keadilan sosial pada layanan kesehatan

1. Pelayanan Kesehatan
Yang Berkeadilan
Rais Reskiawan

2. Of all the forms of inequality,
injustice in health care is the most
shocking and inhumane
Martin Luther King Jr

3. Pendahuluan
 Konstitusi menetapkan kesehatan merupakan hak
fundamental bagi setiap penduduk dan negara
bertanggung jawab untuk memenuhi hak hidup sehat
bagi seluruh penduduk terutama bagi masyarakat
miskin dan tidak mampu.

5. Why equity in health care?
“ The social conscience is more offended by severe
inequality in nutrition and basic shelter, or in access
to medical care, than by the inequality in
automobiles, books, furniture or boats”
Tobin 1970

6. Equity
 Equity adalah keadilan dalam distribusi barang dan
pelayanan di dalam masyarakat (Friedman)
 Equity dalam kesehatan menunjukkan bahwa idealnya
setiap orang memiliki kesempatan yang adil untuk
memperoleh kesehatan yang sebaik-baiknya dan tidak
dirugikan dalam memperoleh pelayanan kesehatan.

7. Prisip Keadilan
Keadilan Horizontal
Perlakuan yang sama
terhadap kondisi yang sama
Keadilan Vertikal
Perlakuan yang
berbeda terhadap
kondisi yang berbeda

8. Keadilan Horizontal
 Sumber daya/pengeluaran yang sama untuk
kebutuhan yang sama
 Penggunaan/penerimaan yang sama untuk kebutuhan
yang sama
 Akses yang sama untuk kebutuhan yang sama
 Tingkat kesehatan yang sama

9. Keadilan vertikal
 Perlakuan tidak sama untuk kebutuhan yang berbeda
 Based on ability to pay

10. Berkeadilan di Pembiayaan
Berkeadilan utk mengakses Infrastruktur
Berkeadilan utk mengakses tenaga kesehatan
Berkeadilan pada Faktor lain yg mempengaruhi

11. Berkadilan dalam pembiayaan
Penggunaan anggaran
PBI
Non PBI

12. Health financing is not only about how much money is
expended by the health sector but also about how
efficiently and equitably resources are raised, pooled, and
allocated to achieve desired health system objectives
such as UHC.

13. Berkadilan dalam infrastruktur

14. Berkadilan utk mengakses
tenaga kesehatan

15. Berkeadilan pada Faktor lain yg
mempengaruhi

16. Health Status: Major Determinants
Environment
Social
Physical
Education
SES
Income
Wealth
Lifestyle
Choices
Beliefs
Biology
Genetics
Healthcare
Health
•Toxins
•Safety
•Neighborhood
•Racism
•Discrimination
•Occupation
•Providers
•Institutions
•Systems
•Policies
H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What
should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J.
Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006.

17. Influence on Excess Mortality:
Poor & Minorities
Lifestyle 30%
Healthcare 10%
All others 60%
H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What
should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J.
Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006, p. 265.

20.  Universal coverage (UC), or universal health coverage (UHC),
is defined as ensuring that all people can use the promotive,
preventive, curative, rehabilitative and palliative health
services they need, of sufficient quality to be effective, while
also ensuring that the use of these services does not expose
the user to financial hardship.
 This definition of UC embodies three related objectives:
 equity in access to health services - those who need the
services should get them, not only those who can pay for them;
 quality of health services is good enough to improve the health
of those receiving services; and
 financial-risk protection - ensuring that the cost of using care
does not put people at risk of financial hardship.

21. Penghambat Ekuitas
 Politik
 Korupsi
 Proteksi terhadap faktor yang mempengaruhi
kesehatan

24. Approaches and Principles1. Focusing on the most disadvantaged groups: This targets
the worst off or poorest groups and aims to improve their
health through specific measures. This approach can
improve the health of those who are worst off, even if the
health gap between rich and poor is unchanged.
2. Narrowing health gaps :This aims to improve the health of
those who are poorest or most disadvantaged by raising
their health outcomes closer to those who are most
advantaged. This usually involves target setting to reduce
the disparity in health outcomes between the most
advantaged and most disadvantaged groups.
3. Reducing the social gradient :Tackling the social gradient in
health involves reducing differences and equalising health
all along the income ladder

25. “It is my aspiration that health will finally
be seen not as a blessing to be wished
for, but as a human right to be fought
for.”
Former United Nations Secretary General, Kofi Annan

26. “It is my aspiration that health will finally
be seen not as a blessing to be wished
for, but as a human right to be fought
for.”
United Nations Secretary General, Kofi Annan

27.  Koefisien Gini meningkat dari 0.37
 (2012) ke 0.41 (2013)

29. Health
Inequalities
“Race” – Ethnicity -
Socioeconomic Status -
Gender - Sexual Orientation - Other
Social
Determinants
Healthcare

30. Definisi UHC
 Universal health coverage (UHC) means that all people
receive the health services they need without suffering
financial hardship when paying for them. The full
spectrum of essential, quality health services should be
covered including health promotion, prevention and
treatment, rehabilitation and palliative care.