TANGGUNGJAWAB HUKUM DOKTER

1

The Use of Health Services under the Garuda
Health System
Asia Pacific Summit on HEALTH INSURANCE and
MANAGED CARE Jakarta, May 23 2002
2
Garuda Medical Centre

• Responsibility
• Health Care Services delivery for employee and
  familiy
• Aviation Health Services for aircrew
• Occupation Health Safety Program
• Cost efficiency

PLAN
CON TROL
MA NA GE
FINANCING
3
Health Care Plan

• Medical Check-Up
• Primary Care Services
• (GP, dentist, Lab., Radiology Physiotherapy
• Secondary Care Services
• Hospitalization Services
• Maternal Services
• Rehabilitation
• Prevention / Vaccination
• Hearing aids, eyeglasses, prostetic appliances
• Dialysis, IVF/GIFT, organ transplant, Coronary by
  pass surgery, chemotheraphy etc.
• Occupational Health Safety Program

4
Health Care Plan

• EXCLUTION
• Cosmetic therapy, cosmetic surgery
• Secondary Infertility
• Supportif therapy (oxygen therapy, chelation th/)
• Drug / alcohol abuse
• Suicides
• Sexual transmitted disease
• Termination of pregnancy w/o medical indication
• Illness or injury because of high risk sport /
  hobby
• Med.check-up, eyeglasses, prostetic appliances,
  hearing aids (spouse children)

5
Health Care Facilities

• Company Facilities
• Garuda Medical Centre - Kemayoran
• Clinic Garuda Sentra Operasi Cengkareng
• Clinic Garuda Building - Jl. Merdeka Selatan
• Clinic Garuda Aviatio Training - Duri Kosambi
• Provider Network
• Clinics
• ( Jabotabek 25 clinics PSDN 38 clinics )
• Hospitals
• ( Jabotabek 19 hospitals PSDN 40
  hospitals )

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HOSPITALIZATION SERVICES
7
JPKM model
HEALTH CARE SERVICES
FINANCING ASPECT

• COMPLETED
• REFERRAL SYSTEM
• PRIMARY CARE as
• GATE KEEPER

• IN ADVANCED
• PREPAID

8
GARUDA SYSTEM
GSM
Fee for service
premi
claim
PROVIDER
PAYOR
Health care services
9
JPKM
GSM
Prepaid payment capitation
premi
PROVIDER
PESERTA
Health care services
10
HEALTH CARE COST ( 1998 - 2001 )
11
HEALTH CARE COST ( 1998 - 2001 )
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Current Condition

• STRENGTH
• - The healthy employee help the sick one
  (cross subsidized)
• - Health Care Plan
• - Integrated Health Care Services
• - Yearly Medical Check-up
• - Maintain cost efficiency
• WEAKNESS
• - Medical Information System
• - Contract Fee for service basis
• - Utilization of Primary Care in Network
  Provider
• - Employee contribution in maintain their own /
  families health
• - No limitation

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Improvement Program
1. PROMOTE and CAMPAIGN HEALTH SETTING
MINDSET 2. PARADIGM Prevent the Problems
rather than Treating the Problems 3.
VALUE CREATION for PATIENTS 4. IMPROVING
MEDICAL INFORMATION SYSTEM 5. FAMILY PHYSICIANS
as agent of change for shifting to Health
Paradigm 6. MAINTAIN DEVELOPED LOCALLY
PROMINENT PROVIDER 7. IMPLEMENTING 7 STEPS
MANAGEMENT TOOLS of JPKM 8. ISO ACCREDITATION
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TERIMAKASIH !
15
terima kasih
16
PENGELOLAAN SDM
JUMLAH DAN KOMPOSISI
PEGAWAI GA TETAP
GA HON. KONTR / WGP / DPP S 2 3
- - DR. PENERBANGAN 5
3 - DR. UMUM
6
- 13 DR. GIGI
5 -
7 DR. SPESIALIS
- 5
20
PARAMEDIS 32 -
53 NON MEDIS / ADM
36 - 32
TOTAL 87
8 125