PERCEPTION MAPPING ON HEALTH CARE INSURANCE PROGRAM IN ACEH: A PHENOMENOLOGY STUDY

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1 PERCEPTION MAPPING ON HEALTH CARE INSURANCE PROGRAM IN ACEH: A PHENOMENOLOGY STUDY Bonaventura Ngarawula Faculty of Social and Political Sciences University of Merdeka, Malang, East Java, Indonesia bonaventur4@gmail.com Sanusi Faculty of Teacher Training and Education University of Syah Kuala, Banda Aceh, Indonesia ABSTRACT Health development is one of the fields in Indonesian national development plan which is basically aimed to create public welfare. Indonesian government Act No. 38/2007 on Government Affairs Division between central government, state government and district/city government mentions that in the field of health, state, district/city has the authority to administer health care insurance according to local conditions. The objective of the research is to study the people s perception of health care insurance program which has been launched by Indonesian government in Eastern Aceh. We found that people who are at higher level of education tend to produce various responses regarding health care insurance program in Aceh. Keywords: Phenomenology study, People s perception, Banda Aceh 1. Introduction Indonesian Government Act No. 38/2007 regarding Division of Government Affairs between Central, State, and District/City government mentions that in the field of health, state, district/city government has authority to administer health care benefits according to local conditions. While Indonesian Law No. 40/2004 on National Social Security System (SSJN) states that health insurance uses principle of social insurance which membership is for all Indonesian citizen, and its premium is based on percentage of income and all members receive the same health services. Through the implementation of the social security system (SSJN), the entire community will get health care benefit from the government, which will have an impact on improving health status. This is in accordance with Indonesian Law No. 36/2009 on health which states that everyone has the same right to gain access to resources in the health sector and has an obligation to come to realize and join the social security program for maintaining and improving the health status high. The cost (premium) of participation the health care insurance becomes a very important issue in almost all region of Indonesia, because it is quite burdensome, especially for the medium and low income level. This is because the poor people have been receiving good health support from the central government (Jamkesmas) and local government (Gakinda). On the other hand, informal Organized by 515

2 workers who do not have a steady income are not a target of the government program in the Jamkesmas both at national, state, and district/city level. They need to be prioritized because this group is quite numerous and has potential to fund for their health-related insurance. The group has the ability to set aside some of their income for health insurance although limited. In Aceh province, since 2005 has been highly conducive situation to health development as compared with 30 the previous years. That year was also the first year after the post-tsunami and post-mou between GAM separatism and the Indonesian government. Before that, the province was an area which was prone to insecurity so that development in all sectors was very difficult. But the challenge which still needs special attention is the limited human resources, both related to technical management and health for state and Sistrict/City both quantitatively and qualitatively. For that fact, Aceh Health Insurance Aceh (JKA) was launched which was designed to be able to meet the expectations of the fulfillment of good quality in health facilities in Aceh. In the early stages, people who are not assured of a wide range of collateral or participants of Jamkesmas become participants of the JKA. In the following years, all types of health insurance must be coordinated in order to receive the same benefits and services. Moreover, Indonesian Law No. 11/2006 regarding autonomy for Aceh government give broad autonomy to the Aceh government for the welfare of the Aceh people. This has given created many types perceptions of society, both negative and positive perception. Based on problem formulation above, the purpose of this study is to examine the perception mapping on Aceh Health Insurance (JKA) program in Aceh, especially in East Aceh district. 2. Literature Reviews 2.1 Condition of Community s Health Health paradigm is the concept of deep thinking which required implementation of many scientific disciplines such as social sciences, cultural sciences, engineering sciences, nutritional sciences, behavioral sciences, religious sciences, and also involves development of political decision makers of national/state level. Interference, intervention, injustice, indifference, and anothers forms resulting in lack of health of the human body, mental, natural environment and social environment, and legal arrangements, as well as in the management of social injustice that they receive, are violation of community rights. Ideal condition is that the public health system should always be monitored and evaluated so that it can be continuously improved directed into a national public health system. The public health system is not just a health care system of the recovery efforts, but also is a system that includes the functions of promotion, prevention, cure and rehabilitation of health so that strong role in the transformation of a healthy culture becomes an important element towards a healthy society. With promotion and prevention efforts against the dangers of the disease, the public health system seeks to reduce the amount of morbidity and health care costs so that they, at the same time, can increase productivity in national level. A development program for the public health system can be considered as responsibility of many parties and in line with central government regulations on corporate social responsibility (CSR). Through mature ability of planning and analysis, an effort to optimize funding and personnel through the mechanism of CSR is expected to achieve an empowerment and community development in all fields. Organized by 516

3 2.2 Phenomenology Phenomenology is a philosophy stream and a method of thinking which was introduced by Husserl (Cohen, 1987; Koch, 1996). It is started from the truth of the phenomenon as it looks to what is (Ferguson, 2001). Speigelberg (1960) described the historical roots of phenomenology as a movement rather than a discrete period of time. A phenomenon that appears is actually a reflection of a reality which does not stand alone because it is an object that is full of transcendental meaning. Therefore, to get the essence of the truth, it must break through beyond the visible phenomena (Waters, 1994). This view is enhanced by Schutz (1967) after combining the transcendental phenomenon of the concept of Husserl and his concept of Weber s verstehen, because the daily social world is always an intersubjective and experience filled with meaning (Ferguson, 2001). Thus, a phenomenon which is revealed by an individual is a reflection of transcendental experience and understanding of the meaning or Verstehen (Ferguson, 2001; Waters, 1994). According Orleans (2000), phenomenology is used in two basic ways, namely (1) to theorize sociological issues which are substantial, and (2) to improve the adequacy of sociological research methods. Furthermore, Orleans explained that phenomenology seeks to offer a correction to pressure on the conceptualization of positivity and methods of research which considers that the issues which are found by the method of phenomenology are interesting thing. 3. Methodology 3.1 Research Approach The approach used in this study is a qualitative approach as described by Locke, et al. (2004). This design can be obtained through overview of a process and explanation of the meaning of phenomenon of Aceh's Health Insurance Program in the community so that it can be disclosed various meanings contained and can answer research questions as well as to get research findings. The use of the research method is in accordance with what was mentioned by Corbin & Strauss (2007). A qualitative approach is chosen after considering that not many theoretical studies on Aceh's Health Insurance Program have been conducted in Aceh community. A qualitative approach is believed to be able to guide searches of new paradigms of government sciences from combinations of research object and researcher perspective. This study was conducted in East Aceh district of Aceh province. 3.2 Sample, Sampling Technique and Research Instrument Instruments in this study are the researchers themselves as the main instrument and instrument aids such as a tape recorder, etc. Meanwhile, regarding research informants, who are expressed by Moleong (2007), we involve people on the background of the study. In more firmly Moleong said that the informant is a person who utilized for providing information about the situation and the setting conditions. To determine a good informant, there are several requirements to be considered: (1) the informant have been long and intensively living together in activities or areas of research studies, (2) the informant have been fully involved in activities or areas, and (3) informants possess sufficient time to provide information (Spradley, 1979). In this research, we use snowball sampling technique for the selection of informants. It means that the researchers need to find a key informant at the first stage. Then, form the key informant we can get another informant to provide additional information (data). The process to get next informants is Organized by 517

4 kept rolling to get more information. Researchers will stop collecting data and other information if the data collected is sufficient to obtain the necessary information. 4. Finding & Discussion 4.1 Demographics Condition of East Aceh District Total population in East Aceh district during the period of last five years continues to show an increasing trend. In 2007 the population reached 313,337 people which then increased to 332,915 people in 2008 and 349,417 people in According to census in 2010, the population of East Aceh reached 360,475 people or about 3.16 percent growth as compared to the one in year Facilities, Infrastructure and Personnel of Health in East Aceh Development in the field of health aim reaches all levels of society so that entirely people are able to obtain health services equitably. The Aceh Health Onsurance, JKA, as a program that provides free of charge health care for poor people, has been implemented in all medical centers in Aceh as well as some government-owned hospitals. Related to that, in 2011, a district general hospital has been built with CSR funds of PT MEDCO, a private company. Other public health facilities tend not to increase in the last few years. There are several health facilities which were damaged due to flood but local government of East Aceh has renovated the damaged facility. The number of doctors and health personnels are not distributed evenly in each district. Likewise, health facilities have not yet spread throughout the district. Moreover, the ratio of doctors to population is 1: 3,098, which means a doctor must handle about 3,098 people in the district, which is ver bad. Meanwhile, the ratio of nurse to population is 1: 420. Thus it can be said that the district of East Aceh is still a shortage of doctors and nurses. But, all people in the district have been receiving health services financed by the government. 4.3 Perception of Aceh People on the JKA Program The Aceh Health Insurance Aceh (JKA) is an implementation of one of many visions and missions of the Aceh s Governor Irwandi Yusuf and Aceh s Vice Governor Muhammad Nazar to promote Aceh. Both are well aware that the development in Aceh would not be optimal without improvement in the quality of public health, especially for the low income people. Now, residents of Aceh only need to show ID card and family card to obtain health services for free at hospitals and medical centers in Aceh. The policy of Aceh government in resolving issues relating to public health through the JKA program has received a great welcome from majority of the people of Aceh. Although in the implementation is still having many shortcomings, but at short period from launching, it has been attracting attention from many elements of society. Based on comments from informants (respondents) who have requested their perception regarding the JKA program, most of them have high expectations for this program to become a priority program for the community. This is because the condition of the people who are mostly economically disadvantaged. Regarding the JKA program which is free of charge, most respondents stated that it is not only to provide very good benefits in health care, but also easy in administration. However, some respondents, especially with higher education level, advised to improve the quality in the treatment of patients. Services and adequate facilities in Organized by 518

5 hospitals must reflect good credibility in dealing with health problems, so that the result can be observed in the good quality of people's lives. In this study, East Aceh district is one of the most populous districts in Aceh. Thus, the optimization of health services at the JKA program is indispensable in order to meet the needs of people in the district. And based observation in this study, we found that almost all people in the district have been receiving (at least once) a treatment in medical center or hospital using JKA program services. In general it can be stated that the people of East Aceh district has a positive perception of the health services program JKA. It can be seen from the behavior of people who are excited waiting in a queue for getting service of the JKA program. Out of various perceptions conveyed by the respondents, it can be seen that almost all respondents expressed about the benefits that have been gained by the JKA program. 5. Conclusion Based on the research results we can conclude that people who are having higher levels of education tend to produce broader response in providing their perceptions of Aceh Health Insurance (JKA) program. For the people of Aceh, the JKA program is free medication in medical centers and hospitals. But, the JKA still has a lot of room to improve the quality of the health service provided by the hospital to the patient. References Cohen, M. (1987). A Historical Overview of the Phenomenologic Movement. Journal of Nursing Scholarship, 19(1), Corbin, J., & Strauss, A. (2007). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (3 rd ed.). Thousand Oaks, CA: Sage. Koch, T. (1996). Implementation of a Hermeneutic Inquiry in Nursing: Philosophy, Rigor and Representation. Journal of Advanced Nursing, 24, Locke, L., Silverman, S. J., & Spirduso, W. W. (2004). Reading and understanding research (2nd ed.). Thousand Oaks, CA: Sage. Moleong, L. J. (2007). Metodologi Penelitian Kualitatif. Bandung: PT Remaja Rosdakarya Offset. Orleans, M. (2000). Phenomenology, Gale Encyclopedia of Sociology 2nd edition Vol. 3, (eds.) Borgatta, E.F., Rhonda, J.V., New York, Gale. Schutz, A. (1967). The Phenomenology of the Social World. in Lehnert, F., Walsh, G. (trans) in The Phenomenology of the Social World, Evanston: Northwest University Press. Speigelberg, H. (1960). The Phenomenological Movement: A historical introduction (2nd ed.). The Hague, The Netherlands: Nijhoff. Spradley, J. P. (1979). The Ethnographic Interview: New York Holt: Rinehart and Winston. Waters, M. (1994). Modern Sociological Theory, London: Sage Publications. Organized by 519