Di akhir pembahasan ada pernyataan mengenai masalah kebijakan. Masalah-masalah kebijakan yang ada dalam kasus ini dapat dikelompokkan menjadi:
- Pelaksanaan Kebijakan mempunyai kemungkinan menghasilkan keadaan yang tidak sesuai dengan tujuan kebijakan ditetapkan.
- Penelitian monitoring kebijakan merupakan hal yang tidak mudah dilakukan.
Silahkan anda memberi komentar, atau tambahan untuk masalah kebijakan yang ada di balik Kasus tersebut.
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Tim kendali mutu dan kendali biaya di BPJS juga sudah melakukan pertemuan-pertemuan dengan stake holder guna penyamaan persepsi, apa yang masih kurang dalam standar pelayanan BPJS. Kedepan diharapkan dengan penyamaan persepsi, akan memudahkan kerjasama dan menghindari fraud dari layanan.
Mengenai pemerataan tenaga medis dan para medis guna peningkatan pelayanan, membutuhkan kebijakan baru dalam penempatan tenaga medis dan para medis dengan kompensasi yang cukup
Menurut saya, kebijakan JKN menggunakan pendekatan Top-Down. Berdasarkan teori , implementasi pendekatan Top-Down adalah pelaksanaan kebijakan oleh pemain ditingkat bawah berdasarkan tujuan yang telah dibuat oleh tingkat yang lebih tinggi atau pusat. Sementara dalam pendekatan Bottom-Up, kebijakan diperankan aktif oleh pelaksana ditingkat bawah dan mereka memiliki keleluasaan untuk merubah kebijakan dalam sistem.
Mengacu pada kasus ini, JKN memiliki ciri sentralistis dalam aspek pembiayaan dengan peraturan yang “indonesia raya” (one fit for all) ,padahal Indonesia memiliki banyak keberagaman. Hal ini memperlihatkan bahwa JKN kurang memberikan keleluasaan untuk pelaksana terutama pelaksana ditingkat bawah untuk merubah kebijakan, sehingga pendekatan bottom-up tidak terlihat dalam kebijakan JKN ini.
Pendekatan Bottom up mempertimbangkan pengaruh-pengaruh lokal dallam kriteria evaluasinya, namun berdasarkan kasus JKN ini, beberapa daerah di Indonesia yang memiliki keterbatasan Fasilitas dan SDM kesehatan lebih sedikit merasakan manfaat JKN daripada di kota besar. Artinya, JKN kurang memperhatikan kondisi spesifik lokal dan secara jelas bahwa bottom-up tidak terlihat dalam kebijakan ini.
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