NILAI STRATEGIS ASOSIASI RUMAH SAKIT DAN HOSPITAL NETWORKING DI ERA MEA
Kuntjoro Adi Purjanto Ketua Umum PERSI Jakarta, 24 Agustus 2016
BIODATA
Dr Kuntjoro Adi Purjanto, Mkes S1 FK UNS Surakarta S2 FK UGM Magister Manajemen RS Jabatan semula sd sekarang: o Pimpinan Puskesmas di Kab Banjarnegara o Direktur RSUD di Kab Banjarnegara & Kota Salatiga o Direktur Jangmed Kemkes o Sekretaris Dirjen BUK Kemkes o o o o o o o o o o
Dosen Dewan Pembina KARS Surveyor Akreditasi KARS Asesor Konsultan Kesehatan Ketua Umum PERSI Dewan Penasehat PP ARSADA Dewas RSUP Sanglah Denpasar Dewas RSUD Moewardi Surakarta Dewas RS Akademik FK UNS Dewan Pengawas LAM-PTkes
o Dll Alamat Email:
[email protected] 2 Telephone: 081 1 27 6858
WHO global strategy on integrated people-centred health services: an overview IPCHS
(WHO global strategy on integrated people-centred health services 20162026, July 2015)
“The single integrated AEC”
“kawasan bebas perdagangan barang, modal dan jasa” ( 7 jenis jasa profesi ) untuk meningkatkan daya saing ekonomi kawasan regional ASEAN”.
menjadikan “ASEAN sebagai basis produksi dunia” serta menciptakan “pasar regional bagi 575 juta jiwa penduduk ASEAN” ( 42% RI,16.5% Philiphina, 15% Vietnam, 12% Thailand )
4 MODE OF SUPPLY
JASA KESEHATAN Mode 1:
Mode 2:
Cross border supply
Consumptio n abroad Pasien berobat ke RS di LN
Telemedicine Telemedicine
Mode 4 : Presence of Natural Persons Tenaga kesehatan WNA
Mode 3: Commercial presence Penanaman Modal Asing RS, Klinik
5
12 Megatrends in Global Health Care 1. Innovation & demand soar in emerging markets (China, India, Turkey, Brazil, etc.) 2. Personalized medicine and technological advances 3. Aging populations and chronic diseases 4. Rising costs 5. Global pandemics (AIDS) 6. Environmental challenges 7. Evidence-based medicine 8. Non-MDs providing care 9. Payers’ influence over treatment decisions 10. The growing role of philanthropy 11. Prevention is the next big business opportunity 12. Medical tourism
Source: 2016-9-1 Dillon. K., & Prokesch. http://hbr.org/web/extras/insight-center/health-care/globaltrends 6
6
Desakan Perubahan: Eksternal Memicu Aliansi • Proses globalisasi menjadi kekuatan utama dibalik pertumbuhan aktivitas nilai tambah lintas batas Negara. • Meningkatkan saling ketergantungan ekonomi. • Melahirkan serangkaian reaksi, tetapi melalui apa yang telah disebut “alliansi kapitalisme”? • Meningkatkan internasionalisasi dan persaingan menimbulkan kebutuhan untuk bekerja sama secara nasional, dan regional. • “ Keseluruhan bisnis adalah keunggulan lokal ”.
Triono Sundoro, 2016
7
Nilai Strategis: Inti Utama • “Menciptakan budaya” atas nilai strategis antara lain kerjasama/kolaborasi, yang bersifat “sustainable” sebagai sebuah “sistem”. • Membutuhkan lebih dari sekedar komitmen dan perubahan semua organisasi yang terhimpun menuju keunggulan keutuhan ( identitas kolektif ) • Kegiatan jangka pendek mungkin cukup untuk norma-norma yang berlaku • Kegiatan jangka panjang dan berkelanjutan, menciptakan budaya kolaborasi memerlukan normanorma yang konsisten dengan dan mendukung kolaborasi 8
Triono Sundoro, 2016
Asean's growing medical and healthcare industry • Middle-income earners are on the rise across the Association of South-East Asian Nations’ (Asean), a demographic shift that is driving demand for better healthcare and medical devices that facilitate more efficient treatment. • Pacific Bridge Medical forecasts this dynamic will help double the value of the medical device market in the region — whose 10 members are Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam — from US$4.6 billion in 2013 to US$9 billion by 2019. IPSOS BUSINESS CONSULTING Geared for health
9
• Asean is home to 620 million people and the world’s third largest workforce. • The region’s economic output is US$2.4 trillion, the seventh largest in the world and above India and will become the fifth largest economy by 2050 (source: McKinsey Global Institute). • Some 125 million households will enter the middle-income bracket by 2025, representing an increase of 87 per cent (source: McKinsey Global Institute).
10
• The region benefits from a bi-modal population. While half of those living in Asean are under 30, there are more than 55 million people over the age of 60, a population larger than Korea and equivalent to that in South Africa(source: United Nations Population Fund). • There is increasing intervention by the public sector in terms of the investment in the healthcare sector and the level of spending
11
Healthcare in Indonesia: a Booming Industry • GROWING HEALTH EXPENDITURE. Indonesia’s healthcare expenditure is estimated to grow by 14.9% annually, reaching US$61 billion by 2018 • NATIONAL HEALTH INSURANCE (JKN). In 2014, the universal healthcare coverage was launched, reaching 130 million registrations by 2015 and aiming to cover all 250 million Indonesians by 2019 • STEEP DEMAND INCREASE. Hospital beds, medical devices, diagnostic tests, IT systems and skilled manpower demand has increased sharply in 2014 and will continue to climb over the next years 12
Universal healthcare plan – the game changer. •
Indonesia’s healthcare expenditure is among the lowest in the region, at only 2.7% of GDP in 2012. The introduction of the universal healthcare plan (JKN) starting in 2014 is expected to change the sector’s outlook in the long run.
•
JKN calls for 100% healthcare coverage for all Indonesians by 2019. This structural change should drive Indonesia’s healthcare spending growth ahead, and be higher than 12% CAGR.
•
Laju Pertumbuhan Majemuk Tahunan (Compound Annual Growth Rate), biasanya disingkat CAGR, adalah konsep bisnis dan investasi yang memperhalus pertumbuhan tahunan dari investasi atau bisnis dalam suatu periode. Konsep sederhana CAGR adalah memandang pertumbuhan tahun demi tahun yang lajunya halus, sehingga mengabaikan volatilitas atau perubahan pertumbuhan.
13
Potential repatriation of Indonesian patients. • In 2012, Indonesian patients were estimated to have accounted for c.48% and c.56% of international patients in Singapore and Malaysia. • We recognize that this represents untapped potential in Indonesia healthcare sector,when Indonesia’s healthcare services improve in the future. • The upside potential is estimated to be as large as c.7% of Indonesia’s current healthcare expenditure of ~US$ 24bn. 14
• According to the Singapore Tourism Board, foreign n visitors seeking healthcare services in Singapore increased at c.9% CAGR between 2008 – 2012 and surpassed 850,000 in 2012. • Indonesian healthcare visitors made up just below 50%, and c. 80% were from Jakarta. • In terms of spending, Indonesian healthcare visitors (including those accompanying someonewith healthcare needs) spent an average of SGD 2,207 (equivalent to Rp20.5m) in 2012. This translates to Rp8.3tr. • According to Malaysia Healthcare Travel Council (MHTC), the number of incoming healthcare travellers reached 671,727 in 2012 (c.16% CAGR from 2008 – 2012). This translates to about Rp5.4 Tr, if we assume 56% are from Indonesia and spend about 30% less per person compared to Singapore. 15
16
IPSOS BUSINESS CONSULTING Geared for health
17
Rising healthcare needs in Indonesia • 2013, Indonesia, the 4th most populated country (~250m people), has potential to see rising healthcare spending, given its demographic shift and rising middle class. • Healthcare expenditure grew 12% CAGR for the past four years, but currently represents only 2.7% of GDP (one of the lowest in the ASEAN region). • Indonesia’s healthcare expenditure is also at a paltry US$132 per capita, while its average life expectancy of 67.8 years is at par with the world’s average. • Indonesia’s population has a median age of 28.9 years and currently, 14% of its population is above 55 years. 18
These statistics indicate the growth potential for Indonesia’s healthcare industry.
19
20
Per 10.000 population
Country
Per 100.000 population
Per 1.000 population
Physicians
Nursing and midwifery personnel
Dentistry personnel
Pharma ceutical personnel
Hospital
Hospitals beds
14.4
80.5
4.2
4.0
1.4
2.8
Cambodia
1.7
7.9
0.2
0.4
0.6
1.2
Indonesia
2.0
13.8
1.0
1.0
0.4
0.9
Laos
1.8
8.8
0.4
1.2
2.2
1.5
Malaysia
12.0
32.8
3.6
4.3
0.5
1.9
Myanmar
6.1
10.0
0.7
-
0.6
1.2
Philippines
-
-
-
8.9
1.8
1.8
Singapore
19.5
57.6
4.1
4.1
0.5
2.0
Thailand
3.9
20.8
2.6
1.3
1.8
1.8
Timor Leste
0.7
11.1
0.4
1.1
-
-
Viet Nam
11.9
12.4
-
3.1
-
1.6
Brunei Darussalam
Amal Sjaaf,2016 Diolah dari : 1. World health statistics 2015, World Health Organization 2015 2. http://data.worldbank.org/indicator/SH.MED.BEDS.ZS , 2015
21
Changing Health Care System o Integration of healthcare delivery organizations o Continual advances in medical technology o Increased collaboration to improve community health status o Increased emphasis on disease prevention and wellness promotion o Growing elderly population o Better-informed patients demanding high-quality care o Pressure to control costs and demonstrate the value of the services delivered o Efforts to implement continuous quality improvement initiatives Implikasi MEA terhadap pelayanan kesehtan khususna perumahsakitan di Indonesia, Adib Yahya 2011
22
Top Issues Confronting Hospitals Financial challenges Health reforms Patient safety & quality Governmental mandates Care for the uninsured Physician-hospital relations Patient satisfaction Technology Personnel shortages 23
Five Hospital Trends to Watch Investment in technology Greater focus on social and mobile marketing opportunities Employer-hospital partnerships Stronger physician relationships Formal population health management programs
24
Ten Ways for Hospitals to Increase Profitability 1. Focus on the continuum of care 2. Design models to reduce readmissions 3. Have a good relationship with payors 4. Manage new service lines to increase market share 5. Control labor costs with meticulous data collecting 6. Reduce supply costs by working with vendors and physicians 7. Improve deficiencies in the ER and Operating room 8. Create population health management programs for chronic illnesses 9. Consider outsourcing some services 10. Revamp the energy cost strategy 25
HOSPITAL SERVICES TO WIN ALL
…
PENGELOLAAN PELAYANAN KESEHATAN YANG MENGUTAMAKAN KEPENTINGAN PASIEN, DOKTER, FARMASI, ASURANSI, PERUSAHAAN PENGGUNA DAN MASYARAKAT UMUM LAINNYA
HOSPITAL’S STAKE HOLDERS 26
HOSPITAL’S STAKEHOLDERS Hospital's stakeholders can include its patients, families and the larger community. Stakeholders also include employees, physicians, businesses and other community health care providers, all of which have an interest in seeing the hospital succeed. 27
SYNERGY AS A STRATEGIC MANAGEMENT PROGRAM TO COLLABORATE WITH HOSPITAL STAKEHOLDERS
28
SYNERGY Synergism, in the world of people, is sometimes used to reference a team. In other words, the effects of synergism are always interdependent and the result of cooperation (Corning, 1996) . Synergy is the close coordination of efforts and resources of individuals working together so that the outcome or performance of the whole is greater than the sum of the parts (PathQuest, 2001). 29
components of synergy There are some components of synergy that must be followed in order to make it effective, especially in the arena of health care. •Some of these elements are : - establishing a clear purpose, - listening actively by focusing on the individual who is speaking, and - having a sympathetic consciousness of another’s distress and a desire to alleviate that distress. - flexibility and openness to another person’s viewpoint 30
COMMUNITY PARTICIPATION AND SYNERGY
A partnership creates synergy by combining the complementary knowledge, skills, and resources of different people and organizations.
31
Who is Involved in the Partnership •
The people and organizations involved in a partnership are the building blocks of synergy.
•
the community stakeholders involved in synergistic partnerships often go well beyond the "usual suspects," including : - service providers - people who use services, - youth and low-income residents who are directly affected by problems, - formal and informal community leaders, - academics in different disciplines, - government agencies, - schools, - businesses, and - faith-based organizations 32
Aspek Fundamental: Aliansi • •
•
Harus membawa manfaat bagi mitra organisasi2 yang terlibat, namun aliansi tidak hanya sekedar perjanjian. Kolaborasi (menciptakan nilai baru secara bersama-sama) dan tidak hanya sekedar pertukaran (mendapatkan suatu pengembalian atas apa yang diberikan). Tidak dapat “dikontrol” oleh sistem yang formal namun memerlukan jaringan keterkaitan interpersonal dan infrastruktur internal yang meningkatkan proses belajar.
33
Kemitraan dalam lingkungan masyarakat Indonesia, • •
•
Mengenal kemitraan sejak berabad- abad; seperti gotong royong, sambat sinambat, partisipasi, mitra masyarakat desa hutan, mitra lingkungan dll. Dalam manajemen modern, baik dalam pengembangan sumberdaya manusia maupun pengembangan kelembagaan / usaha, kemitraan merupakan salah satu strategi yang biasa ditempuh untuk mendukung keberhasilan implementasi manajamen modern. Kemitraan tidak sekedar diterjemahkan sebagai sebuah kerjasama, akan tetapi kemitraan memiliki pola, memiliki nilai strategis dalam mewujudkan keberhasilan suatu lembaga dalam menerapkan manajemen modern.
34
Masalah Kompleks Yang Mengancam • Terjadi pada saat kompleksitas perilaku dan dinamika tinggi; • Realitas sosial kompleks ; • Kelompok berbeda; • Pengambil keputusan memiliki asumsi, nilai, dan keyakinan yang bertentangan satu sama lain King, 1993; Rittel dan Weber, 1973.
35
Tantangan Pengambilan Keputusan Riil • berbagai masalah tidak dapat diselesaikan secara terpisah; • mempertegas kesulitan untuk menghubungkan berbagai asumsi dan nilai yang berbeda; • orang yang berpikir berbeda harus belajar dan menciptakan suatu realitas bersama ; • sesuatu yang pada awalnya tidak dipahami sepenuhnya oleh mereka. 36
Keterkaitan Dalam Sistem: Tantangan • Saling berinteraksi dengan kesalahpahaman, asumsi yang berbeda, dan polarisasi keyakinan dari berbagai kelompok orang. • Memperbaiki komunikasi dan kepercayaan diantara kubu yang berbeda belumlah cukup; • cenderung lebih senang memfokuskan diri pada gejala daripada penyebab utama dan • cenderung mencari penyelesaian yang berpengungkit rendah (low-leverage). 37
Together, a broad array of participants can: * Obtain more accurate information (e.g., about the concerns and priorities of people in the community): * See the "big picture" (e.g., appreciate how different services, programs, and policies in the community relate to each other and to the problems the partnership is trying to address); * Break new ground (e.g., combine statistical and qualitative information to get a better understanding of the root causes of problems and discover innovative approaches to solving problems); and * Understand the local context (e.g., appreciate the values, politics, assets, and history of the local environment and use this information to identify strategies that are most likely to work in that environment. 38
Adib Yahya, 2011
A E M FLEKSIBILITAS
JKN AKREDITA SI •
PerMenkes No. 99/2015 (Revisi Permenkes 71/2013): Pelayanan Kesehatan pada JKN
Tata kelola Rumah sakit yang baik • Tata kelola klinik yang baik • Kendali mutu dan kendali biaya • Pengukuran mutu: Efektivitas, Efisiensi, Aksesibilitas, Pelayanan Fokus Pasien, Equitable dan AP, keamanan Kuntjoro 2014; Bambang Wibowo,2016
A good system in the absence of good attitude is a blind alley 40
SELESAI 41
