Study Guide Health System-Based Practice
List of Content
Curriculum of Health System Based Practice
3
Planners Team
9
Facilitators
9
Reserve Facilitators
10
Time Table
11
Time Table for Discussion of Student Project
23
Assessment Method
23
Module 1 – 18
24
Curriculum Mapping
60
Udayana University, Faculty of Medicine, DME
1
Study Guide Health System-Based Practice
List of Modules
Day 1: MODULE ~ 1
p.24
Introduction to Health System and Primary Health Care: The Basic Principles
Day 2 -3: MODULE ~ 2
Health Indicators and Health Services Related Problems
p.29
Day 2-3: MODULE ~ 3
Health Care System in Several Countries
p.31
Day 4-5: MODULE ~ 4
National Health Care System of Indonesia 2012
p.33
Day 4-5: MODULE ~ 5
Puskesmas as a Primary Health Care Service
p. 35
Day 6-7: MODULE ~ 6
Primary Health Care and Health Promotion
p.37
Day 6-7: MODULE ~ 7
Basic Theories underlying Health Promotion
p.39
Day 8-9: MODULE ~ 8
Health Management in Health Services
p.41
Day 8-9: MODULE ~ 9
Health Workforce and Human Resource Management
p.43
Day 10-11: MODULE ~ 10-11
Quality Management 1 & 2
p.45
Day 12-13: MODULE ~ 12
Management of Facilities, Information, and Finance
p. 49
Day 12-13: MODULE ~ 13
Managed Care
p. 53
Day 14-15: MODULE ~ 14
Health Insurance and SJSN
p. 55
Day 14-15: MODULE ~ 15
Family Medicine Practices: Family as a Unit of Care
p.57
Day 16-17: MODULE ~ 16
Health Delivery System and Family Medicine Practices
p.59
Day 16-17: MODULE ~ 17
Disease Management Skills
p. 63
Day 18-19: MODULE ~ 18
Basic Clinical Skill: Discussion of Student Project
p. 65
Udayana University, Faculty of Medicine, DME
2
Study Guide Health System-Based Practice
CURRICULUM
Health System Based Practice
Competency
Statements
Manage health
services in
primary health
system
Instructional
Goals
Learning Objectives
Topics
1. Demonstrate
ability to provide
health services
in accordance
with a country’s
health system
1. Describe health problems
using health indicators.
2. Describe definition and areas
of health care system
3. Explain the relationship
among people, health
provider and finance state in
health delivery system.
4. Explain the importance of
implementation of health
care system as a solution of
health problem
Health
Indicators and
Health Services
Related
Problems
5.
Introduction to
Health System
and Primary
Health Care:
The Basic
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Udayana University, Faculty of Medicine, DME
Explain the role of a country
in desGNing a health care
system.
Describe the role of health
care system toward health
status of the people.
Describe stakeholders’ roles
in health care system.
Describe the challenges
that might be faced in
delivering health services.
Explain the dilemmas in
delivering health services.
Describe the roles of family
medicine in health care
system.
Describe the steps of family
medicine development.
Explain the objectives of
health services.
Explain the functions of
health services.
Describe the values that
should be included in a
health care system.
Describe the problems of a
country in developing health
care system.
Principles
3
Study Guide Health System-Based Practice
Competency
Statement
Instructional
Goals
Learning Objectives
Topics
16. Explain the challanges that
are faced by every country in
developing a health care
system.
17. Describe the roles of primary
health services in solving the
health care system’s
problems.
Udayana University, Faculty of Medicine, DME
18. Explain the objectives of SKN.
19. Describe the subsystems in
SKN including:
a. Health services.
b. Health financing.
c. Human resources.
d. Drug & health facilities.
e. Community empowerment.
f. Health management
20. Describe relationship among
sub systems.
21. Describe the application of
SKN.
National
Health
System
(Sistem
Kesehatan
Nasional
(SKN)) 2012
22. Describe various types of
Health Care System which
have been or being adopted
by a certain country.
23. Explain advantages and
disadvantages of each
system.
24. Describe the role of
government and private
sector in each system.
25. Describe various professions
in Health Care System.
26. Explain the effect of Health
Care financing to the health
status of people.
27. Describe basic principles of
WHO recommendation to the
National Health Care System
Health Care
System in
Several
Countries
4
Study Guide Health System-Based Practice
Competency
Statement
Instructional
Goals
2. Demonstrate
ability to apply
the concept of
management to
provide health
services at
primary level
Learning Objectives
Topics
28. Describe major factors
affecting health status.
29. Define Health Education and
Health Promotion
30. Explain the aspects of health
promotion based on the
Ottawa Charter.
31. Explain the strategic role of
Health Education and Health
Promotion in achieving
optimum health status of
every individual.
32. Comprehend Health
Promotion glossary.
Primary
Health Care
and Health
Promotion
33. Explain basic theories
underlying Health Education
and Health Promotion.
34. Describe basic principles of
diffusion of innovations and
the decision making process.
35. Summarized major theories of
behavior change.
Basic theories
underlying
health
promotion
1. Describe the structure of
primary health services in
puskesmas.
2. Explain the basic programs
and the additional programs in
puskesmas.
3. Describe the financing system
of
basic
programs
in
puskesmas.
4. Explain the application of
private
health
services
management based on the
finance resources:
Puskesmas
as a Primary
Health Care
Service
a. Askes
b. Askeskin/JPKMM
c. General patients
5. Describe the application of
private and public health
services
management
in
puskesmas.
Udayana University, Faculty of Medicine, DME
5
Study Guide Health System-Based Practice
Competency
Statement
Instructional
Goals
Learning Objectives
6.
7.
8.
9.
Describe the principles of
management in health care
services.
Comprehend the concepts of
managing people in health
services
Explain the concepts of supplies
and stores management (SSM).
Describe how to control
discrepancies in a clinic.
Topics
Health
Management
Concepts in
Health
Services
(Management
of people,
facilities,
information,
finance, and
quality)
10. Comprehend the concepts of
managing information and
finance.
11. Describe basic concept of
quality in health-care
12. Describe how to manage healthcare in whole system for quality
improvement
13. Explain the concept of managed
care.
14. Describe the types of managed
care.
Managed
Care
15. Explain the basic concept of Health
health insurance.
Insurance and
16. Describe several models of SJSN
health insurance.
17. Explain the financing system of
health insurance.
18. Explain the application of health
insurance through SJSN.
19. Describe the application of a
managed
care
in
health
insurance.
3. Apply family
medicine
approach in
primary
health
services
Udayana University, Faculty of Medicine, DME
1. Describe the definition of a
family.
2. Describe the functions of family.
3. Explain the cycle of family
development including the main
objective in each step.
4. Describe the influence of family
toward the health status of its
members.
Family
Medicine
Practices:
Family as a
Unit of Care
6
Study Guide Health System-Based Practice
Competency
Statement
Instructional
Goals
Learning Objectives
Topics
5. Differentiate the characteristics
of a happy and an unhappy
family.
6. Describe the roles of family
doctor in assisting an unhappy
family
7. Explain the level of a doctor’s
involvement in a family with
health problems.
8. Describe the family dynamics
that affecting health status of
family member.
9. Draw and describe a family
genogram.
10. Describe the definition of family
medicine as a discipline.
11. Describe place and position of
family medicine in the health
care system.
12. Explain the knowledge and skill
that are required in family
medicine practice.
13. Compare integrated health
activities within and between
providers.
14. Describe the application of the
principles of family doctor
services covering:
a. personal care
b. primary care
c. comprehensive care
d. continuing care
15. Explain the coordinative and
collaborative aspects using
basic approaches of family
medicine.
16. Describe the basic approaches
of family medicine at the
individual, family and community
levels.
Udayana University, Faculty of Medicine, DME
Health
delivery
system and
family
medicine
7
Study Guide Health System-Based Practice
Competency
Statement
Instructional
Goals
Learning Objectives
17. Describe the differences
between acute and chronic
diseases management.
18. Explain how to help patients
to evaluate their conditions.
19. Describe how to educate
patients with chronic
diseases in order to empower
them in diseases
management.
20. Describe how to make similar
perception of diseases with
patients and how to
determine the objectives to
be achieved together.
21. Explain how to desGN and
to apply the clinical
management of chronic
diseases.
Udayana University, Faculty of Medicine, DME
Topics
Diseases
management
skill
8
Study Guide Health System-Based Practice
~ PLANNERS TEAM ~
No
Name
Department
Phone
1
DR. Luh Seri Ani, SKM., M.Kes
(Coordinator)
Community/Preventive
08123924326
2
dr. Komang Ayu Kartika Sari, MPH
(Secretary)
Community/Preventive
082147092348
3
dr. I Nyoman Sutarsa, MPH
Community/Preventive
087860380028
4
DR. dr. I Wayan Weta, MS, SpGK
Community/Preventive
081337005360
5
dr. I.B. Wirakusuma, MOH
DR. dr. GN Indraguna Pinatih, MSc,
SpGk,Akp
dr. Ni Luh Putu Ariastuti, MPH
Community/Preventive
08124696647
Community/Preventive
08123816424
Community/Preventive
0818560008
6
7
~ FACILITATORS ~
Regular Class (Class A)
No
1
Name
dr. Putu Anda Tusta Adiputra ,
Sp.B(K)Onk
Department
Surgery
Phone
Group
Room
Number
A-1
A.3.09
08123826430
2
dr. Komang Ayu Kartika Sari, MPH
Public Health
082147092348
A-2
A.3.10
3
Ni Wayan Tianing, S.Si, M.Kes
Biochemistry
08123982504
A-3
A.3.11
4
dr. Ni Putu Ekawati, M.Repro,
Sp.PA
A-4
A.3.12
Anatomy Pathology
08113803933
Pharmacy
0811399886
A-5
A.3.13
Interna
08123803985
A-6
A.3.14
ENT
08113809882
A-7
A.3.15
Pharmacology
08123687288
A-8
A.3.16
A-9
A.3.17
A-10
A.3.19
5
Drs. I Nyoman Toya Wiartha, Apt
6
dr. A.A.A. Yuli Gayatri, Sp.PD
7
dr. Made Lely Rahayu, Sp.THT
8
dr. Ida Bagus Ngurah , M For
9
dr. Wira Gotera, Sp.PD-KEMDFINASIM
10 dr. I Wayan Sugiritama, M. Kes
Udayana University, Faculty of Medicine, DME
Interna
Histology
08155736480
08123925104
9
Study Guide Health System-Based Practice
English Class (Class B)
No
Name
Department
Phone
Group Room
Number
Parasitology
08123662311
B-1
A.3.09
Anatomy
085103043575
B-2
A.3.10
Public Health
0818560008
B-3
A.3.11
Interna
08123853700
B-4
A.3.12
B-5
A.3.13
B-6
A.3.14
B-7
A.3.15
B-8
A.3.16
1
dr. Ni Luh Ariwati
2
dr. Muliani , M Biomed
3
dr. Ni Luh Putu Ariastuti, MPH
4
dr. I Ketut Mariadi, Sp.PD
5
Desak Gde Diah Dharma Santhi,
S.Si, Apt, M.Kes
Clinical Pathology
0817569021
dr. I Gusti Ngurah Wien Aryana ,
Sp.OT
Orthopaedi
0811385263
dr. I Gusti Ngurah Pramesemara ,
S.Ked
Andrology
081338605087
dr. I Gusti Lanang Ngurah Agung
Artha Wiguna, Sp.OT (K)
Orthopaedi
0811388859
Interna
08123989192
B-9
A.3.17
Orthopaedi
081338493832
B-10
A.3.19
6
7
8
9
dr. Putu Andrika, Sp.PD-KIC
10 dr. I Gede Eka Wiratnaya, , Sp.OT
Reserve Facilitators
No
Name
Department
Phone
1 DR. dr. GN Indraguna Pinatih, MSc, SpGk,
Akp
2 dr. A.A.Sg. Sawitri, MPH
Com/Prev
08123816424
Com/Prev
0817340145
3
DR. dr. I Wayan Weta, MS, SpGK
Com/Prev
081337005360
4
DR. Luh Seri Ani, SKM., M.Kes
Com/Prev
08123924326
Udayana University, Faculty of Medicine, DME
10
Study Guide Health System-Based Practice
~ TIME TABLE ~
Regular Class (A)
Days/date
Time
Activity
Venue
Lecturers
dr. I Nyoman
Sutarsa,
MPH
Introductory Lecture
08.00 – 09.00
Introduction to Health System
and Primary Health Care: The
Basic Principles
Theatre Room
(4th floor)
1
09.00 – 11.00
Movie Presentation (“John Q” )
Theatre Room
(4th floor)
Tuesday
14th of April
11.00 – 12.30
SGD (Task-1)
12.30 – 13.00
Independent Learning
13.00 – 14.00
Student presentation (SP) and
feedback
Discussion
Room (DR)
Class Room
(CR) 3.01
Introductory lecture
09.00 – 10.00
Health Indicators and Health
Services Related Problems
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
DR. Luh Seri
Ani, SKM.,
M.Kes
Introductory Lecture
10.00 – 11.00
Health Care System in Several
Countries
11.00 – 12.00
Break/Lunch
12.00 – 15.00
SGD (Task-2): Health Indicators
and Health Services Related
Problems
2
Wednesday
15th of April
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
DR
SGD (Task-3): Health Care
System in Several Countries
Student presentation and feedback:
09.00 – 10.00
3
Thursday
16th of April
Health Indicators and Health
Services Related Problems
CR 3.01
DR. Luh Seri
Ani, SKM.,
M.Kes
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
Student presentation and feedback:
10.00 – 11.00
Health Care System in Several
Countries
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
Udayana University, Faculty of Medicine, DME
11
Study Guide Health System-Based Practice
Days/
date
Activity
Time
Venue
Introductory Lecture
09.00 – 10.00
National Health Care System of
Indonesia 2012
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
Introductory Lecture
4
Friday
17th of
April
10.00 – 11.00
Puskesmas as a Primary Health
Care Service
11.00 – 12.00
Break/Lunch
Lecturers
SGD (Task-4):
12.00 – 15.00
National Health Care System of
Indonesia 2012
DR
SGD (Task – 5):
Puskesmas as a Primary Health
Care Service
09.00 – 10.00
5
Monday
20th of
April
10.00 – 11.00
Student Presentation and
Feedback:
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
National Health Care System of
Indonesia 2012
Student Presentation and
Feedback:
Puskesmas as a Primary Health
Care Service
11.00 – 12.00
Break/Lunch SGD
12.00 – 15.00
Independent Learning
Introductory Lecture
09.00 – 10.00
Primary Health Care and Health
Promotion
Introductory Lecture
6
10.00 – 11.00
Basic Theories underlying Health
Promotion
11.00 – 12.00
Break/Lunch
Tuesday
21st of
April
SGD (Task-6):
12.00 – 15.00
Primary Health Care and Health
Promotion
DR
SGD (Task-7):
Basic Theories underlying Health
Promotion
Udayana University, Faculty of Medicine, DME
12
Study Guide Health System-Based Practice
Days/
date
09.00 – 10.00
7
Wednesday
22nd of April
Activity
Time
10.00 – 11.00
Student Presentation and
Feedback:
Student Presentation and
Feedback:
Break/Lunch
12.00 – 15.00
Independent Learning
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
CR 3.01
Health Management in Health
Services
Introductory Lecture
23rd of April
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
Basic Theories underlying Health
Promotion
Introductory Lecture
8
Thursday
Lecturers
Primary Health Care and Health
Promotion
11.00 – 12.00
09.00 – 10.00
Venue
10.00 – 11.00
Health Workforce and Human
Resource Management
11.00 – 12.00
Break/Lunch
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
dr. Komang Ayu
Kartika Sari, MPH /
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
SGD (Task-8):
12.00 – 15.00
Health Management in Health
Services
DR
SGD (Task-9):
Health Workforce and Human
Resource Management
09.00 – 10.00
9
Friday
24th of April
10.00 – 11.00
Student Presentation and
Feedback:
CR 3.01
Health Management in Health
Services
Student Presentation and
Feedback:
Health Workforce and Human
Resource Management
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
Udayana University, Faculty of Medicine, DME
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
dr. Komang Ayu
Kartika Sari, MPH /
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
13
Study Guide Health System-Based Practice
Days/
date
10
Monday
27th of April
Activity
Time
09.00 – 10.00
Introductory Lecture
Quality Management (1)
10.00 – 11.00
Introductory Lecture
Quality Management (2)
11.00 – 12.00
Break/Lunch
Venue
Lecturers
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
SGD (Task-10):
12.00 – 15.00
Quality Management (1)
DR
SGD (Task-11):
Quality Management (2)
11
Tuesday
28th of April
09.00 – 10.00
Student Presentation and
Feedback:
Quality Management (1)
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
10.00 – 11.00
Student Presentation and
Feedback:
Quality Management (2)
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
Introductory Lecture
12
Wednesda
y
29th of April
09.00 – 10.00
Management of Facilities,
Information, and Finance
CR 3.01
10.00 – 11.00
Introductory Lecture
Managed Care
CR 3.01
11.00 – 12.00
Break/Lunch
DR. dr. I Wayan
Weta, MS, SpGK
SGD (Task-12):
12.00 – 15.00
Management of Facilities,
Information, and Finance
DR
SGD (Task-13):
Managed Care
13
Thursday
30th of April
09.00 – 10.00
Student Presentation and
Feedback:
Management of Facilities,
Information, and Finance
10.00 – 11.00
Student Presentation and
Feedback:
Managed Care
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
Udayana University, Faculty of Medicine, DME
CR 3.01
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
DR. dr. I Wayan
Weta, MS, SpGK
14
Study Guide Health System-Based Practice
Days/date
14
Monday
4th of May
Time
Activity
Venue
Lecturers
09.00 – 10.00
Introductory Lecture
Health Insurance and SJSN
CR 3.01
dr. I Nyoman
Sutarsa, MPH
10.00 – 11.00
Introductory Lecture
Family Medicine Practices:
Family as a Unit of Care
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
11.00 – 12.00
Break/Lunch
SGD (Task-14):
Health Insurance and SJSN
12.00 – 15.00
15
Tuesday
5th of May
16
Thursday
7th of May
SGD (Task-15):
Family Medicine Practices:
Family as a Unit of Care
DR
Student Presentation and
Feedback:
Health Insurance and SJSN
CR 3.01
09.00 – 10.00
10.00 – 11.00
Student Presentation and
Feedback:
Family Medicine Practices:
Family as a Unit of Care
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
09.00 – 10.00
Introductory Lecture
Health Delivery System and
Family Medicine Practices
10.00 – 11.00
Introductory Lecture
Disease Management Skills
11.00 – 12.00
Break/Lunch
12.00 – 15.00
SGD (Task-16):
Health Delivery System and
Family Medicine Practices
dr. I Nyoman
Sutarsa, MPH
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
DR
SGD (Task-17):
Disease Management Skills
17
Friday
8th of May
09.00 – 10.00
Student Presentation and
Feedback:
Health Delivery System and
Family Medicine Practices
CR 3.01
10.00 – 11.00
Student Presentation and
Feedback:
Disease Management Skills
CR 3.01
11.00 – 12.00
Break/Lunch
12.00 – 15.00
Independent Learning
Udayana University, Faculty of Medicine, DME
DR. dr. I Wayan
Weta, MS, SpGK
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
15
Study Guide Health System-Based Practice
Days/date
18
Monday,
11th of May
19
Tuesday, 12th
of May
20
Wednesday,
13th of May
Time
Activity
Venue
Lecturers
Basic Clinical Skill
CR 3.01
Team
CR 3.01
Team
CR 3.01
Team
(Group Discussion of Student
Project)
Basic Clinical Skill
(Group Discussion of Student
Project)
Presentation of Student Project
Thursday, 14th of May 2015 – Pre-Examination Break
Monday, 18th
of May
Udayana University, Faculty of Medicine, DME
Final Examination
Team
16
Study Guide Health System-Based Practice
~ TIME TABLE ~
English Class (B)
Days/
date
Time
Activity
Venue
Lecturers
dr. I Nyoman
Sutarsa,
MPH
Introductory Lecture
08.00 – 09.00
Introduction to Health System
and Primary Health Care: The
Basic Principles
Theatre Room
(4th floor)
1
09.00 – 11.00
Movie Presentation (“John Q” )
Theatre Room
(4th floor)
Tuesday
14th of April
11.00 – 12.30
Independent Learning
12.30 – 14.00
SGD (Task-1)
14.00 – 15.00
Student presentation (SP) and
feedback
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
2
Wednesda
y
15th of April
Discussion
Room (DR)
Class Room
(CR) 3.01
Introductory lecture
13.00 – 14.00
Health Indicators and Health
Services Related Problems
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
DR. Luh Seri
Ani, SKM.,
M.Kes
Introductory Lecture
14.00 – 15.00
09.00 – 12.00
Health Care System in Several
Countries
SGD (Task-2): Health Indicators
and Health Services Related
Problems
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
DR
SGD (Task-3): Health Care
System in Several Countries
3
Thursday
16th of April
12.00 – 13.00
Break/Lunch
Student presentation and feedback:
13.00 – 14.00
Health Indicators and Health
Services Related Problems
CR 3.01
DR. Luh Seri
Ani, SKM.,
M.Kes
CR 3.01
dr. I Nyoman
Sutarsa,
MPH
Student presentation and feedback:
14.00 – 15.00
Health Care System in Several
Countries
Udayana University, Faculty of Medicine, DME
17
Study Guide Health System-Based Practice
Days/
date
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
Venue
Lecturers
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
CR 3.01
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
Introductory Lecture
4
Friday
17th of
April
Activity
Time
13.00 – 14.00
National Health Care System of
Indonesia 2012
Introductory Lecture
14.00 – 15.00
Puskesmas as a Primary Health
Care Service
SGD (Task-4):
09.00 – 12.00
National Health Care System of
Indonesia 2012
DR
SGD (Task – 5):
Puskesmas as a Primary Health
Care Service
5
Monday
20th of
April
12.00 – 13.00
13.00 – 14.00
14.00 – 15.00
Student Presentation and
Feedback:
CR 3.01
National Health Care System of
Indonesia 2012
Student Presentation and
Feedback:
Independent Learning
12.00 – 13.00
Break/Lunch
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
Introductory Lecture
13.00 – 14.00
21st of
April
Primary Health Care and Health
Promotion
Introductory Lecture
14.00 – 15.00
Basic Theories underlying Health
Promotion
Udayana University, Faculty of Medicine, DME
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
dr. I.B Wirakusuma,
MOH / DR. dr. I
Wayan Weta, MS,
SpGK
Puskesmas as a Primary Health
Care Service
09.00 – 12.00
6
Tuesday
Break/Lunch SGD
18
Study Guide Health System-Based Practice
Days/
date
Activity
Time
Venue
Lecturers
SGD (Task-6):
09.00 – 12.00
Primary Health Care and Health
Promotion
DR
SGD (Task-7):
Basic Theories underlying Health
Promotion
7
Wednesd
ay22nd of
April
12.00 – 13.00
13.00 – 14.00
14.00 – 15.00
Break/Lunch
Student Presentation and
Feedback:
Student Presentation and
Feedback:
Basic Theories underlying Health
Promotion
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
13.00 – 14.00
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
Primary Health Care and Health
Promotion
Introductory Lecture
8
Thursday
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH /
dr. Ni Luh Putu
Ariastuti, MPH
CR 3.01
Health Management in Health
Services
23rd of
April
Introductory Lecture
14.00 – 15.00
Health Workforce and Human
Resource Management
Udayana University, Faculty of Medicine, DME
CR 3.01
dr. Komang Ayu
Kartika Sari, MPH
/ DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
dr. Komang Ayu
Kartika Sari, MPH
/ DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
19
Study Guide Health System-Based Practice
Days
/date
Activity
Time
Venue
Lecturers
SGD (Task-8):
09.00 – 12.00
Health Management in Health
Services
DR
SGD (Task-9):
Health Workforce and Human
Resource Management
9
Friday
24th of
April
12.00 – 13.00
13.00 – 14.00
14.00 – 15.00
10
Monday
27th of
April
Break/Lunch
Student Presentation and
Feedback:
CR 3.01
Health Management in Health
Services
Student Presentation and
Feedback:
CR 3.01
Health Workforce and Human
Resource Management
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Introductory Lecture
Quality Management (1)
14.00 – 15.00
Introductory Lecture
Quality Management (2)
dr. Komang Ayu
Kartika Sari, MPH
/ DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
dr. Komang Ayu
Kartika Sari, MPH
/ DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
SGD (Task-10):
09.00 – 12.00
Quality Management (1)
SGD (Task-11):
DR
Quality Management (2)
11
Tuesda
y
28th of
April
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Student Presentation and
Feedback:
Quality Management (1)
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
14.00 – 15.00
Student Presentation and
Feedback:
Quality Management (2)
CR 3.01
dr. I Nyoman
Sutarsa, MPH / dr.
Ni Luh Putu
Ariastuti, MPH
Udayana University, Faculty of Medicine, DME
20
Study Guide Health System-Based Practice
Days/
date
12
Wednes
day
29th of
April
Time
Activity
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
Venue
Lecturers
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGK, Akp
Introductory Lecture
13.00 – 14.00
14.00 – 15.00
Management of Facilities,
Information, and Finance
Introductory Lecture
Managed Care
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
SGD (Task-12):
09.00 – 12.00
13
Thursda
y
30th of
April
14
Monday
4th of
May
Management of Facilities,
Information, and Finance
DR
SGD (Task-13):
Managed Care
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Student Presentation and
Feedback:
Management of Facilities,
Information, and Finance
14.00 – 15.00
Student Presentation and
Feedback:
Managed Care
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Introductory Lecture
Health Insurance and SJSN
14.00 – 15.00
Introductory Lecture
Family Medicine Practices:
Family as a Unit of Care
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
CR 3.01
dr. I Nyoman
Sutarsa, MPH
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
SGD (Task-14):
Health Insurance and SJSN
15
Tuesday
5th of
May
09.00 – 12.00
SGD (Task-15):
Family Medicine Practices:
Family as a Unit of Care
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Student Presentation and
Feedback:
Health Insurance and SJSN
DR
CR 3.01
CR 3.01
14.00 – 15.00
dr. I Nyoman
Sutarsa, MPH
DR. dr. I Wayan
Weta, MS, SpGK
Student Presentation and
Feedback:
Family Medicine Practices:
Family as a Unit of Care
Udayana University, Faculty of Medicine, DME
21
Study Guide Health System-Based Practice
16
Thursday
7th of
May
Days/date
09.00 – 12.00
Independent Learning
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Introductory Lecture
Health Delivery System and
Family Medicine Practices
14.00 – 15.00
Introductory Lecture
Disease Management Skills
Time
09.00 – 12.00
17
Friday
8th of May
18
Monday,
11th of May
19
Tuesday,
12th of May
20
Wednesda
y, 13th of
May
Activity
SGD (Task-16):
Health Delivery System and
Family Medicine Practices
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
Venue
Lecturers
DR
SGD (Task-17):
Disease Management Skills
12.00 – 13.00
Break/Lunch
13.00 – 14.00
Student Presentation and
Feedback:
Health Delivery System and
Family Medicine Practices
14.00 – 15.00
Student Presentation and
Feedback:
Disease Management Skills
Basic Clinical Skill
CR 3.01
DR. dr. I Wayan
Weta, MS, SpGK
CR 3.01
DR. dr. GN
Indraguna Pinatih,
MSc, SpGk, Akp
CR 3.01
Team
CR 3.01
Team
CR 3.01
Team
(Group Discussion of Student
Project)
Basic Clinical Skill
(Group Discussion of Student
Project)
Presentation of Student Project
Thursday, 14th of May 2015 – Pre-Examination Break
Monday,
18th of May
Udayana University, Faculty of Medicine, DME
Final Examination
Team
22
Study Guide Health System-Based Practice
TIME TABLE FOR DISCUSSION OF STUDENT PROJECT
(Regular and English Class)
Date:
No
1. Monday
11th May 2015
2. Tuesday
12th May 2015
Class
Group SGD
Activity
Time/Place
1
Regular I, II, III, IV, V
Group Discussion
08.00 – 09.30 / Class room
2
Regular VI, VII, VIII, IX, X
Group Discussion
09.30 – 11.00 / Class room
11.00 – 12.00 WITA
Break/Lunch
3
English
I, II, III, IV, V
Group Discussion
12.00 – 13.30 / Class room
4
English
VI, VII, VIII, IX, X
Group Discussion
13.30 – 15.00 / Class room
Guidance:
1. Each group is required to bring at least one laptop.
2. Each group will be provided with data/report of a community health center and will
discuss the data based on a guideline. The data/report and the discussion guideline
will be provided before the first discussion session.
ASSESSMENT METHOD
Student assessment of this block consists of:
1. a paper test with multiple choice questions at the end of the block with a proportion
of 80% of the total score
2. a student project with a proportion of 15% of the total score
3. evaluation of activity during the small group discussion with a proportion of 5% of the
total score
Udayana University, Faculty of Medicine, DME
23
Study Guide Health System-Based Practice 2015
Day 1
MODULE ~ 1
MODULE~1
Introduction to Health System and Primary Health Care:
The Basic Principles
dr. I Nyoman Sutarsa, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Explain the role of a country in designing a health care system.
Describe the role of health care system toward health status of the people.
Describe stakeholders’ roles in health care system.
Describe the challenges that might be faced in delivering health services.
Explain the dilemmas in delivering health services.
Describe the roles of family medicine in health care system.
Describe the steps of family medicine development.
Explain the objectives of health services.
Explain the functions of health services.
Describe the values that should be included in a health care system.
Describe the problems of a country in developing health care system.
Explain the challanges that are faced by every country in developing a health care
system.
13. Describe the roles of primary health care in solving the health care system’s problems.
CURRICULUM CONTENTS:
Introduction to Health System and Primary Health Care: The Basic Principles
ABSTRACTS
(References: “John Q” movie; Boelen C, et al, pp.1-36)
Meeting People’s Health Needs
This topic covers the philosophy of Health Care System in which each country has a
fundamental interest and responsibility for maintaining and improving the health status of its
people. To reach this responsibility, each country should always consider its social and
economic well being in order to be able to set up an appropriate organization, staffing and
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
financing health care system. The organization should be initiated by government authorities
and fully supported by health professionals, academic institutions and civil society.
The Health Care System is intended to provide a high quality of health care services.
However, the system should always agree with the basic principles of health care which
include quality, equity, relevance and cost-effective to meet an optimal health status of its
people. In this regards, Family Medicine seems to be the best choice for delivering health
care services at the front line.
Family Medicine is believed be able to adapt with health system challenges and creating
synergies among polarities which universally been encountered by every country. Therefore,
flexibility of each stakeholder will be necessary in order to manage tensions exemplified by
preceding polarities in health care. Careful assessment of each nation’s economic, political
and social conditions and epidemiological pattern of disease will allow leaders to select
appropriate health policy strategies and to determine the resources necessary for Family
Medicine to grow and contribute to health system improvements.
Strategies for changes toward implementing Family medicine approach could be initiated by
presenting evidence in which factual information and arguments emphasizing the benefit of
it. It is also necessary to show living examples by doing side-visits and case studies to
successful family medicine program.
Improving Health Care System
This chapter reviews the goals, functions and values of health care systems. It also
describes common challenges that undermines their successful implementation and outlines
strategies to respond to these challenges. It provides the context for assessing the
contributions that family medicine can make to people’s health as an integral component of
health care systems.
The goals of health care system are to achieve optimal level of health as define by The
World Health Organization at the smallest possible discrepancies in health status among
individuals and groups. Therefore, health care systems should consist of several functions
such as providing health care services, generating human and physical resources, financing
and collecting data to inform planning and policy development. Furthermore, responsible
leadership should direct and coordinate these interdependent functions to achieve the best
possible outcomes.
The importance of applying basic fundamental values of health care system is also covered
in this subject. The values include quality, equity, relevance and cost effective.. In short,
health care system of every country should provide a high quality of health care services
possible at an affordable cost of the government and individual. The services should also
equally assessable to everyone and relevance to the majority health problem of every
country.
In this topic, the trends affecting health service delivery are also covered such as burden and
changing pattern of disease, ageing and population growth, globalization and immediate
challenges. The importance of primary health care and its implementation strategies is also
discussed to face those challenges. Uniting stakeholders through partnership is essential at
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
the desGNing and implementing primary health care for achieving the optimum health status
of the people.
SCENARIO & LEARNING TASKS
SYNOPSIS OF “JOHN Q” MOVIE
Several concepts of Health System Based Practice that you can see in the movie:
1. Health care system in America uses social and private health insurance system. It can be
seen in the movie while John Q brings his son to the hospital, he is asked to show the
health insurance card at the receptionist.
2. Communication is an important thing in health care system. We can see in the movie, the
doctor and the head of the hospital call John Q and his wife to explain their son’s
condition. The doctor explains the condition of the patient and the alternative treatment. It
is very important to use language that can be understood by the patient’s family. The
head of the hospital explains about the cost of the treatment and John Q’s health
insurance.
3. Health care system using health insurance has several models such as HMO, PPO, IPA
and IPO. There is a scene that shows the first insurance followed by John Q is PPO. In
PPO model, a company must pay a quite expensive premium. The company where John
Q works then changes his insurance into HMO because he becomes a part time worker.
The insurance is changed without any communication with John Q. Because of that
change, John Q cannot get full treatment for his son.
4. Note: In HMO system, clients must pay a fixed amount of money and get the health
services that are appropriate to the premium (contract). It has been arranged since the
first contract. HMO will pay a doctor based on the standard in the contract, and then the
doctor cannot make an additional examination even though it is needed by patient.
5. A nurse in the movie says that the heart disease suffered by John Q’s son cannot be
detected because the health insurance only covers particular examination.
6. Health care system of a country is also influenced by its political condition:
1. The head of the hospital says that changing the health care system needs the
legislative involvement. 2. There are different opinions in the community. People who
are contra say that there are still a lot of people who cannot afford the health services.
On the other hand, the government tries to emphasize the importance of a country’s
authority to deliver health services. 3. It can be seen that government wants to hide the
real situation because there will be a general election soon.
7. The mass media has various roles in disseminating the real situation. It can help the
health care system to be better in the future.
Task 1
1. Discuss in your group the importance of health care system for a country. Discussion
should include the objectives of the government and the other stakeholders’ roles in the
health care system. The discussion should also cover the challenges that might be faced
in developing the health system and the dilemmas that need to be anticipated.
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
2. Discussion should be expanded to values that are included in national health care
system. What trends and challenges that might appear in the future of health services?
What strategies should be prepared to solve the problems?
3. Discuss about the possibility of family medicine in national health care system. How is
the possibility of the role of Family Medicine in Indonesia and Malaysia’s Health Care
System? Through which steps Family Medicine possibly to be introduced in those
countries?
Discuss in your group the phenomena of health care system implementation; please refer to
the movie presentation.
1. Why did the hospital refuse to deliver complete treatment to John Q’s son?
2. How many and what institutions that were responsible to cover John Q’s son
hospitalization?
3. Why did John Q feel that his son has the right for hospitalization without any additional
expectations?
4. Refer to the above phenomena and discuss the background of health care financing.
5. PPO and HMO give health service based on contract, not comprehensive care. Please
discussed within the group, what type of health insurance that implemented by PPO or
HMO? Is it social, regulated private or voluntary private insurance?
6. What are the duties of the government to solve the problem of highly cost health care?
7. Explain the relationship between politics and health care service in the movie.
Self assessment
1.
How are the roles of the government in health care system?
2.
Describe several factors that influence health status of the people!
3.
Describe stakeholder’s roles in health care system!
4.
Explain challenges that are faced by every country in arranging health care system!
5.
What dilemmas are possibly to appear in developing health care system? Explain your
answer!
6.
What are the roles of Family Medicine in health care system? Explain your answer!
7.
Describe several steps that should be taken in introducing family medicine!
8.
9.
What will be the ultimate objective of health care system? Explain your answer!
Describe several functions of health care system!
10. Describe problems and challenges that are possibly to be faced by every country in
developing health care system.
11. Explain why delivering Primary Health Services has an important role in health care
system.
12. What strategies must be prepared to solve the problems in developing health care
system? Explain your answer!
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
Day 2 - 3
MODULE~2
Health Indicators and Health Services Related Problems
DR. Luh Seri Ani, SKM., M.Kes
AIM:
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1.
2.
3.
4.
Describe health problems using health indicators
Describe definition and areas of health care system
Explain the relationship among people, health provider and finance state in health
delivery system.
Explain the importance of implementation of health care system as a solution of health
problem
CURRICULUM CONTENTS:
Health Indicators and Health Services Related Problems
ABSTRACT
(References: Gan GL, et al, pp.14-21)
There are three dimensions of health delivery service namely: patient, health provider and
payment system. In general, the medical service is expensive, because it implements high
competency of human resources, sophisticated medical technology and some kinds of drug
regiments. If there is no medical guarantee (insurance) system, patient often complaints a
high cost of medical service that is not affordable. This problem usually appears in countries
where there is no social health guarantee systems conducted by the state or health
insurance.
SCENARIO AND LEARNING TASKS
Task 2
Based on Primary Health Centre’s data, health indicators of the sub-district displayed in
table below:
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
Table 1. Health Indicators of Sundari Loka Sub District, 2006.
Indicators
Rate
1. Infant Mortality Rate (per 1000 life birth)
68.0
2. Under five mortality Rate (per 1000 under five children)
81.0
3. Mother mortality rate (per 100,000 live births)
450
4. Crude mortality rate (per 1000 people)
6.5
5. Life expectancy (year):
-
55
Males
Females
60
6. Under weight birth (%)
25
7. Children with Protein Energy Malnutrition (%)
40
8. Latrine occupation (%)
40
8. Interpret the community health status in sub-district of Sundari Loka year 2006 (Compare
to data in Indonesia (available in Gan, G.L.))
Self Assessments:
1. Describe several aspects that are related to health problem and health care services.
2. Explain the rights and duties of medical doctor as a health provider in health care
system.
3. Describe the prevalent health problems related to health care services in a clinic
(hospital).
4. What necessary choices that should be prepared to anticipate the health problem?
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
MODULE~3
Health Care System in Several Countries
dr. I Nyoman Sutarsa, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1. Describe various types of health care system which have been or being adopted by a
certain country.
2. Explain advantages and disadvantages of each system.
3. Describe the role of government and private sector in each system.
4. Describe various professions in health care system.
5. Explain the effect of health care financing to the health status of people.
6. Describe basic principles of WHO recommendation to the National Health Care
System
CURRICULUM CONTENTS:
Health Care System in Several Countries
ABSTRACT
(References: Taylor, RJ, pp.133-144 & Boelen C, et al, pp.1-36)
The topic covers a wide range of Health Care System which has been or being
adopted by many countries. In one hand, such system is totally own and control by the
government (totalitarian) while the other is totally private (liberal). In addition, combination of
the two systems is also being practiced by many countries in which government and private
working side by side in synergy. Description of advantages and disadvantages of each
system and the role of primary care/private sector are also covered in this topic. Further
description concerning the role of various professions in Health Care System and allocation
of fund are also discussed in this topic. No matter which Health System is adopted, the basic
principle of WHO recommendation should always be put into consideration which include
optimum health status of people, responsiveness and fair financing.
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
SCENARIO & LEARNING TASKS
Task 3
1. Discuss in the group about 3 types of National Health Care System. The discussion
should also include the advantages and disadvantages of each system. Give at least
1 example the country that adopting each system!
2. Discuss about the role of the government and private sectors in each system!
3. Identify various types of professions taking part in National health Care System and
estimated budget allocation among them depending upon the economic status of the
country.
4. Discuss in the group about possible health seeking pattern of family in each types of
Health Care System if each of the following is happening:
a. One family member is suffering from pink eyes.
b.
A child in the family suffering from short breathing, coughing and extreme
raise of body temperature!
c. One family member suffering from prominent chest pain followed by cold
sweating. He has been experiencing similar symptoms previously!
d. A 60 years old grandfather is suffering from chronic coughing and blood strip in his
sputum. He also lost his appetite and body weight.
Self Assessment
1. Describe 3 types of National Health Care System which have been or being adopted
and give at least 1 example of the country!
2. Explain the advantages and disadvantages of each system!
3. What is the role of the government and private sectors in each system!
4. Define various types of professions and their role in National Health Care System
and average budget allocation among them depending upon the economic status of
the country!
5. Describe 3 basic fundamental principles of WHO recommendation that should be
considered in developing National Health Care System!
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
Day 4 - 5
MODULE~4
National Health Care System of Indonesia 2012
dr. I.B Wirakusuma, MOH
DR. dr. I Wayan Weta, MS, SpGK
_____________________________________________________
AIMS
Demonstrate ability to provide health services in accordance with a country’s health system
LEARNING OUTCOMES:
1. Explain the objectives of SKN.
2. Describe the subsystems in SKN including:
a. Health services.
b. Health financing.
c. Human resources.
d. Drug & health facilities.
e. Community empowerment.
f. Health management
3. Describe relationship among sub systems.
4. Describe the application of SKN
CURRICULUM CONTENTS:
National Health Care System of Indonesia 2012
ABSTRACTS
(References: Gan GL, et al, pp.14-21; SKN 2012, pp.1–97; Azwar A.)
Indonesia National Health System (SKN) 2012 is the order that organizes all Indonesian
nation resources through integrated, and synergisted approaches, for guaranting the optimal
public health status, as a representative of people wellbeing, that has been mentioned in
preface of Indonesian Constitutions (UUD 1945).
SKN 2012 consists of six sub systems namely:
1. Health care service
2. Health financing
3. Human health resources
4. Drug and health facilities
5. Community empowerment
6. Health management
Udayana University Faculty of Medicine, DME
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Study Guide Health System-Based Practice 2015
SCENARIO & LEARNING TASK
As a developing country with population more than 200 million, Indonesia has
complex health problems. The average per capita income is 680 US dollar per year. More
than 30% of the population is under the poverty line. Thirty percent of the health financing is
from government and 70% is from community. Most of the government’s funding is for public
services while the community funding is for private services. About 80% of the community
funding is available from fee for services and 20% is from insurance. Based on the gross per
capita income, only 2,5% of it is allocated for health financing. Because most of the
population is not covered by health insurance, they don’t depend on any particular health
services. The authority of health provider is quite high. People are often unable to pay health
services especially in a hospital. They are even getting poorer, because they have to spend
almost all of their money to pay the health services.
Task 4
1.
2.
3.
4.
5.
What components should be considered to find the solution of various problems above?
How is the application of public and private health services in Indonesia?
How public and private services will be applied based on SKN 2012?
Can SKN 2012 give the solution of all problems above? Explain the several possibilities!
What facilities need to be prepared and optimal zed in order to apply the SKN 2012
concept?
Self Assessment
1. What is the background of SKN 2012?
2. What are the subsystems of SKN 2012? What are the relevancies of each subsystem
toward health problems in Indonesia?
3. Who are the subjects of SKN 2012? What are the roles of each subject?
4. How is the financing system of public health services based on SKN 2012?
5. How is the financing system of private health services based on SKN 2012?
6. How should the following system be done to deliver comprehensive, holistic, integrative
and continuous services?
a. Financing system
b. Services approaches
c. Teamwork of the subjects
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MODULE~5
Puskesmas as a Primary Health Care Service
dr. I.B Wirakusuma, MOH
DR. dr. I Wayan Weta, MS, SpGK
_____________________________________________________
AIM
Demonstrate ability to apply the concept of management to provide health services at
primary level.
LEARNING OUTCOMES
(Reference: Azwar, A.)
1.
2.
3.
4.
Describe the structure of primary health services in puskesmas.
Explain the basic programs and the additional programs in puskesmas.
Describe the financing system of basic programs in puskesmas.
Explain the application of private health services management based on the finance
resources:
a. Askes
b. Askeskin/JPKMM
c. General patients
5. Describe the application of private and public health services management in
puskesmas.
CURRICULUM CONTENTS
Puskesmas as a Primary Health Care Service
SCENARIO AND LEARNING TASK
Scenario:
Sub-district of Sundari Loka with population of 30,000 people, most of them work as
farmers, their income not constant depend on climate and natural condition, the average
income only sufficient for simple daily life. In Sub-district there are one Public Health Center
(PHC/Puskesmas), 4 health satellites (Puskesmas Pembantu), and 8 village’s midwifes
(bidan di desa). There are also 2 private medical doctors, 4 private midwifes, and 2 nurses.
Beside of the conventional health provider, there are also 3 traditional healers.
The six basic programs that are served by Public Health Center namely:
1.
2.
3.
4.
5.
6.
Mother and child health and family planning.
Communicable and non communicable disease program
Environmental health
Community nutrition program
Health education
Polyclinic services
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People who go to public health center pay less than those who go to private health
services. People choose whether the public or private health services, depend on their
perception and financial situation.
Task 5
1. Describe the characteristics and examples of public health services!
2. Describe the characteristics and examples of private health services!
3. Discuss the differences between public and private health services!
4. Based on the above scenario, discuss how the health care system in Sundari Loka is!
5. Discuss the concept of integrated health services!
6. Discuss the concept of comprehensive health services!
Self Assessment
1. Differentiate the finance resources, facilities and human resources between public and
private health services!
2. Discuss the differences between structured and unstructured health services!
3. Discuss the differences between structure of public health services and private health
services!
Day 6 - 7
MODULE~6
Primary Health Care and Health Promotion
dr. Komang Ayu Kartika Sari, MPH
dr. Ni Luh Putu Ariastuti, MPH
AIMS:
Demonstrate ability to provide health services in accordance with a country’s health system.
LEARNING OUTCOMES:
1.
2.
3.
4.
Describe major factors affecting health status
Define Health Education and Health Promotion
Explain the aspects of health promotion in the Ottawa Charter
Explain the strategic role of Health Education and Health Promotion in achieving
optimum health status of every individual
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CURRICULUM CONTENTS:
Primary Health Care and Health Promotion
ABSTRACTS
(Reference: FHI, WHO, Jirojwong, S.)
This topic contains major factors affecting health status. It also describes the definition of
Health Education and Health Promotion and their strategic roles in improving health status of
every individual in the community. It explains how the aspects of health promotion
conceptualised by The Ottawa Charter. The topic also describes some health behaviors that
need to be practiced by every individual in order to be able to maintain his/her health status.
SCENARIO & LEARNING TASKS
Task 6
Discuss in your group the following topics or aspects of Public Health:
1.
2.
3.
4.
5.
6.
The definition of Public Health
The definition of health
Major factors affecting health status
The definition of Health Education and Health Promotion
Aspects of health promotion in the Ottawa Charter
The strategic role of Health Education and Health Promotion in achieving optimum
health status of every individual
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MODULE~7
Basic Theories underlying Health Promotion
dr. Komang Ayu Kartika Sari, MPH
dr. Ni Luh Putu Ariastuti, MPH
AIM:
Demonstrate ability to provide health services in accordance with a country’s health system.
LEARNING OUTCOMES:
1.
2.
3.
4.
Explain basic theories underlying Health Education and Health Promotion
Describe basic principles of diffusion of innovations and the decision making process
Summarized major theories of behavior change
Comprehend Health Promotion glossary
CURRICULUM CONTENTS:
Basic Theories underlying Health Promotion
ABSTRACT
(References: FHI, WHO, Nutbeam, D.)
This topic discusses basic theories underlying Health Education and Health Promotion and
their relationship to basic principles of diffusion of innovations and decision making process.
Moreover, the topic also summarized major theories of behavior change and health
promotion glossary.
SCENARIO AND LEARNING TASK
Task 7
Discuss in your group the following topics or aspects of Public Health:
1.
2.
3.
4.
5.
6.
Some basic theories underlying Health Education and Health Promotion
Basic principles of diffusion of innovations and the decision making process.
Classification of individual based on their rates of adoption
Major theories of behavior change.
Describe relationship between decision making and stages of behavior change.
Comprehend Health Promotion glossary.
Self Assessments:
1.
2.
3.
4.
5.
Describe the definition of Public Health.
Compare the previous definition of health with the latest one.
Describe 4 major factors affecting health status. Which one is the most prominent?
Describe the definition of Health Education and it gradual sifts to Health Promotion.
Explain the strategic role of Health Education and Health Promotion in achieving optimum
health status of every individual.
6. Describe some basic theories underlying Health Education and Health Promotion.
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7. Describe basic principles of diffusion of innovations and the decision making process.
8. Describe classification of individual based on their rates of adoption and their specific
characteristics.
9. Explain 4 major theories of behavior change.
10.
Describe relationship between decision making and stages of behavior change.
11.
Describe 7 core definitions of Health Promotion and some important terminology
being used in Health Promotion.
Day 8 - 9
MODULE~8
Health Management in Health Services
dr. Komang Ayu Kartika Sari, MPH
DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
AIMS:
Demonstrate ability to apply the concept of management to provide health services at
primary level
LEARNING OUTCOMES:
Describe the principles of management in health care services.
CURRICULUM CONTENTS:
Health Management in Health Services
ABSTRACT
(Reference: Gan GL, et al, pp.78-87)
A doctor is often the manager of the practice. Managing is to get work done through the
efforts of others. Managing is also producing an aoutput from input and process. The four
basic functions of a manager are planning, organizing, leading and control. The process
whereby one person influences the thoughts and behaviors of others is a definition of
leadership. Between the extrems of complete autocracy on the one hand and a totally
permissive approach on the other, there exists a continuum of possible leadership styles.
Each of us has a basic personal leadership style and may be motivating or demotivating
depending on the situation. An insight of the range of personal leadership styles helps us to
choose what is appropriate for the situation.
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SCENARIO & LEARNING TASKS
TASK 8
CASE-1
Dr. Drupadi will make a family medicine clinic in Denpasar. It needs knowledge and basic
competencies in management.
a. Discuss some definitions of management.
b. What aspects needed to be managed in a clinic?
CASE-2
Dr. Drupadi thinks that finally she has to be the manager of his clinic. If she doesn’t want to,
she has to choose somebody with good qualification.
a. What skills must be owned by a manager?
b. What are the roles of a manager in leading a clinic?
c. What is the meaning of leadership?
CASE-3
In a meeting (conducted after the clinic was made), dr. Drupadi tells all of her staff that
purposes of the clinic were responsibilitiy of all staff to achive them.
a. Which leadership model is applied by dr. Drupadi?
b. Explain the reasons of your answer!
SELF ASSESSMENT
1. Describe the definitions of management.
2. Explain the meaning of planning in management.
3. Explain in your own words the meaning of leading in management. What do we need to
be a good leader?
4. What components must be in control process?
5. Describe in your own words the definition of human skill.
6. What is the meaning of leadership?
7. Make a comparation of the task, group and individual need leadership model!
8. Describe the meaning of personal leadership!
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MODULE~9
Health Workforce and Human Resource Management
dr. Komang Ayu Kartika Sari, MPH
DR. dr. GN Indraguna Pinatih, MSc, SpGK, Akp
AIM:
Demonstrate ability to apply the concept of management to provide health services at
primary level.
LEARNING OUTCOME:
Comprehend the concepts of managing people in health services
CURRICULUM CONTENTS:
Health Workforce and Human Resource Management
ABSTRACT
(Reference: Gan GL, et al, pp.78-87)
Motivating staff to contribute their best is a big challange. There is a need for an ongoing
appraisal of the motivation level of staff. Channels for upward communication must be open
for staff dissatisfaction to be identified and dealt with before it has caused widespread
motivational problems. People management also requires the ability and willingness to deal
with unpleasant issues, such as grievances, discrepancies and absenteeism.
SCENARIO AND LEARNING TASK
Task 9
CASE-1
Cleaning services have a lot of duties including cleaning the clinic and open the clinic’s door
every morning. Ambulance’s driver has duties to bring the referred patients to hospital and
take the doctor to patient’s house for oncall services.
a. Which model of leadership that is needed for those cases?
b. Discuss your reason in your group!
CASE-2
Dr. Drupadi notices that her staff have different motivation. There are dilligent staff while the
others will take the job only if they are asked to.
a. What are the possible cause of different motivation level of staff?
b. What should be done to increase the motivation of staff in the clinic?
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CASE-3
Sinta, the clinic nurse, reports that there are fewer antibiotics in the place than they should
be. Ambulance driver has already been absent for 4 times because of sickness and out of
town. Dr. Bima and dr. Arjuna complained that their rooms are less ventilated.
a. What problems are facedby dr. Drupadi?
b. Which problem must be solved soon?
c. How to solve the absence problem?
CASE-4
Dr. Drupadi’s clinic has been operated for 2 years, she wants to develop it (open the new
clinics) in Kuta.
a. What sould be done by dr. Drupadi?
b. Explain the steps that must be taken by her.
c. Explain the meaning of SWOT analysis.
d. Are point b and point c different?
Self Assessments:
1.
2.
3.
4.
5.
6.
Explain the diagram that shows the scope of human resources management.
How many factors that influence motivation? Explain each of the components!
Describe the meaning of grievances and give 1 example.
Describe the meaning of discrepancies and give 1 example.
Explain how we can solve absenteeism problem!
Describe the meaning of one minute manager!
Day 10 - 11
M O D U L E ~ 10 - 11
Quality Management 1 & 2
dr. I Nyoman Sutarsa, MPH
dr. Ni Luh Putu Ariastuti, MPH
AIM:
Demonstrate ability to apply the concept of management to provide health services at
primary level
LEARNING OUTCOMES:
1. Describe basic concept of quality in health-care
2. Describe how to manage health-care in whole system for quality improvement
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CURRICULUM CONTENTS:
Quality Management
ABSTRACT
(References: Gan GL, et al, pp.108-110; Boelen C, et al, pp.148-160; WHO. Quality of Care)
There are wide variations in standards on health care delivery within and between health
care systems. The aim of managing quality is optimizing resource use and expanding
coverage based on a specified standard. The process of improving quality in health-care
would be based on sound local strategies in order to achieve the best results by optimizing
resources use and new investment.
Quality of Health Care
Quality in health care is simply defined as care that meets or exceeds expectations, both
technical and patient satisfaction. In can be evaluated by three indicators those are (1)
structure personnel, facilities, equipment, organization and coverage), (2) process (activities
with continuous monitoring and evaluation), and (3) outcomes (health status of patient or
community). Dimensions of quality in health care would be (1) effective (improved health
outcomes), (2) efficient (maximize resource use), (2) accessible (timely and geographically),
(4) acceptable (patient centered needs), (5) equitable (does not vary in quality), and (6) safe
(minimize risk and harm). Besides that health care would be also comprehensive (includes
primary, secondary and tertiary prevention), and appropriate (evidence based).
The Process of Quality Improvement
Managing quality in health care means that to follow the process of quality improvement.
This process includes three steps those are (1) analysis (stakeholder involvement,
situational analysis and confirmation of health goals), (2) building strategy (defining quality
goals and choosing interventions for quality), and (3) implementation (process of
implementation and monitoring progress). However, the quality intervention would be
determined by six dimensions such as leadership, management information system, patient
or population engagement, regulation (standard), organizational capacity, and the model of
care. Implementation change may be needed that based on monitoring progress or self
auditing process.
SCENARIO & LEARNING TASKS
Task 10
There are wide variations in standards on health-care delivery within and between healthcare systems. The aim of managing quality is optimizing resource use and expanding
coverage based on a specified standard. The process of improving quality in health-care
would be based on sound local strategies in order to achieve the best results by optimizing
resources use and new investment.
1. Describe quality of health-care based on point of view of patients and healthcare
providers.
2. Describe dimensions of health-care quality, and give example for each dimension.
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3. Describe assessment of health-care quality, and what indicators do we use?
4. Describe the difference between quality goals and health goals, and give examples.
5. Describe seven activities (elements) those are grouped into three categories (analysis,
strategy and implementation) for quality improvement, and give examples foe each
element.
6. Describe six domains of quality intervention, and give examples for each domain.
7. Explain what quality assurance program in health-care is.
8. Explain the importance of self-auditing or self evaluation for quality assurance program,
and what aspects?
Task 11
Case: MELATI Health Center
Health Centre of Melati that located in suburban area was always crowded by
ambulatory patients, especially on Monday. Some patients often stand on their own legs
in a relative inconvenient space because of unfriendly weather and limited seats in the
waiting room. That was quite common; the patients have to wait 2 hours until they got
turn of medical service. However, Melati Health Centre becomes the first choice of
community for seeking health services, because of some reasons. The price of visit to
Melati Health Centre is relatively very cheap, and the location is not so far from most of
the community.
Monday at 9.30 AM: Conversation between patients in waiting room
Mrs Ani: “Finally the doctor is coming too. Last week I had same experience, wait from 7 AM,
and did not know what time the doctor would come. Then I had turn at 10 AM”.
Mrs Mur: “There are 2 doctors here, which one you will meet?”
Mrs Ani: “Who knows, which doctor would come. I just need my daughter get examination
and medicine”.
Mrs Mur: “What’s happened with your daughter?”
Mrs Ani: “At the beginning my daughter was suffered from high fever, and the followed by
bad coughing. That was 4 four days already. Three days ago she was treated here
but she won’t recover. Even she was getting difficulties to breathe and fever again.
To go to private doctor must be very expensive, maybe I can’t afford it”.
Mrs Mur: “Yes, the condition of my son is almost same as your daughter. Two days ago I
came about 11 AM. One staff here got angry with me, why I came late at afternoon,
and I forgot to bring the control card of my son. At that time there was no doctor,
because of official meeting somewhere. My son was treated by one midwife, and up
to now he won’t recover”.
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At 10 AM the same day: between doctor and patient
Doctor: “What’s happened with your daughter?”
Patient: “My daughter was treated three days ago, but she still suffered from high fever.
Please Doctor, help my daughter”.
Doctor: “Your daughter was 4 years old, yes? (Saw the card). Please, lying down there
(pointed the bed). Woo, your daughter is quite ill”
Patient: “Please help doctor, I want my daughter get recover”
Doctor: “Ye, if she still gets fever, please control again (writing prescription). Please, you get
medicine next door”.
At 11 AM: at Pharmacy of Health Centre
Pharmacy’s staff: “Mom, there was no stock of antibiotic that was written in this prescription.
The doctor should write other kind of antibiotic”
Patient’ mother: “Do I have to turn back to the doctor?”
Pharmacy’s staff: “No need Mom. Maybe the antibiotic could not be changed. (the
pharmacy’s staff knows that was no stock of other antibiotics). Mom, there is one
pharmacy not so far from here. Maybe you can buy the antibiotic over there.
Patient’ mother: “…………… ?????” (I am worried that my money is not enough).
Questions:
1. From the above case, please analyze how was the health service quality of Melati Health
Centre? Analyze each dimension of quality!
2. What kind of strategy that you can implement in order to increase the health service
quality in that health centre?
Self Assessment
1.
2.
3.
4.
5.
Could you explain what means by quality in health-care?
How you will implement each dimension of quality in health-care delivery?
How you can optimize resource use for better quality of heal-care.
Could you explain building strategy for quality in health-care?
What indicators do you use to assess quality and health outcomes?
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Day 12 - 13
M O D U L E ~ 12
Management of Facilities, Information, and Finance
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
AIM:
Demonstrate ability to apply the concept of management to provide health services at
primary level
LEARNING OUTCOME:
1. Explain the concepts of supplies and stores management (SSM).
2. Describe how to control discrepancies in a clinic.
3. Comprehend the concepts of managing information and finance.
CURRICULUM CONTENTS:
Management of Facilities, Information, and Finance
ABSTRACT
Managing Facilities
(Reference: Gan GL, et al, pp.87-90)
The supplies and stores system deals with ordering, receipt, maintenance, and issue when
required. The supplies can range from drugs and pharmaceuticals to syringes and needles
as well as general use items like stationery. Stocks of pharmaceuticals and medical require
close monitoring to ensure they do not deteriorate or reach expiry dates, they are not pilfered
and their storage and usage comply with existing regulations.
The operating principles of supplies and stores management are: have an efficient system,
determine stocking levels, have a storekeeper, insist on bin cards, have an ordering system,
have a store ledger, have defined procedures, conduct regular stock takings and have a
system to deal with problems.
Managing Information
(Reference: Gan GL, et al, pp.90-97)
Medical records are more than a documentation of clinical details. Properly kept and used,
they allow us to see the problem solving process from which we can deliver better care. An
effective record keeping system contributes to the standard of care. Attention paid to how
medical records are organized, filed, and maintained is integral to effective practice. The
problem oriented medical record (POMR) is better than the source oriented medical record
(SOMR) and we should progress towards it.
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Managing Finance
(References: Gan GL, et al, pp.97-107; Boelen C, et al, pp.135-143; Sulastomo, pp. 173180)
Financial management consists of: keeping proper records of income, expenditure and
profit; preparing financial statements at the end of accounting period; analysing financial
statements and taking the necessary actions; implementing inventory and stock control
processes; acting on discrepancies; ensuring that financial records are audited and
developing financial plans.
It is essential to have accurate knowledge of the financial status of the practice in order to
plan ahead. This is in turn dependent on keeping proper records for income, expenditure
and profit.
It is also important to have summaries of the financial activities of an organization, which
contain information useful to management (financial statement). Financial audits and
financial planning, as the other activities, have purposes to ensure accountability in the use
of financial and material resources and to develop the organization’s budgets (operating
budgets and financial budgets) respectively.
SCENARIO AND LEARNING TASK
TASK 12
CASE 1
After the medicines have been lost several times, dr. Drupadi evaluates the system of
managing facilities and utilities in her clinic.
a.
b.
c.
d.
e.
f.
What are the principles of managing facilities and utilities?
Explain briefly each of the principles!
Describe the possible causes of discrepancies in facilities and utilities management.
What efforts should be done to prevent the discrepancies happened again?
What rules should be determine in managing drugs and chemical agent?
What principles should be noticed in managing drugs and vaccines?
CASE-2
Dr. Drupadi’s clinic is going very well. The number of patients has already increased from 510 patients per day in first few years, to 20-30 patients per day now. The nurse finds
difficulties to look for medical records of the patients. The doctor also finds difficulties in
making diagnosis because the previous medical records cannot be found.
a.
b.
c.
d.
e.
f.
What are the benefit of using medical records? Why is it very important?
What are the principles of managing patients’ medical records?
What are the differences between SOMR and POMR? Which one is better?
What steps should be taken to manage the medical record better?
How are the principles of computer usage in managing medical records?
How is the using of PDA to look for an information?
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CASE-3
One day, Dr. Drupadi saw somebody in medical record room whom are known as a
boyfriend of a nurse in that medical record room. She saw him openned and read several
medical records on the nurse’s table. After gave advices and told him to go out, dr. Drupadi
called some nurses that worked in medical records room.
a. What information will dr. Drupadi tell to her nurses?
b. When are medical records able to be informed to people other than patients?
CASE-4
After being operated for 5 years, dr. Drupadi’s clinic shows an increasing of the number of
patients. However, she has never got a high income even though the finance capital has
never runned out. Her wish to develop a clinic in Kuta has not been realized. All this time, dr.
Drupadi manage her clinic’s finance, helped by one of her nurse.
1. What should be done to manage a clinic’s finance?
2. What is the meaning of:
a. financial records?
b. financial statement?
c. financial audit?
3. Do we need to do an external audit?
CASE-5
Based on an audit result of a public accountant, the doctor and the nurse has already made
a complete finance records. However dr. Drupadi has not made a good financial planning,
particularly in calculating the unit cost of each services in the clinic.
a. What is the meaning of financial planning?
b. What is the definition of unit cost?
c. Why is it mportant to determine the unit cost?6
CASE-6
Based on the audit result, dr. Drupadi then calculates the unit cost of her clinic’s services.
First, she determines the components such as fix cost, operational cost and maintenance
cost. Then she determines the output of the working unit which is an outpatient care and
calculates the total of fix, operational and maintenance cost. After that she divides the total
cost by production of each working unit to get the unit cost. At last, she determines the
marginal cost to get the tariff.
a. What is the definition of fix cost? Give the example!
b. What is the deinition of marginal cost? Give the example!
c. Is unit cost the same as tariff? Discuss your answer!
Self Assessments
1. Give some examples of “supplies”!
2. Why do we need to monitor drugs and chemical agents stock?
3. What is the meaning of “first in, first out” system (FIFO)?
4. How to manage a cold chain for vaccines?
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5. What is the meaning of discrepancies in managing facilities and utilities? Give some
examples of its possible causes!
6. What is the definition of medical records? Why do we need medical records?
7. How many groups of people are allowed to read the medical records? Explain who they
are!
8. What should be done to manage information using a computer?
9. Why is managing finance important for family doctor’s practice?
10. What is the meaning of financial records? Explain in your own words and give some
examples!
11. Mention the steps of managing finance!
12. What is the important activity in financial planning?
13. What is the definition of financial audits?
14. What is the meaning of finance analysis and unit cost? Why do we need to know a unit
cost?
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M O D U L E ~ 13
Managed Care
DR. dr. I Wayan Weta, MS, SpGK
AIMS:
Demonstrate ability to apply the concept of management to provide health services at
primary level
LEARNING OUTCOMES:
1. Explain the concept of managed care.
2. Describe the types of managed care.
CURRICULUM CONTENTS:
Managed Care
ABSTRACT
(References: Sulastomo; Thabrany H.;Subawa)
There are two models of health care depend on their financing systems, namely:
1. Indemnity care: post paid direct payment, fee for service-out of the pocket, curative
oriented.
2. Managed care: prospective payment, capitation, comprehensive care oriented.
Managed (health) care is the system that integrates both financial and health care services.
Health care services through managed care approach will produce more cost-effective
services.
Characteristics of managed health care are:
-
Developing financial and health care system
-
Implementing family medicine concept
-
Implementing referral care system
-
Implementing prospective payment system
-
Applying standard price of drugs
SCENARIO & LEARNING TASK
Case:
Dr. Ketut Cespleng is a famous general practitioner in Denpasar. Not less than 15
patients get treatment in 2 hours at his practice. His equipments are modern such as USG,
ECG, roentgen, laboratory, and drug store beside his practice. Putu Gd Ajum, a patient,
came to his practice complaining headache, nausea and fever since in the morning. To
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make the diagnosis, dr. Ketut did an anamnesis, physical examination, additional
examination such as ECG, USG, roentgen and laboratory examination, and then give 5
branded medicine to Putu Gd Ajum. He then paid (a fee for services) Rp 555.500,-. Putu
Ajum was very satisfied to get complete medical care and many kinds of medicine; the
doctor was also very friendly. Spending a lot of money was not a problem for him because
he was very rich.
Task 13
Discuss in your group:
1.
Did dr. Cespleng use the managed care approach in his practice? Explain the reasons
of your answer!
2.
What were the possible reasons why dr. Cespleng uses that kind of practice method?
3.
How is the cost effectiveness of the medical care given by dr. Cespleng?
4.
Mention several factors why dr. Cespleng’s patients feel satisfied with the services!
5.
Did his ability to satisfy the patients mean he had already worked professionally?
6.
Describe several consequences that are possible to happen if the above services are
applied for patients with health insurance.
7.
What are the obstacles of managed care application in Indonesia?
SELF ASSESSMENT
1.
Describe the differences between conventional indemnity care and managed care.
2.
Describe what the backgrounds of managed care concepts (such as HMO, PPO, etc)
are.
3.
Explain several reasons why managed care concept is applied by almost all countries in
the world?
4.
5.
What is the meaning of “cost control”?
What is the definition of “quality control”?
6.
What is the definition of “cost effectiveness”?
7.
What are the differences between bipartite and tripartite managed care? Describe the
advantages and the disadvantages of those managed care.
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Study Guide Health System-Based Practice 2015
Day 14 - 15
M O D U L E ~ 14
Health Insurance and SJSN
dr. I Nyoman Sutarsa, MPH
AIMS:
Demonstrate ability to apply the concept of management to provide health services at
primary level.
LEARNING OUTCOMES:
1.
2.
3.
4.
5.
Explain the basic concept of health insurance.
Describe several models of health insurance.
Explain the financing system of health insurance.
Explain the application of health insurance through SJSN.
Describe the application of a managed care in health insurance.
CURRICULUM CONTENTS:
Health Insurance and SJSN
ABSTRACTS
(References: Sulastomo; Thabrany H.; Subawa)
Insurance is a social device for reducing risk of financial loss, which involves the principle of
pooling or co mining separate exposure so that the risk for the group is reduced by the
operation of the law of overage. Health insurance includes all such devices with reduces the
risk of financial loss from ill-health (Deckerson, 1963, in Sulastomo, 2004). There are three
kinds of it namely, social, private voluntary, and regulated private health insurance. Social
health insurance is not profit oriented. Private voluntary and regulated private health
insurance are profit oriented. There are some differences of sharing risk among these
insurances. Social health insurance has most complete sharing risk (rich-poor, ill-health, oldyoung, high risk-low risk), and private voluntary has the least (only ill-health). Social health
insurance applies comprehensive health care approach, but in private voluntary and
regulated private health services depend on selective contract. Social health insurance is
usually conducted by the state, while private voluntary and regulated private are generally
operated by insurance companies.
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SCENARIO & LEARNING TASKS
Case:
The populations of CintaDamaiVillage are members of social health insurance
program (Jaminan Pemeliharaan Kesehatan Masyarakat/JPKM). They have to pay a same
premium of Rp 20.000/family/month. The health services covered by the insurance are
comprehensive cares (primary, secondary and tertiary cares). Dr. Koming is acting as the
primary health provider in the village. Tut Bagus, a member of the JPKM program, came to
see dr. Koming complaining his penis had been swollen. He felt very painful during passing
water. He also has morning discharge for several days. He honestly confessed that he had
sex with a prostitute several times. Without talking and advising too much, dr. Koming gave
the medicine. On the next 3 days, Tut Bagus came back with his wife to dr. Koming’s
practice. His wife complained with vaginal discharge and swollen vulva. Dr. Koming then
gave a medicine to her. One week later Tut Bagus came back again and complaining of
being very weak, difficult to sleep and lost his appetite.
Task 14
Discuss in your group:
1. Based on the scenario above, which one of health insurance program was followed by
Tut Bagus? Describe the reasons of your answer!
2. Had dr. Koming given a comprehensive care? Explain your answer!
3. Had dr. Koming applied the managed care concepts? Explain your answer!
4. What can be concluded from frequent attendance of Tut Bagus to dr. Koming’s practice?
5. Is there an over-utility aspect? In which component?
Self assessment
1.
Describe several types of “sharing risk” in health insurance!
2.
Explain the differences between social and commercial health insurance!
3.
4.
Describe the types of rating based on actuarial analysis!
Describe several paying systems to the health provider.
5.
Which one of the health insurance program will be implemented in Indonesia?
6.
Why should managed care be applied for patients that are covered by health insurance?
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Study Guide Health System-Based Practice 2015
M O D U L E ~ 15
Family Medicine Practices: Family as a Unit of Care
DR. dr. I Wayan Weta, MS, SpGK
AIMS:
Apply family medicine approach in primary health services
LEARNING OUTCOMES:
1. Describe the definition of a family.
2. Describe the functions of family.
3. Explain the cycle of family development including the main objective in each step.
4. Describe the influence of family toward the health status of its members.
5. Differentiate the characteristics of a happy and an unhappy family.
6. Describe the roles of family doctor in assisting an unhappy family
7. Explain the level of a doctor’s involvement in a family with health problems.
8. Describe the family dynamics that affecting health status of family member.
9. Draw and describe a family genogram.
CURRICULUM CONTENTS:
Family Medicine Practices: Family as a Unit of Care
ABSTRACTS
(Reference: Gan GL, et al, pp.56-62)
This topic covers a wide range of aspects related to family as a unit of care. It describes who
forms a family and how an individual enters and leaves the family. The general role of family
is also covered particularly in seeking health care delivery. It also describes reasons of
individual to form a family and family life cycle starting from married couple without children
until ageing family members and is ended up with the death of both spouses. Each stage of
family cycle is completed with its specific role and functions and estimated length of time for
each period.
The family’s influence on the individual health is also discussed in this subject. In addition,
the characteristics of a happy and unhappy family are identified to be used by the physician
to give the best possible support for specific health problem to each family. The level of
physician involvement to family members suffering a health problem is also specified in this
subject. There are a few examples of emergency care and house calls commonly dealt by
physician at the front line of health care services. Finally, this topic assesses the family
dynamic which includes its structure (genogram) and relationship among members in the
family.
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SCENARIO & LEARNING TASKS
Task 15
1. Discuss about family dynamics covering membership, functions and the role changes in
the development cycle.
2. Draw your own family’s genogram and (if possible) explain the meaning of your diagram
to your group!
Explain generally the social economics status and the relationship among your family
member. Is there any genetic disease in your family?
Self Assessments
1. Describe the definition of family and how it is formed.
2. Describe the functions of family!
3. Explain the steps of family cycle and the roles in each step!
4. How is the influence of family toward its member’s health status? Explain your answer!
5. Compare the characteristics of a happy family and an unhappy family!
6. How are the roles of family doctor in assisting an unhappy family? Explain your answer!
7. Describe the family dynamics that can influence the health status of its members.
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Study Guide Health System-Based Practice 2015
Day 16 - 17
M O D U L E ~ 16
Health Delivery System and Family Medicine Practices
DR. dr. I Wayan Weta, MS, SpGK
AIMS:
Apply family medicine approach in primary health services
LEARNING OUTCOMES:
1.
2.
3.
4.
5.
Describe the definition of family medicine as a discipline.
Describe place and position of family medicine in the health care system.
Explain the knowledge and skill that are required in family medicine practice.
Compare integrated health activities within and between providers.
Describe the application of the principles of family doctor services covering:
a. personal care
b. primary care
c. comprehensive care
d. continuing care
6. Explain the coordinative and collaborative aspects using basic approaches of family
medicine.
7. Describe the basic approaches of family medicine at the individual, family and community
levels.
CURRICULUM CONTENTS:
Health Delivery System and Family Medicine Practices
ABSTRACTS
(References: Boelen C, et al, pp.37-48; Gan GL, et al, pp.42-49)
Family medicine is a discipline concerns with the provision of personal, primary,
comprehensive and continuing health care of individual in relation to their family, community
and environment. The central value of family medicine is to anticipate and avoid
fragmentation of care and impersonal care brought by subspecialisation and growth of high
medical technology.
Implementation of family medicine practice must be supported by health care delivery
system and prospective payment health insurance. Prospective payment supports the
comprehensive care service (especially promotive and preventive), that can not be
constructed in post payment system (fee for service).
As a good primary health provider, doctor must have basic family medicine competencies.
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The competency characteristics of family doctors are in:
Attitudes:

Patient centre care and attention to doctor-patient relationship

Holistic approach to the patient and his/her problem that contribute to ill-health and well
being not only physical, but also social and psychological dimensions (the bio-psychosocial model of ill-health) as well as from the family and community.

Emphasize on preventive medicine, because it has greater long term impact on health
status than curative medicine.
Central values of family doctor’s work:

Looks after health problem that may be initially unclear.

Looks after whole spectrum of age (specialist in breadth, unlike hospital specialist- in
depth).
 Looks after patient not only in consultation room but also at home and other settings.
Skill:

General clinical skill

Special clinical skill:
1. Doctor-patient relationship
2. Communication
3. Skill in managing special groups of patient
4. Solute undifferentiated problems
5. Identify risk and early departure from normality.

Skill in resource management

Practical management skill
SCENARIO & LEARNING TASKS
Scenario:
A 25 years old woman came to “Sehat” family medicine clinic, complaining that she had
been coughing for 1 month. She also experienced fever particularly at night and loosing
weight.
The patient had worked as a waitress in a cafe and also as a commercial sex worker since 5
years ago. One of her client was suffering from HIV-AIDS and died several days before.
Task 16
As a family doctor you are required giving appropriate service.
1. What will you do to apply patient-center care with attention to doctor-patient
relationship?
2. How do yo do the holistic approach to this patient?
3. How do you do the preventive medicine to this problem? Who is the target of
preventive medicine? Explain your reason!
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4. What do you do to solve the undifferentiated/unclear case above?
5. With whom the coordinative and collaborative cares should be done?
6. What approach should you take for the medical team, family and community to solve
this problem?
Self Assessments
1. What are the differences between family medicine services and conventional general
practitioner?
2. What are the authorities and the duties of family doctor?
3. Explain the 7 areas of integrated health services.
4. Describe the principles of family medicine service approach.
M O D U L E ~ 17
Disease Management Skills
DR. dr. GN Indraguna Pinatih, MSc, SpGk, Akp
AIMS:
Apply family medicine approach in primary health services
LEARNING OUTCOMES:
1. Describe the differences between acute and chronic diseases management.
2. Explain how to help patients to evaluate their conditions.
3. Describe how to educate patients with chronic diseases in order to empower them in
diseases management.
4. Describe how to make similar perception of diseases with patients and how to determine
the objectives to be achieved together.
5. Explain how to design and to apply the clinical management of chronic diseases.
CURRICULUM CONTENTS:
Disease Management Skills
ABSTRACTS
(Reference: Gan GL, et al, pp.145-155)
Medical services must be constructed depend on type of illnesses whether acute or
chronic disease. There are two approaches of care: doctor centered and patient centered.
Doctor centered only works in acute care, not works effectively in chronic disease care. New
disease paradigm is needed for chronic disease care. Effective chronic disease care
requires two things; the medical care team and an active involved patient (patient centered).
Patients must be empowered to solve their problems, they can change their behavior. The
patient should be able to set self management goal for their problem. Patient Intervention
grouped included into three strategies: Education, Behavior and Affective. Health provider
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team must imply the care management process included: Practice guideline, population
disease management, case management, health promotion or disease prevention, and
clinical information system.
Frame work for action of the team is how to:
1.
2.
3.
4.
Identify the problem
Organize a multidisciplinary team
Define core component, treatment protocols and evaluation methods
Measure the outcome and aims.
The ways ahead those are emphasized in disease management:








Providing care that is respectful to patients preferences
Educating and supporting patient to self-manage their condition
Linking to resources in the broader community
Developing and supporting health care providers
Reorganizing health system
Coordinating care across patients condition
Monitoring quality of service and outcome
Reorganizing health care financing
SCENARIO & LEARNING TASKS
Task 17
Case 1:
Mr. Nyoman Polos, a 50 years old man, came to his family doctor, dr. Siddhi. He complained
about frequent coughing for more than 1 month and sometimes he saw blood strip the
sputum. He lost weight and weak. He was diagnosed with tuberculosis (TB) based on the
physical and laboratory results. The treatment regimen was given for 6 months. In the first
month he had to take 5 different pills every day. For the following 5 months he had to take
the medicine twice a week.
At the end of the first month he stopped the medication for several reasons such as he felt
his complain would not getting better, he lost his hearing and worried about experiencing
severe side effects. He then tried to find alternative medication by visiting a traditional
healer.
Assignments:
Discuss in your group:
What are Mr. Nyoman Polos’ reasons to stop his medication?
If you are his family doctor, what will you do to anticipate the drop out of the treatment?
What can you do to empower patients to help themselves?
What can you do to the patients’ family to prevent the drop out of the treatment?
Try to develop a TB medication system which involves the family to increase compliance.
Explain how is the methode of the system! (Read: The DOTS system from WHO)
6. What should be done to prevent transmission of the diseases to the other family
members?
7. What approach will you use toward the patients’ behavior using alternative medication?
1.
2.
3.
4.
5.
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Case 2:
Luh Manis, a 35 years old woman, a housewife, came to dr. Siddhi complaining of feeling
thirsty and hungry very often. She also felt weak since few months. Luh Manis loved to eat
various food until she gain weight. She was diagnosed suffering from Diabetes Mellitus
(DM). The doctor said that the disease could not be totally recovered without controlling her
eating habit. The doctor adviced to combine the treatment with life style modification such as
diet control and appropriate sports. She had never comply the doctor’s advice.
Her disease became uncontrolled. She is now suffering from a severe wound at her right leg
and cannot be treated with antibiotics. The only choice to save her life is by performing
amputation of her leg.
Assignments:
1. What was the cause of Luh Manis’ difficulties to change her habits?
2. How to make the same perception between doctor and patients?
3. How to determine the objectives of the treatment in order to be understood and applied
by the patients?
4. What kind of approach should be used to anticipate such a case above?
5. As a family doctor, what should you inform to the patient and her families related to the
amputation that must be done?
Self Assessments
1. Compare the approaches of caring the acute and chronic diseases!
2. Describe the differences between doctor centered model and patient centered model in
treatment program!
3. What information should be told to patients with chronic diseases in order to make them
actively involved in their treatment?
4. How to make the same perception of diseases between doctor and patient?
5. How to determine the objectives of the treatment in order to be understood and obeyed
by the patients
Day 18 & 19
M O D U L E ~ 18
Basic Clinical Skills
(Discussion of Student Project)
Data/report and discussion guidelines will be provided before the first discussion
session
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Study Guide Health System-Based Practice 2015
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
9
Senior Clerkship
8
Senior clerksh
ip
7
6
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III
(6 weeks)
Clinic
Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The Cardiovascular
System and
Disorders
(4 weeks)
The Urinary System
and Disorders
(3 weeks)
The Reproductive
System and Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System, Metabolism
and Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition and
Disorders
(2 weeks)
BCS (1 weeks)
Elective Study II
(1 weeks)
5
BCS (1 weeks)
BCS (1 weeks)
BCS (1 weeks)
4
3
2
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health System-based
Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
-
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
1
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
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