Corporate Governance

Prof Tjandra Yoga Aditama

7

Palais de Nation, Geneve

What is UHC?• UHC means that all individuals and communities receive the health

services they need without suffering financial hardship.

• It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

UHC enables everyone to access the services that address the most important causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

(http://www.who.int/health_financing/universal_coverage_definition/en/)

What UHC is not

There are many things that are not included in the scope of UHC:

• UHC does not mean free coverage for all possible health interventions, regardless of

the cost, as no country can provide all services free of charge on a sustainable basis.

• UHC is not just about health financing. It encompasses all components of the health

system: health service delivery systems, the health workforce, health facilities and

communications networks, health technologies, information systems, quality assurance

mechanisms, and governance and legislation.

• UHC is not only about ensuring a minimum package of health services, but also about

ensuring a progressive expansion of coverage of health services and financial protection

as more resources become available.

• UHC is not only about individual treatment services, but also includes population-based

services such as public health campaigns, adding fluoride to water, controlling mosquito

breeding grounds, and so on.

• UHC is comprised of much more than just health; taking steps towards UHC means

steps towards equity, development priorities, and social inclusion and cohesion.

Pertama, gedungnya cukup baik dan bersih. Saya pergi

ke Instalasi Gawat Darurat (IGD) dan ternyata tidak

penuh pasien.

Ke dua, waktu masuk IGD kebetulan lihat dokternya

yang mengalungkan stetoskop di lehernya. Teman yang

antar saya (dokter dari Myanmar) lalu "sok akrab" dan

langsung menegor dokter itu dan bilang : "halo dokter,

ini ada Profesor saya mau cabut jahitan". Si dokternya

lalu bilang langsung aja masuk terus lalu belok kanan,

ternyata itu langsung masuk IGD dan ruang operasi

kecil. Saya langsung disuruh tidur, dokternya -yang

pakai sorban warna pink dan di foto kelihatan seperti

dokter dan pasiennya sama2 "tolak pinggang"-

langsung menangani bersama dua perawatnya, jahitan

saya dicabut dan beres.

Ke tiga, setelah selesai tindakan

maka baru saya diantar sama dia

ke tempat pendaftaran, dan dia

bilang sama petugasnya: "ini

berikan karcis yang 100 rupee

(sekitar Rp 20,000), jangan yang

400 rupee”. Saya tidak mengerti

juga kenapa murah banget.

.

Ke empat, sambil nunggu karcis

maka dokter ber "promosi" bahwa

RS nya sudah terakreditasi

internasional, dan bahkan yang

termasuk pertama di India. Hal ini

yang perlu juga ditiru bahwa mutu

pelayanan yang di jaga dengan

akreditasi perlu diketahui

pengunjung RS.

.

Ke lima, sesudah dokter ini

menyelesaikan catatan medik dan

waktu saya mau pamit, maka dia

memberikan kartu nama telpon

emergency RS. Dia bilang:" kita kan

nggak pernah tahu apa yang mungkin

akan terjadi, maka ini nomor

emergency ya kalau2 diperlukan".

Saya kira ini bentuk pelayanan yang

baik, mungkin dapat juga kita tiru

Pengalaman di RS

• Lingkungan bersih

• Pelayanan cepat

• “human touch ”

• Semua petugas promosi

• Akreditasi sebagai indikator mutu

• Hubungan kelanjutan

• Sistem berbeda

Two major initiatives in health sector as part of Ayushman Bharat

1.Health and wellness centre

2. National Health Protection Scheme (NHPS)

1.Health and wellness centre:

• 1.5 lakh centres will bring health care system closer to the homes of people.

• These centres will provide comprehensive health care, including for maternal and child health services, mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers.

• These centres will also provide free essential drugs and diagnostic services.

2. National Health Protection Scheme (NHPS)

• Will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries)providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

• The impact of NHPS will be in terms of benefitting more than 37% of the population, meaning that nearly all the poor and vulnerable families will be covered mainly for secondary and tertiary care.

• Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of:

– Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)

– Covering almost all secondary and many tertiary hospitalizations. (except a negative list)

– Coverage of 5 lakh for each family, (no restriction of family size)

– This will lead to increased access to quality health and medication.

– In addition, the unmet needs of the population

which remained hidden due to lack of financial resources will be catered to.

–This will lead to:

• timely treatments,

• patient satisfaction,

• productivity and efficiency,

• job creation

• improvement in health outcomes

• improvement in quality of life

GOOD CORPORATE GOVERNANCE

GOOD CORPORATE GOVERNANCE

Menurut FCGI(Forum for Corporate Governance in Indonesia) :

• Yaitu separangkat peraturan yang mengatur

hubungan yang berkaitan dengan hak-hak dan

kewajiban dari :

– pemegang saham,

– pengurus (pengelola) perusahaan,

– pihak kreditor,

– pemerintah,

– karyawan, serta

– para pemegang kepentingan intern dan

ekstern lainnya .

Dengan kata lain…….

• Corporate Governance Suatu sistem yang mengatur dan mengendalikan perusahaan.

• Dengan TUJUAN menciptakan nilai tambah bagi semua pihak yang berkepentingan (stakeholders).

Menurut IICG(The Indonesian Institute for Corporate Governance)

• Yaitu Proses dan struktur yang

ditetapkan dalam menjalankan

perusahaan, dengan tujuan utama

meningkatkan nilai pemegang

saham dalam jangka panjang,

dengan tetap memperhatikan

kepentingan stakeholders yang

lain.

Four Pillars

of Corporate Governance

Accountability

Fairness

Transparency

Independence

Akuntabilitas

• Perusahaan harus memiliki ukuran kinerja dan ada sistem check and balance dalam pengelolaan perusahaan

• Untuk itu perusahaan harus menjamin dilaksanakannya ketentuan-ketentuan yang berlaku dan menjadi good corporate citizenyang peduli pada lingkungan dan melaksanakan tanggungjawab sosial.

Fairness

Protect Shareholders rights

Treat all shareholders including minorities, equitably

Provide effective redress for violations

Kewajaran

• Perusahaan harus

memperhatikan seluruh

kepentingan stakeholdersberdasarkan azas kesetaraan

dan kewajaran (equal treatment)

Transparan

• Dapat mengungkapkan atau memberikan

informasi tepat waktu, memadai, jelas dan

akurat yang mudah diakses oleh stakeholders sesuai dengan haknya.

• Kebijakan perusahaan terutama yang

menyangkut hal-hal strategis harus tertulis dan

dikomunikasikan kepada stakeholders

• Menetapkan tanggungjawab yang jelas dari

masing-masing organ perusahaan yang

selaras dengan visi, misi, strategi dan sasaran

usaha

Independen

• Artinya dalam mengambil

keputusan, perusahaan harus

obyektif dan bebas dari segala

tekanan dari siapapun serta

bebas dari conflict of interest.

Transparancy Keterbukaan

Accountability Akuntabilitas

Independency Independen

Fairness Kewajaran

Stakeholders Pihak yg

berkepentingan

PRINSIP UTAMA GCG

PRINSIP GOOD CORPORATE

GOVERNANCE

• TRANSPARENCY

• ACCOUNTABILITY

• RESPONSIBILITY

• INDEPENDENCY

• FAIRNESS

Responsibility

◻ Perusahaan harus mematuhi peraturan

perundang-undangan serta melaksanakan

tanggung jawab terhadap masyarakat dan

lingkungan sehingga dapat terperlihara

kesinambungan usaha dalam jangka panjang

dan mendapat pengakuan sebagai good

corporate citizen

Menjaminkeputusan

strategik dapatdilakukan

dengan benardan efektif.

Mencegahterjadinyabenturan

kepentingan(conflicts of

interest) berbagai

pihak

Menjaga agar kepentingan

manajerpuncak selalu

sejalandengan

kepentinganstakeholders.

PENTINGNYA GCG

SA SURE

CLINICAL GOVERNANCE

Clinical Governance

• Clinical Governance is the framework through which the hospital is accountable for continuous improvements in services and quality creating an environment of clinical excellence.

• It is a patient-centred approach to care that is accountable in providing a safe, high quality service in an open and questioning environment.

• The key components of Clinical Governance are:• Clear lines of responsibility and accountability for the overall

quality of clinical care• A comprehensive programme of quality improvement activities• Clear policies aimed at managing risk

1. Patient Value and EngagementThis pillar focuses on communicating bi-directionally with patients and patient

support groups. Patients’ experiences should be the fundamental source of the definition of “quality.”

2. Professional Development and CredentialingThis pillar emphasises continuing professional development for all

healthcare workers and also privileging and re-privileging

3.Risk ManagementThis pillar concentrates on minimising clinical risk and improving patient safety

through identification and reduction of potential risks and examination of adverse

incidents for etiology factors and trends within and across services.

4.Professional EvaluationInformation on clinical outcomes is key to improvement and accountability. This pillar

centers on tools such as promulgation of clinical standards, establishment of clinical

indicators and clinical audit. The intention is to establish a culture of awareness,

accountability and responsibility.

Four Pillars of Clinical Governance

Five criteria

1. Governance and quality improvement systems

• There are integrated systems of governance to actively manage

patient safety and quality risks

2. Clinical practice

• Care provided by the clinical workforce is guided by the best

current practice

3. Performance and skills management

• Managers and the clinical workforce have the right

qualifications, skills and approach to provide safe, high quality

health care

4. Incident and complaints management

• Patient safety and quality incidents are recognised, reported

and analysed, and this information is used to improve safety

systems

5. Patient rights and engagement

• Patient rights are respected and their engagement in their care

is supported

Seven pillars of clinical governance

1. Service user, carer and public involvement

2. Clinical effectiveness

3. Clinical risk management

4. Education, training and development

5. Use of information

6. Staffing and staff management

7. Clinical audit

T e r I m a k a s I h

D h a y a v a d