic of Indonesia Number 52 Year 2016, the definition of incentives should be excluded from capitation and non-capitation tariff as the reward for a good performance and not for the service. The author proposes the incentives for diabetes care to be implemented in the primary health care center (Puskesmas) who have mandatory to carry out community and individual health efforts. Moreover, understanding that tackling diabetes burden is a complex medical issue and requires a multidisciplinary teamwork, the incentives are provided based on interprofessional collaboration and not for individuals or institutions. Finally, monitoring and evaluation are also parts of P4P design to establish continual improvement of the system.

The second plan is to improve primary-care infrastructures and resources because the issues such as the number of doctors, diagnostic labs, and consistent availability of appropriate medications are central to ensure that Puskesmas are fit for the purpose. The third plan is creating national diabetes plan and developing policies to promote and enforce healthier lifestyles. The national diabetes plan focuses on creating the ways of improving, establishing, and measuring impacts of the diabetes programs. Moreover, developing policies to promote and enforce healthier lifestyles, such as Gula Garam Lemak transparency policy, are also required to reduce the diabetes risk factors. In light of the foregoing, it is crucial for the government to implement the three comprehensive strategic plans to tackle the burden of diabetes as the catastrophic disease in Indonesia. 
Prioritas Pencapaian Prestasi Tahun Tingkat
1 Granted by University of Fukui for basic science, microbiology and 5th year clinical clerkship Japan International Student Exchange Program 2018 Internasional Lihat
2 Juara 1 Assessment Beastudi Etos Nasional 2017 Nasional Lihat
3 Juara 1 Esai Ilmiah 3rd Hypothalamus Competition 2017 Nasional Lihat
4 Juara 1 Esai Ilmiah Populer 10th Scientific Atmosphere 2017 Nasional Lihat
5 Juara 1 Esai Ilmiah Diponegoro Medical and Health Science (DMHSC) 2016 Nasional Lihat
6 Juara 1 Paper Competition PTTEP Indonesia Writing Competition 2016 Nasional Lihat
7 Juara 1 Esai Populer Hasanuddin Scientific Fair (HSF) 2016 2016 Nasional Lihat
8 Best Article Literature Review Indonesian International (bio)Medical Student Congress (INAMSC) 2016 Internasional Lihat
9 Juara 1 Esai Sekolah Kastrat Latihan Kepemimpinan Manajemen Mahasiswa dan Sekolah Kastrat Wilayah 4 2016 Nasional Lihat
10 Juara 3 Essay Competition Preevent Seminar Archaea "SEMARAK" 2016 Nasional Lihat

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