ANALISIS BIAYA PENGOBATAN STROKE SEBAGAI PERTIMBANGAN DALAM PENETAPAN PEMBIAYAAN KESEHATAN BERDASAR INA-CBGs DI ERA JAMINAN KESEHATAN NASIONAL 2014 BERDASARKAN PERMENKES NO. 69 TAHUN 2013
Nama Rumpun Ilmu: Farmasi Klinik
LAPORAN PENELITIAN UNGGULAN PRODI
ANALISIS BIAYA PENGOBATAN STROKE SEBAGAI PERTIMBANGAN
DALAM PENETAPAN PEMBIAYAAN KESEHATAN BERDASAR INA-CBGs
DI ERA JAMINAN KESEHATAN NASIONAL 2014
BERDASARKAN PERMENKES NO. 69 TAHUN 2013
TIM PENGUSUL :
Ingenida Hadning, M.Sc., Apt.
(19850304201004173122/0504038501)
Bangunawati Rahajeng, M.Si., Apt
(19701105201110173154/0505117002)
Indriastuti Cahyaningsih, M.Sc., Apt
(19850526201004173121/0526058501)
Pinasti Utami, M.Sc., Apt.
(19850318201004173123/0518038501)
HALAMAN PENGESAHAN
PRA USULAN PENELITIAN UNGGULAN PRODI
Judul Penelitian
: Analisis Biaya Pengobatan Penyakit Dengan Prevalensi
Tinggi Sebagai Pertimbangan Dalam Penetapan
PROGRAM STUDI FARMASI
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH YOGYAKARTA
AGUSTUS 2016
51
DAFTAR ISI
Hal
Halaman Pengesahan ...........................................................................................................
2
Daftar Isi............................................................................................................................
3
Ringkasan..........................................................................................................................
4
Pendahuluan........................................................................................................................
4
Kelayakan Teknis.................................................................................................................
5
Metode dan Mekanisme Alih Teknologi/desiminasi dan atau Intervensi Sosial.................
7
Pemanfaatan Hasil ...............................................................................................................
8
Organisasi dan Personil Pelaksana Kegiatan .....................................................................
9
Pembahasan .........................................................................................................................
49
Keterbatasan Penelitian …………………………………………………………………...
50
Kesimpulan …………………………………………………………..................................
51
Saran …………………………………………………………………………………........
Jadwal Kegiatan ................................................................................................................
52
Indikator Keberhasilan ........................................................................................................
52
Daftar Pustaka ...................................................................................................................
53
Biodata Ketua dan Anggota ................................................................................................
57
51
RINGKASAN
Pemberlakuan tarif INA-CBG’s pada pembiayaan pasien stroke peserta
JKN di seluruh rumah sakit di Indonesia menuntut pihak rumah sakit untuk dapat
melakukan kendali mutu dan biaya perawatan seefisien mungkin. Penelitian ini
bertujuan untuk mengetahui rerata biaya riil pengobatan pasien stroke rawat inap
di RS PKU Muhammadiyah Yogyakarata dan perbedaanya dengan tarif INACBG’s berdasarkan Permenkes No. 69 Tahun 2013.
Penelitian dilakukan secara observasional dengan desain cross sectional.
Pengambilan data dilakukan secara retrospektif dengan subjek penelitian adalah
seluruh populasi pasien stroke rawat inap peserta JKN yang memenuhi kriteria
inklusi dan eksklusi penelitian yang terdaftar dari bulan Januari - Juni 2014. Data
penelitian berupa direct medical cost yang dianalisis kesesuaiannya dengan tarif
INA-CBG’s. Analisis data dilakukan dengan uji statistik t test.
Rerata biaya riil pasien rawat inap untuk kelas I dengan kode G-4-14-I
sebesar Rp. 6.175.260,- ± Rp. 3.641.107,-, G-4-15-I sebesar Rp.10.260.320,- ±
Rp.7.107.732,-, G-4-15-II sebesar Rp.7.692.475,- ± Rp.2.339.329,-, G-4-15-III
sebesar Rp.11.318.550,- ± Rp.9.457.199,-. Kelas II dengan kode G-4-13-I sebesar
Rp 8.078.200,-, G-4-14-I sebesar Rp 3.705.700,-, G-4-14-II sebesar Rp
3.719.950,- ± Rp 1.591.202,-, G-4-15-I sebesar Rp 3.957.000,-, G-4-15-II sebesar
Rp 6.095.950,- ± Rp 3.114.451,-. Kelas III dengan kode INA-CBG’s G-4-13-I
sebesar Rp 4.074.000,-, G-4-14-I sebesar Rp 1.881.600,- ± Rp 454.952,-, G-4-14II sebesar Rp 1.593.262,- ± Rp 666.908,-, G-4-15-I sebesar Rp 2.817.880,- ± Rp
1.240.742,-, G-4-15-II sebesar Rp 2.211.500,- ± Rp 1.223.001,-. Pada kelas I dan
II, secara statistik tidak terdapat perbedaan yang signifikan antara rerata biaya riil
dengan tarif INA-CBG’s. Pada kelas III terdapat perbedaan yang signifikan pada
kode G-4-14-II dan G-4-15-II, namun tidak terdapat perbedaan yang signifikan
pada kode G-4-14-I dan G-4-15-I. Dalam penelitian ini dapat disimpulkan tidak
terdapat perbedaan yang signifikan antara rerata biaya riil dengan tarif INACBG’s. RS PKU Muhammadiyah Yogyakarta telah mampu mengelola tarif INACBG’s penyakit stroke rawat inap yang ditetapkan oleh pemerintah.
Kata kunci : stroke, analisis biaya, INA-CBGs, Permenkes No. 69 Tahun 2013.
51
PENDAHULUAN
Dengan diberlakukannya Peraturan Presiden RI No.12 Tahun 2013 tentang
Jaminan Kesehatan yang diselenggarakan oleh Badan Penyelenggara Jaminan
Sosial Kesehatan (BPJS Kesehatan) dimana mulai 1 Januari 2014 semua
penduduk Indonesia akan memperoleh jaminan berupa perlindungan kesehatan
berupa manfaat pemeliharaan kesehatan dan perlindungan dalam memenuhi
kebutuhan dasar kesehatan, maka untuk pembayaran fasilitas kesehatan bagi
pasien rawat inap BPJS Kesehatan melakukan pembayaran berdasarkan
Indonesian Case Based Groups (INA-CBG’s). Dalam sistem INA-CBGs
komponen biaya yang ditanggung oleh pihak BPJS Kesehatan terdiri atas biaya
perawatan, penginapan, tindakan, obat-obatan, penggunaan alat kesehatan, dan
jasa yang dihitung terpadu dalam paket. Dengan demikian analisis biaya
pengobatan rawat inap sangat dibutuhkan dalam perencanaan pengobatan. Hasil
penelitian diharapkan dapat memberi gambaran mengenai kemampuan rumah
sakit dalam mengendalikan biaya pengobatan sesuai tarif pelayanan kesehatan
yang berlaku dalam penyelenggaraan program jaminan kesehatan 2014 serta dapat
dijadikan salah satu evaluasi pelaksanaan program jaminan kesehatan di
Indonesia.
Rumusan Masalah : Seperti apakah kesesuaian biaya riil pengobatan penyakit
stroke bagi pasien rawat inap di Rumah Sakit PKU Muhammadiyah Yogyakarta
dengan besarnya pembiayaan kesehatan berdasarkan Permenkes RI No 69 Tahun
2013 tentang Standar Tarif Pelayanan Kesehatan Pada Fasilitas Kesehatan
Tingkat Pertama dan Tingkat Lanjutan Dalam Penyelenggaraan Program Jaminan
Kesehatan?
Tujuan : Mengetahui apakah besarnya biaya riil pengobatan penyakit stroke bagi
pasien rawat inap di Rumah Sakit PKU Muhammadiyah Yogyakarta telah sesuai
dengan pembiayaan kesehatan berdasarkan Permenkes RI No 69 Tahun 2013
tentang Standar Tarif Pelayanan Kesehatan Pada Fasilitas Kesehatan Tingkat
51
Pertama dan Tingkat Lanjutan Dalam Penyelenggaraan Program Jaminan
Kesehatan.
Lokasi kegiatan : Rumah Sakit PKU Muhammadiyah Yogyakarta dan Program
Studi Farmasi FKIK UMY.
KELAYAKAN TEKNIS
Beragam guideline pengobatan penyakit stroke menyebabkan beragam
pula jumlah biaya yang harus dibayar oleh penderita atau keluarga penderita atau
pihak BPJS Kesehatan. Bila penanganan atau pemilihan obat tidak tepat maka
dapat menyebabkan waktu tinggal di rumah sakit menjadi lebih lama atau
terjadinya komplikasi yang lain yang pada akhirnya akan terjadi pembengkakan
biaya. Besarnya biaya pengobatan selain dipengaruhi oleh jenis terapi obat yang
digunakan juga dipengaruhi oleh jenis tindakan yang diberikan tenaga medis,
keahlian tim medis dalam mendiagnosis secara cepat dan tepat, serta kepatuhan
tenaga medis terhadap clinical pathway yang telah ditetapkan rumah sakit
sebelumnya. Dalam sistem INA-CBGs komponen biaya yang ditanggung oleh
pihak asuransi kesehatan terdiri atas biaya perawatan, penginapan, tindakan, obatobatan, penggunaan alat kesehatan, dan jasa yang dihitung terpadu dalam paket.
Dengan diberlakukannya INA-CBGs pada pembiayaan rumah sakit, maka analisis
biaya pengobatan rawat inap sangat dibutuhkan dalam perencanaan pengobatan
sehingga rumah sakit dapat melakukan penghematan biaya agar rumah sakit tidak
merugi. Analisis biaya tersebut selain berguna dalam hal mengajukan klaim
kepada pihak asuransi kesehatan juga dapat digunakan dalam memberikan
pengobatan yang tepat bagi pasien berdasarkan data biaya pengobatan.
Penelitian dilakukan dengan tahapan sebagai berikut :
1. Tahap persiapan
Tahapan ini meliputi pengurusan ijin serta persiapan lembar pencatatan
data pasien dan lembar pencatatan biaya pengobatan stroke.
2. Tahap pelaksanaan
51
Pelaksanaan penelitian dilakukan dalam bentuk kegiatan :
a. Review rekam medik di rumah sakit untuk mendapatkan data
karakteristik demografi yang meliputi nama pasien, nomor rekam
medik, usia, jenis kelamin pasien; lama dirawat di rumah sakit (tanggal
dan jam masuk-keluar rumah sakit), tanggal dan jam serangan, faktor
resiko, catatan penggunaan obat, catatan keperawatan, hasil uji
laboratorium yang telah dilakukan, dan hasil terapi yang diukur dari
indek barthel. Semua data tersebut dicatat dalam lembar pencatatan
data pasien.
b. Penelusuran biaya terapi pasien stroke berdasarkan data rekam medis
pasien. Biaya penggunaan obat dan alat kesehatan ditelusuri dari
instalasi farmasi rumah sakit, sedangkan tarif biaya tindakan medis,
biaya perawatan, biaya pemeriksaan penunjang (biaya laboratorium,
fisioterapi, dan gizi), biaya administrasi, biaya penunggu pasien dan
sewa ruangan, biaya kartu berobat, dan biaya karcis ditelusuri dari
bagian administrasi keuangan.
3. Tahap pengolahan dan analisis data
Data dari rekam medis pasien dan data dari penelusuran biaya pengobatan
pasien setelah terkumpul akan dilakukan pengolahan dan analisis data
sesuai metode analisis yang digunakan.
Penelitian ini akan dilakukan berkesinambungan dengan melibatkan
beberapa rumah sakit yang mengikuti program Jaminan Kesehatan
Nasional (JKN) dan meneliti penyakit yang lebih luas. Hasilnya
diharapkan dapat dijadikan sebagai salah satu evaluasi pelaksanaan
program jaminan kesehatan di Indonesia.
Mitra Industri/lembaga pemerintah/badan litbang : RS PKU Muhammadiyah
Yogyakarta dan BPJS Kesehatan (PT.Askes Persero).
51
METODE DAN MEKANISME ALIH TEKNOLOGI/DISEMINASI DAN
ATAU INTERVENSI SOSIAL
Penelitian ini merupakan penelitian observasional dengan rancangan
penelitian cross sectional menurut perspektif rumah sakit. Metode pengambilan
data secara retrospektif. Subyek penelitian yang digunakan adalah seluruh
populasi pasien rawat inap peserta JKN di Rumah Sakit PKU Muhammadiyah
Yogjakarta yang menderita penyakit stroke dari bulan Januari - Juni 2014 yang
memenuhi kriteria inklusi penelitian dan telah dikelompokkan berdasarkan INACBGs. Analisis data dilakukan dengan uji statistik MannWhitney.
Hasil
penelitian diharapkan dapat
memberi
gambaran
mengenai
kemampuan rumah sakit dalam mengendalikan biaya pengobatan sesuai tarif
pelayanan kesehatan yang berlaku dalam penyelenggaraan program jaminan
kesehatan 2014 serta dapat dijadikan acuan bagi BPJS Kesehatan dalam
mengambil kebijakan.
PEMANFAATAN HASIL
Strategi Pemanfaatan Hasil Kegiatan :
1. Hasil penelitian akan diterbitkan pada jurnal ilmiah dan dipresentasikan di
forum-forum ilmiah.
2. Hasil penelitian akan diberikan kepada rumah sakit terkait dan BPJS
kesehatan.
Intervensi sosial yang dapat memperbaiki karakter bangsa : Hasil
penelitian diharapkan dapat bermanfaat bagi rumah sakit dengan memberi
gambaran mengenai kemampuan rumah sakit dalam mengendalikan biaya
pengobatan sesuai tarif pelayanan kesehatan yang berlaku dalam penyelenggaraan
program jaminan kesehatan 2014 serta dapat dijadikan acuan bagi BPJS
Kesehatan dalam mengambil kebijakan.
Manfaat jangka panjang dapat dirasakan oleh masyarakat : berupa
pelayanan kesehatan yang baik dan berkualitas.
51
STRATEGI
PELEMBAGAAN
INDUSTRIALISASI
KE
ARAH
KARAKTER BANGSA
(tidak ada )
ORGANISASI DAN PERSONIL PELAKSANA KEGIATAN
TABEL 1. Organisasi dan Profil
Ingenida
Bangunawati
Indriastuti
Pinasti Utami
Hadning
Rahajeng
Cahyaningsih
Gelar
M.Sc., Apt
M.Si., Apt
M.Sc., Apt
M.Sc., Apt
Jenis Kelamin
Wanita
Wanita
Wanita
Wanita
Unit Kerja
Farmasi
Farmasi
Farmasi
Farmasi
Bidang
Manajemen
Farmasi
Farmasi
Farmasi
Keahlian/Tugas Farmasi/Ketua Klinik/Peneliti Klinik/Peneliti Klinik/Peneliti
Peneliti
Pendidikan
S2
S2
S2
S2
16 jam/mgg
16 jam/mgg
16 jam/mgg
16 jam/mgg
terakhir
Alokasi waktu
PEMBAHASAN
Stroke Patient Characteristic at Jogja Hospital
During January – June 2014 there were 49 stroke patients at PKU
Muhammadiyah Yogyakarta Hospital who fulfilled the inclusion criteria. There
were 2 patients with code I619 (Intra-cerebral Hemorrhage), 20 patients with code
I639 (Cerebral Infarction), and 27 patients with code I64 (Unspecified Stroke).
Stroke patient characteristic can be seen on the table 1 as below.
Table 1. Stroke Patient Characteristic with JKN membership at PKU
Muhammadiyah Yogyakarta Hospital during January – June 2014
51
Characteristics
Intra-cerebral
Hemorrhage (I619)
(n=2)
%
Cerebral Infarction
(I639)
(n=20)
%
Unspecified Stroke
(I64)
(n=27)
%
Sex:
Male
Female
Age :
≤ 55 years of
age
> 55 years of
age
1
1
50
50
14
6
70
30
19
8
70
30
0
0
4
13
3
7
2
100
9
27
13
30
Most of stroke patient with diagnosis code of I619 (Intra-cerebral
Hemorrhage), I639 (Cerebral Infarction), and I64 (Unspecified Stroke) were aged
55. It might be due to the risk of stroke will increase 2 times after age 55 [11]. At
the elderly group, the risk of hypertension increases because the blood vessels
become more rigid and less elastic [12], whereas the hypertension is the most
important risk factor of stroke [13] [14]. According to the result of stroke patient’s
case study with cerebral infarction (I639) and non-specific stroke cases (I64), it
has been known that male has higher stroke prevalence than female (70% and
30%). According to [4], men have higher risk to get stroke compared to women in
the same age. It is caused by women’s hormones that have protective roles toward
the diseases related to blood artery [15]. Furthermore, man also have higher
potential to get stroke because of their life style like smoking, staying up to work,
and high rate of stress [16].
One of the factors affecting the length of stay in acute ischemic stroke
patients was age of 65 years or more [17]. Another study stated an increase of
length of stay in diabetic patients with the age of 60 years or more, and a decrease
of length of stay in female patients [18].
Costs Analysis Based on INA-CBGs
The amount of INA-CBGs costs decided by the government varies for each
diagnosis coding and is affected by the disease severity. While diagnosis code is
determined by hospital’s coding officer, INA-CBGs code and the disease severity
was calculated by INA-CBGs owned by JKN central management. INA-CBGs
code determination is done on concordance with the primary diagnosis code,
secondary diagnosis code, medical procedures, and length of stay. Those variables
51
are input by hospital coding officer along with Jamkesmas reporting in each day
through hospital-owned INA CBGs software [19] [20] [21]. The average cost of
patient care based on the average length of stay can be seen on Table 2 as below.
Class
I
II
III
Tabel 2. The average cost of patient care based on the average length of stay with
JKN membership at PKU Muhammadiyah Yogyakarta Hospital
during January 2014 – June 2014
Intra-cerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage (I619)
Real
Length of Stay
Length of Stay
Length of Stay
Cost
P
P
P
<
≥
≥7
≥8
< 7 Days
< 8 Days
Days
Days
Days
Days
Mean
2.753.750, 9.698.2
5.546.160, 13.030.
(Rp)
00
00,00 0,18
00
550,00 0,0
7
DS
5.064.9
1.898.157, 5.786.6 08
66.680,17
(Rp)
78,15
31
43,19
≥5
≥7
8 Days - Days
< 5 Days
< 7 Days
Days
Days
Mean
8.078.2
4.275.4
3,893,7
6,695,600
6.127.600
0,3
(Rp)
00
00
00
0,00
33
DS
805.67 5
0
3.069.691
(Rp)
7
12
≥5
≥5
- Days
< 5 Days
< 5 Days
Days
Days
Days
4.074.0
1.252.225 1.916.7
1.375.275 1.920.0
Mean
00
33
33
0,02
0,0
(Rp)
5
00
217.174
671.13
512.371
1.138.1
DS
0
3
74
(Rp)
The relation between the length of stay and treatment cost was analysed using
Pearson and Spearman correlation test. Based on bivariat corelation analysis
stroke with diagnose code I639 (Cerebral Infarction) with p value is 0,05 for class I (0,187), and diagnose code
I64 (Unspecified Stroke) with p value is 0,05 for class II (0,333). Those diagnose codes have positive correlation
coefficient, and it can be concluded that there is a positive correlation between the
length of stay and treatment cost which means the longer the patient stay the
higher treatment cost would be [9] [17] [22].
Details of the average treatment cost of stroke patients consisted of direct
51
medical
and non-medical costs as seen in Table 3. The greatest components of stroke
treatment cost from all the diagnostic codes and all class for direct medical cost
were medicine cost and medical equipment cost (Rp 859.333 to Rp 5.829.066),
visite fee (Rp 210.000 to Rp 1.517.000), and electro medic and radiology
diagnostic cost (Rp 139.800 to Rp 1.333.860), and the greatest component of
direct non medical cost were room cost (Rp 150.000 to Rp 2.907.500).
Cost
Variable
Visit fee
Electromedi
c & Radio
Diagnostic
Laboratory
analysis
Rehabilitatio
n medic
Nursing
Medicine,
medical eq
Table 3. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class I with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage
(I619)
Real cost
Real cost (Rp.)
Real cost (Rp.)
<
≥ Days
≤ 7 Days
> 7 Days
≤ 7 Days
>7 Days
Days
Mea
Mea
Mean
Mean
Mean
Mean
% n
%
%
%
%
%
n
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
586.666
1.275.75
1.517.83
11,7
13,6 614.000 11,3
11,7
±
0±
3±
3
9
±189156
5
3
318.682
632.652
1517833
1.333.86
873.700
580.675
17,4
409.540
10,3
0
6,23
7,57
±
±
6
± 326971
1
±113758
104.228
137.331
1
388.975
763.660
906.133
324.100
14,1
±
±
±105916
6,48
4,17
7
± 164209
1
207.269
1172636
1
60.666 ±
110.250
409.540
223.666
1,21
1,18
1,38
1,73
105.077
± 83.683
± 81309
±195535
132.250
50.000 ±
72.000 ±
117.166
±
1
1,42
1,33
0,91
19.000
18096
±82176
133.315
1.956.36 39,1 5.149.47 55,2 2.119.52 39,1 5.829.06 45,0
6±
0
5±
6
0±
7
6
4
51
2.497.17
7
Nutrition
Room
Administrati
on
Total
5.013.34
2
4.375 ±
0
0
0,05
8.750
Direct Non Medical Cost
16,5
1.046.66
1.545.62
9
20,9
6±
5±
2
761.090
617.124
1170054
105.000
± 22.516
5.003.16
4
85.640 ±
20526
5.411.56
0
2,1
100
131.375
± 72.269
9.318.75
0
1,41
100
0
1.272.40
0±
635182
±291631
4
0
23,5
1
1,58
100
0
2.907.50
0
±137832
4
106.573
± 22847
12.941.7
97
0
22,4
7
0,82
100
Table 4. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class II with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Hemorrhage
Cerebral Infarction (I639)
Unspecified Stroke (I64)
(I619)
Cost
Real cost
Real cost (Rp.)
Real cost (Rp.)
Variable
8 Days
< 5 Days
≥ 5 Days
< 7 Days
≥ 7 Days
Mean
Mean
Mean
Mean
Mean
%
%
%
%
%
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
607.500
11, 617.500 14,
11,
±
Visit fee
775,000 9.6 795,000
9,9 435,000
8
± 81.317
4
2
357.088
Electromedi
472.500
714.800 11,
12,
c & Rad
591,800 7,3 139,800 2,1
480,000
± 10.606 11
± 42.426
7
3
Diagnostic
741.800
Laboratory
17, 628.500 10,
±
73,000
0,9 324,000 4,8
73,000
1,9
analysis
3
± 3.535
3
636.961
100.000
Rehabilitatio
89.000 ±
±
280,000 3,5
0
0
2,3
1,5
0
0
n medic
12.727
141.421
Nursing
136,000 1,7 113,000 1,7 75.500 ± 1,8 101.500 1,7
68,000
1,7
51
Medicine,
medical eq
Nutrition
Room
Administrati
on
Total
4,145,40
0
51,
3
0
0
2,000,00
0
24,
8
77,000
0,9
8.078.20
0
10
0
17.677
1.314.10
0±
4,332,30 64,
30,
1.234.04
0
7
7
2
6.250 ± 0,1
0
0
8.838
5
Direct Non Medical Cost
862.500 21,
13,
900,000
±
2
4
159.099
85.250 ±
2
91,500
1,4
8.838
6.695.60 10 4.275.40 10
0
0
0
0
± 19.091
2.575.75
0±
2.002.59
7
0
1.332.50
0±
696.500
78.050 ±
19.021
6.127.60
0
41,
8
42
1,626,10
0
0
0
0
21,
7
1,120,00
0
28,
8
1,3
91,600
10
0
3.893.70
0
2,4
10
0
Table 5. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class III with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage
(I619)
Cost
Real cost
Real cost (Rp.)
Real cost (Rp.)
Variable
Days
< 5 Days
≥ 5 Days
< 5 Days
≥ 5 Days
Mean
Mean
Mean
Mean
Mean
%
%
%
%
%
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
387.500
18. 210.000± 16,
20, 272.500± 19, 702.833±
Visit fee
775,000
24
±
5
75.608
8
2
96.393
8
277929
229.820
Electromedi
537.600
11.
42, 389.533±
380.450± 27, 437.044±
465.000
15
c & Rad
±
20,
4
9
259.984
189.628
7
281.118
48.400
Diagnostic
3
Laboratory
74.000 ±
180.500±
153.000± 11, 266.011±
193.000 4.7
5,9
9,4
9,1
analysis
2.000
112.690
71.498
1
173.553
Rehabilitatio
20.000 ±
66.666 ±
10.000±
75.555±
240.000 5.8
1,6
3,5
0,7
2,6
n medic
40.000
74.475
20.000
67.659
Nursing
110.000 2.7 14.000 ± 1,1 48.750 ± 2,5 25.500± 1,9 70.277±3 2,4
51
Medicine,
medical eq
Nutrition
Room
Administrati
on
Total
1.409.00
0
0
34.
6
0
825.000
20.
3
77.000
1.9
4.074.00
0
10
0
19.339
22.044
173.500 13, 429.783± 22,
± 89.302
9
218.512
4
0
0
Direct Non Medical Cost
150.000
337.500± 17,
12
± 61.237
155.523
6
73.125 ±
76.500 ±
4
5,8
7.750
1.224
1.252.22 10 1.916.73 10
5
0
2
0
16.114
270.050±
222.917
0
187.500±
43.301
76.275±
1.517
1.375.27
5
19,
6
0
13,
6
5,5
10
0
3.155
859.333± 29,
749.244 4
0
0
433.333± 14,
97.628
8
75.644± 2,6
4.179
2.920.03 10
0
0
The costs of medicine and medical equipment, visite fee, and electromedic and
radiology diagnostic cost were affected by the accuracy of diagnosis, treatment
selection, and stroke comorbidities factors [9] [17] [22] [23]. Those factors then
will directly affect the patient’s length of stay and treatment cost as seen on Table
2.
Other studies have concluded that the length of stay for ischemic stroke patient
in Sardjito Hospital was affected by stroke severity [9]. The difference in length
of stay of general disease was affected by the disease severity and comorbid factor
such as myocardial infarction and congestive heart failure [22] [24] [25] [26].
Some factors that might lengthen the hospitalization of acute ischemic stroke
patients were diabetes mellitus, atrial fibrillation, type of stroke, stroke treatment,
and stroke relaps [17].
The stroke therapy costs for all diagnose codes at PKU Muhammadiyah
Yogyakarta Hospital are not only affected by the type and number of drugs used
but also affected by other additional medications to treat the stroke comorbid
factors. The more type of drugs used for stroke treatment the higher the treatment
cost should be. Moreover, the more comorbid factors the higher the treatment
cost should be as well [9] [17] [22] [23].
As seen on Table 6, the most common comorbid factor in stroke, in diagnosis
code of I619, I639, and I64 was hypertension (50%, 67%, and 54%). It was
consistent with the theory stating hypertension were the most common comorbid
factors in ischemic stroke as well as in hemorrhagic stroke [4] [9] [25] [27].
51
Table 6. Stroke comorbid factors of Jamkesmas membership at PKU
Muhammadiyah Yogyakarta hospital during January–June 2014
Intracerebral
Cerebral
Unspecified
Hemorrhage (I619) Infarction (I639)
Stroke (I64)
Comorbid
Factors
(n=
(n=2 )
%
(n=21)
%
%
28)
Hypertension
1
50
14
67
15
54
Diabetes
4
19
6
21
Mellitus
Dyslipidemia
2
10
3
11
Sepsis
0
0
0
0
Vertigo/migrain
1
5
Cardiac
3
14
3
11
problem
Depression
Seizure
Hypertension might cause intracranial vessel rupture or become stenotic. The
ruptur vessel will cause intracranial haemorrhage, but when the the vessel become
stenotic it might disturb intracranial blood flow and, eventually, brain cellular
death. Moreover, the rise in blood pressure might faster the plaque formation
process, endothelial layer damage, and finally plaque would be prone to rupture
and causes thrombus. Thrombus then will occlude blood vessel locally, or become
emboly in blood stream into cerebrovascular system [12].
One sample t test result were used to find any significant discrepancy between
real stroke treatment coast and the amount of INA-CBGs cost when t-test were
not available due to abnormally distributed data. The analysis results can be seen
in Table 7.
51
Class
I
Table 7. Correlation Between Real Cost and INA-CBGs Cost
Tarif INABiaya Riil
Kode
Kode INACBG’s
Diagnostik
CBG’s
Mean
SD
Mean
SD
I639
G-4-14-I
6.175.260
3.641.107 5.158.795 0
164
G-4-15-I
10.260.320
7.107.732 4.021.093 0
164
G-4-15-II
7.692.475
2.339.329 4.799.193 0
164
G-4-15-III
11.318.550
9.457.199 6.851.464 0
II
I639
I64
III
I619
I639
I639
I64
I64
G-4-14-II
G-4-15-II
G-4-13-I
G-4-14-I
G-4-14-II
G-4-15-I
G-4-15-II
5.770.350
6.095.950
4.074.000
1.881.600
1.593.262
2.817.880
2.211.500
1.308.501
3.114.451
7.996.295
4.113.594
454.952
666.908
1.240.742
1.223.001
2.705.047
3.684.853
6.663.579
2.872.209
3.427.995
0
0
0
0
0
0
0
Sig.
0,566
0,121
0,090
0,625
0.180
0.655
0,180
0,000
0,500
0,026
The amount of real stroke treatment cost at PKU Muhammadiyah Yogyakarta
Hospital for diagnosis code of I639 and I64 in class I were averagely higher than
the amount of INA-CBGs cost for the same diagnosis code and the same class. In
class II the amount of real stroke treatment cost for diagnosis code of I639 were
were averagely lower than the amount of INA-CBGs cost, while it was higher for
diagnosis code of I64 for real stroke treatment. In class III the amount of real
stroke treatment cost for diagnosis code of I619 were higher than the amount of
INA-CBGs while it was lower for diagnosis code of I639 and I64 for real stroke
treatment cost. Moreover, One Sample t test analysis for class I diagnose code
I639 and I64 with p value was > 0.05, class II diagnose code I639 and I64 with p
value was > 0.05, and class III diagnose code I639 (G-4-14-I) and I64 (G-4-15-I)
with p value was > 0.05. That meant there was an insignificant discrepancies
between real stroke treatment cost and the corresponding INA-CBG’s cost. In the
other side One Sample t test analysis for class III diagnose code I639 (G-4-14-II)
and I64 (G-4-15-II) with p value was < 0.05, that meant there was a significant
discrepancies between real stroke treatment cost and the corresponding INACBG’s cost. According to the aforementioned analysis it was concluded that the
hospital was adequately capable of doing rate management determined by INACBGs. By doing so, the hospital did not have to bear too many cost deficits [9].
As seen on table 8 and 9 there are some losses need to be covered by PKU
Muhammadiyah Yogyakarta during 6 months of the study (January 2015 – June
51
2015) for all stroke diagnosis codes and severity class I and II as much as Rp
59.104.642 and Rp 2.882.777. The cost deficits might actually be anticipated if its
causes and solutions were known before. One of its possible causes were branded
medicine prescribing that might actually be substituted with generic medicine
eventhough some of the prescribing has already used generic medicine [9].
Table 8. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke class I
at PKU Muhammadiyah Yogyakarta Hospital during January-June 2014
Total Tarif
Kode
Kode INA- Jumlah Total Biaya Riil
INA-CBG’s
Diagnosis
CBG’s
Pasien
(Rp.)
(Rp.)
I639
G-4-14-I
6
30.876.300,00 25.793.975,00
I639
G-4-14-II
1
5.587.000,00
9.329.010,00
I639
G-4-14-III
1
17.726.200,00 11.665.308,00
I64
G-4-15-I
5
51.301.600,00 20.105.465,00
I64
G-4-15-II
5
30.769.900,00 19.196.772,00
I64
G-4-15-III
2
22.637.100,00 13.702.928,00
Total
158.898.100,00 99.793.458,00
Kerugian
59.104.642,00
Table 9. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke
class II at PKU Muhammadiyah Yogyakarta Hospital
during January-June 2014
Total Tarif
Kode
Kode INA- Jumlah Total Biaya Riil
INA-CBG’s
Diagnosis
CBG’s
Pasien
(Rp.)
(Rp.)
I629
G-4-13-II
1
8.078.200,00
4,502,470.00
I639
G-4-14-I
1
3.705.700.00
4,421,824.00
I639
G-4-14-II
2
11.540.700,00 15.992.590,00
I64
G-4-15-I
1
3.957.000,00
3.446.651,00
I64
G-4-15-II
2
12.191.900,00
8.227.188,00
Total
39.473.500,00 36.590.723,00
Kerugian
2.882.777,00
51
Table 10. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke
class III at PKU Muhammadiyah Yogyakarta Hospital
during January-June 2014
Kode
Kode INAJumlah
Total Biaya Riil
Total Tarif INADiagnosa
CBG’s
Pasien
(Rp)
CBG’s (Rp)
I629
G-4-13-I
1
4.074.000
2.705.047
I639
G-4-14-I
2
3.763.200
7.369.706
I639
G-4-14-II
8
12.746.100
53.308.632
I64
G-4-15-I
5
14.089.400
14.361.045
I64
G-4-15-II
8
17.692.000
27.423.960
Total
52.364.700
105.168.390
Selisih
Rp 52.803.690,The government-determined INA-CBGs code very depended with the
diagnosis code reported by hospital coding officers, thus diagnosis writing
accuracy and medical procedure writing completeness became the primary
factors due to the discrepancy of INA-CBGs rate for every code and severity
level determined by primary and secondary diagnosis and the medical
procedures [9] [19] [21] [28]. This rate difference became the main problem
in coding process. Management of PKU Muhammadiyah Yogyakarta
Hospital had to socialize to doctors regarding the coding process and the
importance of correct and detailed diagnosis writing that might cause
inaccurate rate deciding. Thus, solving this problem might be a step to
prevent hospital loss.
Based on the above discussion, there are some important factors to be
concerned for managing JKN rate effectively: the accuracy of diagnosis,
treatment decision and nursing care for the stroke’s treatment and also its
comorbid factors. They are also important issues to avoid hospital’s financial
loss. Hospital management is expected to demonstrate those important issues
to their medical staffs and paramedics to reach the same level of
understanding and commitment in the medical team at PKU Muhammadiyah
Yogyakarta Hospital.
KETERBATASAN PENELITIAN
Keterbatasan dari penelitian ini adalah
a. Penelitian ini dilakukan secara restrospektif menggunakan data rekam
medis pasien sehingga tidak diketahui secara pasti keadaan pasien yang
51
sebenarnya dan hanya bisa melihat dari data yang tertulis dalam rekam
medis.
b. Klasifikasi severity dan biaya penggantian pengobatan penyakit stroke
dalam sistem komputasi BPJS yang belum diketahui secara pasti.
KESIMPULAN DAN SARAN
1.
Kesimpulan
Tidak ada perbedaan signifikan antara rata-rata biaya riil terapi stroke dengan
pembiayaan kesehatan berdasarkan Permenkes Nomor 69 Tahun 2013,
sehingga rumah sakit mampu mengelola pembiayaan terapi dengan optimal.
2.
Saran
a. Perlu dilakukan penelitian lebih lama untuk mendapatkan jumlah sampel
yang lebih banyak sehingga data yang diuji dapat lebih valid.
b. Penelitian ini perlu dilakukan juga terhadap rumah sakit lain sehingga
data yang didapatkan akan berguna bagi pemerintah sebagai bahan
evaluasi terhadap kebijakan BPJS Kesehatan.
51
JADWAL KEGIATAN
No
Kegiatan
Bulan
I
1
II
III
IV
V
VI
√
√
√
√
√
√
√
√
VII
VIII
Tahap Persiapan
a. Pengurusan ijin
√
b. Persiapan lembar pencatatan
√
biaya pengobatan pasien
2
Tahap Pelaksanaan
a. Penelusuran biaya penggunaan
obat dan alat kesehatan dari
instalasi farmasi rumah sakit
b. Penelusuran
biaya
tindakan
√
medis, perawatan, pemeriksaan
penunjang, administrasidan sewa
ruangan dari bagian administrasi
keuangan
3
Tahap Penyelesaian
a. Rekapitulasi data penelitian
√
b. Pengolahan dan analisis data
√
c. Penyusunan laporan akhir
√
d. Pengumpulan laporan akhir
√
51
INDIKATOR KEBERHASILAN
Tuliskan indikator keberhasilan penelitian mengikuti tabel sebagai berikut :
Capaian yang Ditargetkan*
No.
Jenis Luaran
Tahun I
Tahun II
Tahun III
1
Pelayanan jasa (status:
pengembangan, uji coba,
penerapan, evaluasi)
Kerja sama (status: penjajakan,
pelaksanaan, evaluasi kerja sama)
Analisis data
Evaluasi hasil
penelitian
RS terkait
& BPJS
RS terkait
& BPJS
Masukan bagi
rumah sakit dan
BPJS
RS terkait
& BPJS
2
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51
LAPORAN PENELITIAN UNGGULAN PRODI
ANALISIS BIAYA PENGOBATAN STROKE SEBAGAI PERTIMBANGAN
DALAM PENETAPAN PEMBIAYAAN KESEHATAN BERDASAR INA-CBGs
DI ERA JAMINAN KESEHATAN NASIONAL 2014
BERDASARKAN PERMENKES NO. 69 TAHUN 2013
TIM PENGUSUL :
Ingenida Hadning, M.Sc., Apt.
(19850304201004173122/0504038501)
Bangunawati Rahajeng, M.Si., Apt
(19701105201110173154/0505117002)
Indriastuti Cahyaningsih, M.Sc., Apt
(19850526201004173121/0526058501)
Pinasti Utami, M.Sc., Apt.
(19850318201004173123/0518038501)
HALAMAN PENGESAHAN
PRA USULAN PENELITIAN UNGGULAN PRODI
Judul Penelitian
: Analisis Biaya Pengobatan Penyakit Dengan Prevalensi
Tinggi Sebagai Pertimbangan Dalam Penetapan
PROGRAM STUDI FARMASI
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH YOGYAKARTA
AGUSTUS 2016
51
DAFTAR ISI
Hal
Halaman Pengesahan ...........................................................................................................
2
Daftar Isi............................................................................................................................
3
Ringkasan..........................................................................................................................
4
Pendahuluan........................................................................................................................
4
Kelayakan Teknis.................................................................................................................
5
Metode dan Mekanisme Alih Teknologi/desiminasi dan atau Intervensi Sosial.................
7
Pemanfaatan Hasil ...............................................................................................................
8
Organisasi dan Personil Pelaksana Kegiatan .....................................................................
9
Pembahasan .........................................................................................................................
49
Keterbatasan Penelitian …………………………………………………………………...
50
Kesimpulan …………………………………………………………..................................
51
Saran …………………………………………………………………………………........
Jadwal Kegiatan ................................................................................................................
52
Indikator Keberhasilan ........................................................................................................
52
Daftar Pustaka ...................................................................................................................
53
Biodata Ketua dan Anggota ................................................................................................
57
51
RINGKASAN
Pemberlakuan tarif INA-CBG’s pada pembiayaan pasien stroke peserta
JKN di seluruh rumah sakit di Indonesia menuntut pihak rumah sakit untuk dapat
melakukan kendali mutu dan biaya perawatan seefisien mungkin. Penelitian ini
bertujuan untuk mengetahui rerata biaya riil pengobatan pasien stroke rawat inap
di RS PKU Muhammadiyah Yogyakarata dan perbedaanya dengan tarif INACBG’s berdasarkan Permenkes No. 69 Tahun 2013.
Penelitian dilakukan secara observasional dengan desain cross sectional.
Pengambilan data dilakukan secara retrospektif dengan subjek penelitian adalah
seluruh populasi pasien stroke rawat inap peserta JKN yang memenuhi kriteria
inklusi dan eksklusi penelitian yang terdaftar dari bulan Januari - Juni 2014. Data
penelitian berupa direct medical cost yang dianalisis kesesuaiannya dengan tarif
INA-CBG’s. Analisis data dilakukan dengan uji statistik t test.
Rerata biaya riil pasien rawat inap untuk kelas I dengan kode G-4-14-I
sebesar Rp. 6.175.260,- ± Rp. 3.641.107,-, G-4-15-I sebesar Rp.10.260.320,- ±
Rp.7.107.732,-, G-4-15-II sebesar Rp.7.692.475,- ± Rp.2.339.329,-, G-4-15-III
sebesar Rp.11.318.550,- ± Rp.9.457.199,-. Kelas II dengan kode G-4-13-I sebesar
Rp 8.078.200,-, G-4-14-I sebesar Rp 3.705.700,-, G-4-14-II sebesar Rp
3.719.950,- ± Rp 1.591.202,-, G-4-15-I sebesar Rp 3.957.000,-, G-4-15-II sebesar
Rp 6.095.950,- ± Rp 3.114.451,-. Kelas III dengan kode INA-CBG’s G-4-13-I
sebesar Rp 4.074.000,-, G-4-14-I sebesar Rp 1.881.600,- ± Rp 454.952,-, G-4-14II sebesar Rp 1.593.262,- ± Rp 666.908,-, G-4-15-I sebesar Rp 2.817.880,- ± Rp
1.240.742,-, G-4-15-II sebesar Rp 2.211.500,- ± Rp 1.223.001,-. Pada kelas I dan
II, secara statistik tidak terdapat perbedaan yang signifikan antara rerata biaya riil
dengan tarif INA-CBG’s. Pada kelas III terdapat perbedaan yang signifikan pada
kode G-4-14-II dan G-4-15-II, namun tidak terdapat perbedaan yang signifikan
pada kode G-4-14-I dan G-4-15-I. Dalam penelitian ini dapat disimpulkan tidak
terdapat perbedaan yang signifikan antara rerata biaya riil dengan tarif INACBG’s. RS PKU Muhammadiyah Yogyakarta telah mampu mengelola tarif INACBG’s penyakit stroke rawat inap yang ditetapkan oleh pemerintah.
Kata kunci : stroke, analisis biaya, INA-CBGs, Permenkes No. 69 Tahun 2013.
51
PENDAHULUAN
Dengan diberlakukannya Peraturan Presiden RI No.12 Tahun 2013 tentang
Jaminan Kesehatan yang diselenggarakan oleh Badan Penyelenggara Jaminan
Sosial Kesehatan (BPJS Kesehatan) dimana mulai 1 Januari 2014 semua
penduduk Indonesia akan memperoleh jaminan berupa perlindungan kesehatan
berupa manfaat pemeliharaan kesehatan dan perlindungan dalam memenuhi
kebutuhan dasar kesehatan, maka untuk pembayaran fasilitas kesehatan bagi
pasien rawat inap BPJS Kesehatan melakukan pembayaran berdasarkan
Indonesian Case Based Groups (INA-CBG’s). Dalam sistem INA-CBGs
komponen biaya yang ditanggung oleh pihak BPJS Kesehatan terdiri atas biaya
perawatan, penginapan, tindakan, obat-obatan, penggunaan alat kesehatan, dan
jasa yang dihitung terpadu dalam paket. Dengan demikian analisis biaya
pengobatan rawat inap sangat dibutuhkan dalam perencanaan pengobatan. Hasil
penelitian diharapkan dapat memberi gambaran mengenai kemampuan rumah
sakit dalam mengendalikan biaya pengobatan sesuai tarif pelayanan kesehatan
yang berlaku dalam penyelenggaraan program jaminan kesehatan 2014 serta dapat
dijadikan salah satu evaluasi pelaksanaan program jaminan kesehatan di
Indonesia.
Rumusan Masalah : Seperti apakah kesesuaian biaya riil pengobatan penyakit
stroke bagi pasien rawat inap di Rumah Sakit PKU Muhammadiyah Yogyakarta
dengan besarnya pembiayaan kesehatan berdasarkan Permenkes RI No 69 Tahun
2013 tentang Standar Tarif Pelayanan Kesehatan Pada Fasilitas Kesehatan
Tingkat Pertama dan Tingkat Lanjutan Dalam Penyelenggaraan Program Jaminan
Kesehatan?
Tujuan : Mengetahui apakah besarnya biaya riil pengobatan penyakit stroke bagi
pasien rawat inap di Rumah Sakit PKU Muhammadiyah Yogyakarta telah sesuai
dengan pembiayaan kesehatan berdasarkan Permenkes RI No 69 Tahun 2013
tentang Standar Tarif Pelayanan Kesehatan Pada Fasilitas Kesehatan Tingkat
51
Pertama dan Tingkat Lanjutan Dalam Penyelenggaraan Program Jaminan
Kesehatan.
Lokasi kegiatan : Rumah Sakit PKU Muhammadiyah Yogyakarta dan Program
Studi Farmasi FKIK UMY.
KELAYAKAN TEKNIS
Beragam guideline pengobatan penyakit stroke menyebabkan beragam
pula jumlah biaya yang harus dibayar oleh penderita atau keluarga penderita atau
pihak BPJS Kesehatan. Bila penanganan atau pemilihan obat tidak tepat maka
dapat menyebabkan waktu tinggal di rumah sakit menjadi lebih lama atau
terjadinya komplikasi yang lain yang pada akhirnya akan terjadi pembengkakan
biaya. Besarnya biaya pengobatan selain dipengaruhi oleh jenis terapi obat yang
digunakan juga dipengaruhi oleh jenis tindakan yang diberikan tenaga medis,
keahlian tim medis dalam mendiagnosis secara cepat dan tepat, serta kepatuhan
tenaga medis terhadap clinical pathway yang telah ditetapkan rumah sakit
sebelumnya. Dalam sistem INA-CBGs komponen biaya yang ditanggung oleh
pihak asuransi kesehatan terdiri atas biaya perawatan, penginapan, tindakan, obatobatan, penggunaan alat kesehatan, dan jasa yang dihitung terpadu dalam paket.
Dengan diberlakukannya INA-CBGs pada pembiayaan rumah sakit, maka analisis
biaya pengobatan rawat inap sangat dibutuhkan dalam perencanaan pengobatan
sehingga rumah sakit dapat melakukan penghematan biaya agar rumah sakit tidak
merugi. Analisis biaya tersebut selain berguna dalam hal mengajukan klaim
kepada pihak asuransi kesehatan juga dapat digunakan dalam memberikan
pengobatan yang tepat bagi pasien berdasarkan data biaya pengobatan.
Penelitian dilakukan dengan tahapan sebagai berikut :
1. Tahap persiapan
Tahapan ini meliputi pengurusan ijin serta persiapan lembar pencatatan
data pasien dan lembar pencatatan biaya pengobatan stroke.
2. Tahap pelaksanaan
51
Pelaksanaan penelitian dilakukan dalam bentuk kegiatan :
a. Review rekam medik di rumah sakit untuk mendapatkan data
karakteristik demografi yang meliputi nama pasien, nomor rekam
medik, usia, jenis kelamin pasien; lama dirawat di rumah sakit (tanggal
dan jam masuk-keluar rumah sakit), tanggal dan jam serangan, faktor
resiko, catatan penggunaan obat, catatan keperawatan, hasil uji
laboratorium yang telah dilakukan, dan hasil terapi yang diukur dari
indek barthel. Semua data tersebut dicatat dalam lembar pencatatan
data pasien.
b. Penelusuran biaya terapi pasien stroke berdasarkan data rekam medis
pasien. Biaya penggunaan obat dan alat kesehatan ditelusuri dari
instalasi farmasi rumah sakit, sedangkan tarif biaya tindakan medis,
biaya perawatan, biaya pemeriksaan penunjang (biaya laboratorium,
fisioterapi, dan gizi), biaya administrasi, biaya penunggu pasien dan
sewa ruangan, biaya kartu berobat, dan biaya karcis ditelusuri dari
bagian administrasi keuangan.
3. Tahap pengolahan dan analisis data
Data dari rekam medis pasien dan data dari penelusuran biaya pengobatan
pasien setelah terkumpul akan dilakukan pengolahan dan analisis data
sesuai metode analisis yang digunakan.
Penelitian ini akan dilakukan berkesinambungan dengan melibatkan
beberapa rumah sakit yang mengikuti program Jaminan Kesehatan
Nasional (JKN) dan meneliti penyakit yang lebih luas. Hasilnya
diharapkan dapat dijadikan sebagai salah satu evaluasi pelaksanaan
program jaminan kesehatan di Indonesia.
Mitra Industri/lembaga pemerintah/badan litbang : RS PKU Muhammadiyah
Yogyakarta dan BPJS Kesehatan (PT.Askes Persero).
51
METODE DAN MEKANISME ALIH TEKNOLOGI/DISEMINASI DAN
ATAU INTERVENSI SOSIAL
Penelitian ini merupakan penelitian observasional dengan rancangan
penelitian cross sectional menurut perspektif rumah sakit. Metode pengambilan
data secara retrospektif. Subyek penelitian yang digunakan adalah seluruh
populasi pasien rawat inap peserta JKN di Rumah Sakit PKU Muhammadiyah
Yogjakarta yang menderita penyakit stroke dari bulan Januari - Juni 2014 yang
memenuhi kriteria inklusi penelitian dan telah dikelompokkan berdasarkan INACBGs. Analisis data dilakukan dengan uji statistik MannWhitney.
Hasil
penelitian diharapkan dapat
memberi
gambaran
mengenai
kemampuan rumah sakit dalam mengendalikan biaya pengobatan sesuai tarif
pelayanan kesehatan yang berlaku dalam penyelenggaraan program jaminan
kesehatan 2014 serta dapat dijadikan acuan bagi BPJS Kesehatan dalam
mengambil kebijakan.
PEMANFAATAN HASIL
Strategi Pemanfaatan Hasil Kegiatan :
1. Hasil penelitian akan diterbitkan pada jurnal ilmiah dan dipresentasikan di
forum-forum ilmiah.
2. Hasil penelitian akan diberikan kepada rumah sakit terkait dan BPJS
kesehatan.
Intervensi sosial yang dapat memperbaiki karakter bangsa : Hasil
penelitian diharapkan dapat bermanfaat bagi rumah sakit dengan memberi
gambaran mengenai kemampuan rumah sakit dalam mengendalikan biaya
pengobatan sesuai tarif pelayanan kesehatan yang berlaku dalam penyelenggaraan
program jaminan kesehatan 2014 serta dapat dijadikan acuan bagi BPJS
Kesehatan dalam mengambil kebijakan.
Manfaat jangka panjang dapat dirasakan oleh masyarakat : berupa
pelayanan kesehatan yang baik dan berkualitas.
51
STRATEGI
PELEMBAGAAN
INDUSTRIALISASI
KE
ARAH
KARAKTER BANGSA
(tidak ada )
ORGANISASI DAN PERSONIL PELAKSANA KEGIATAN
TABEL 1. Organisasi dan Profil
Ingenida
Bangunawati
Indriastuti
Pinasti Utami
Hadning
Rahajeng
Cahyaningsih
Gelar
M.Sc., Apt
M.Si., Apt
M.Sc., Apt
M.Sc., Apt
Jenis Kelamin
Wanita
Wanita
Wanita
Wanita
Unit Kerja
Farmasi
Farmasi
Farmasi
Farmasi
Bidang
Manajemen
Farmasi
Farmasi
Farmasi
Keahlian/Tugas Farmasi/Ketua Klinik/Peneliti Klinik/Peneliti Klinik/Peneliti
Peneliti
Pendidikan
S2
S2
S2
S2
16 jam/mgg
16 jam/mgg
16 jam/mgg
16 jam/mgg
terakhir
Alokasi waktu
PEMBAHASAN
Stroke Patient Characteristic at Jogja Hospital
During January – June 2014 there were 49 stroke patients at PKU
Muhammadiyah Yogyakarta Hospital who fulfilled the inclusion criteria. There
were 2 patients with code I619 (Intra-cerebral Hemorrhage), 20 patients with code
I639 (Cerebral Infarction), and 27 patients with code I64 (Unspecified Stroke).
Stroke patient characteristic can be seen on the table 1 as below.
Table 1. Stroke Patient Characteristic with JKN membership at PKU
Muhammadiyah Yogyakarta Hospital during January – June 2014
51
Characteristics
Intra-cerebral
Hemorrhage (I619)
(n=2)
%
Cerebral Infarction
(I639)
(n=20)
%
Unspecified Stroke
(I64)
(n=27)
%
Sex:
Male
Female
Age :
≤ 55 years of
age
> 55 years of
age
1
1
50
50
14
6
70
30
19
8
70
30
0
0
4
13
3
7
2
100
9
27
13
30
Most of stroke patient with diagnosis code of I619 (Intra-cerebral
Hemorrhage), I639 (Cerebral Infarction), and I64 (Unspecified Stroke) were aged
55. It might be due to the risk of stroke will increase 2 times after age 55 [11]. At
the elderly group, the risk of hypertension increases because the blood vessels
become more rigid and less elastic [12], whereas the hypertension is the most
important risk factor of stroke [13] [14]. According to the result of stroke patient’s
case study with cerebral infarction (I639) and non-specific stroke cases (I64), it
has been known that male has higher stroke prevalence than female (70% and
30%). According to [4], men have higher risk to get stroke compared to women in
the same age. It is caused by women’s hormones that have protective roles toward
the diseases related to blood artery [15]. Furthermore, man also have higher
potential to get stroke because of their life style like smoking, staying up to work,
and high rate of stress [16].
One of the factors affecting the length of stay in acute ischemic stroke
patients was age of 65 years or more [17]. Another study stated an increase of
length of stay in diabetic patients with the age of 60 years or more, and a decrease
of length of stay in female patients [18].
Costs Analysis Based on INA-CBGs
The amount of INA-CBGs costs decided by the government varies for each
diagnosis coding and is affected by the disease severity. While diagnosis code is
determined by hospital’s coding officer, INA-CBGs code and the disease severity
was calculated by INA-CBGs owned by JKN central management. INA-CBGs
code determination is done on concordance with the primary diagnosis code,
secondary diagnosis code, medical procedures, and length of stay. Those variables
51
are input by hospital coding officer along with Jamkesmas reporting in each day
through hospital-owned INA CBGs software [19] [20] [21]. The average cost of
patient care based on the average length of stay can be seen on Table 2 as below.
Class
I
II
III
Tabel 2. The average cost of patient care based on the average length of stay with
JKN membership at PKU Muhammadiyah Yogyakarta Hospital
during January 2014 – June 2014
Intra-cerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage (I619)
Real
Length of Stay
Length of Stay
Length of Stay
Cost
P
P
P
<
≥
≥7
≥8
< 7 Days
< 8 Days
Days
Days
Days
Days
Mean
2.753.750, 9.698.2
5.546.160, 13.030.
(Rp)
00
00,00 0,18
00
550,00 0,0
7
DS
5.064.9
1.898.157, 5.786.6 08
66.680,17
(Rp)
78,15
31
43,19
≥5
≥7
8 Days - Days
< 5 Days
< 7 Days
Days
Days
Mean
8.078.2
4.275.4
3,893,7
6,695,600
6.127.600
0,3
(Rp)
00
00
00
0,00
33
DS
805.67 5
0
3.069.691
(Rp)
7
12
≥5
≥5
- Days
< 5 Days
< 5 Days
Days
Days
Days
4.074.0
1.252.225 1.916.7
1.375.275 1.920.0
Mean
00
33
33
0,02
0,0
(Rp)
5
00
217.174
671.13
512.371
1.138.1
DS
0
3
74
(Rp)
The relation between the length of stay and treatment cost was analysed using
Pearson and Spearman correlation test. Based on bivariat corelation analysis
stroke with diagnose code I639 (Cerebral Infarction) with p value is 0,05 for class I (0,187), and diagnose code
I64 (Unspecified Stroke) with p value is 0,05 for class II (0,333). Those diagnose codes have positive correlation
coefficient, and it can be concluded that there is a positive correlation between the
length of stay and treatment cost which means the longer the patient stay the
higher treatment cost would be [9] [17] [22].
Details of the average treatment cost of stroke patients consisted of direct
51
medical
and non-medical costs as seen in Table 3. The greatest components of stroke
treatment cost from all the diagnostic codes and all class for direct medical cost
were medicine cost and medical equipment cost (Rp 859.333 to Rp 5.829.066),
visite fee (Rp 210.000 to Rp 1.517.000), and electro medic and radiology
diagnostic cost (Rp 139.800 to Rp 1.333.860), and the greatest component of
direct non medical cost were room cost (Rp 150.000 to Rp 2.907.500).
Cost
Variable
Visit fee
Electromedi
c & Radio
Diagnostic
Laboratory
analysis
Rehabilitatio
n medic
Nursing
Medicine,
medical eq
Table 3. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class I with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage
(I619)
Real cost
Real cost (Rp.)
Real cost (Rp.)
<
≥ Days
≤ 7 Days
> 7 Days
≤ 7 Days
>7 Days
Days
Mea
Mea
Mean
Mean
Mean
Mean
% n
%
%
%
%
%
n
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
586.666
1.275.75
1.517.83
11,7
13,6 614.000 11,3
11,7
±
0±
3±
3
9
±189156
5
3
318.682
632.652
1517833
1.333.86
873.700
580.675
17,4
409.540
10,3
0
6,23
7,57
±
±
6
± 326971
1
±113758
104.228
137.331
1
388.975
763.660
906.133
324.100
14,1
±
±
±105916
6,48
4,17
7
± 164209
1
207.269
1172636
1
60.666 ±
110.250
409.540
223.666
1,21
1,18
1,38
1,73
105.077
± 83.683
± 81309
±195535
132.250
50.000 ±
72.000 ±
117.166
±
1
1,42
1,33
0,91
19.000
18096
±82176
133.315
1.956.36 39,1 5.149.47 55,2 2.119.52 39,1 5.829.06 45,0
6±
0
5±
6
0±
7
6
4
51
2.497.17
7
Nutrition
Room
Administrati
on
Total
5.013.34
2
4.375 ±
0
0
0,05
8.750
Direct Non Medical Cost
16,5
1.046.66
1.545.62
9
20,9
6±
5±
2
761.090
617.124
1170054
105.000
± 22.516
5.003.16
4
85.640 ±
20526
5.411.56
0
2,1
100
131.375
± 72.269
9.318.75
0
1,41
100
0
1.272.40
0±
635182
±291631
4
0
23,5
1
1,58
100
0
2.907.50
0
±137832
4
106.573
± 22847
12.941.7
97
0
22,4
7
0,82
100
Table 4. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class II with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Hemorrhage
Cerebral Infarction (I639)
Unspecified Stroke (I64)
(I619)
Cost
Real cost
Real cost (Rp.)
Real cost (Rp.)
Variable
8 Days
< 5 Days
≥ 5 Days
< 7 Days
≥ 7 Days
Mean
Mean
Mean
Mean
Mean
%
%
%
%
%
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
607.500
11, 617.500 14,
11,
±
Visit fee
775,000 9.6 795,000
9,9 435,000
8
± 81.317
4
2
357.088
Electromedi
472.500
714.800 11,
12,
c & Rad
591,800 7,3 139,800 2,1
480,000
± 10.606 11
± 42.426
7
3
Diagnostic
741.800
Laboratory
17, 628.500 10,
±
73,000
0,9 324,000 4,8
73,000
1,9
analysis
3
± 3.535
3
636.961
100.000
Rehabilitatio
89.000 ±
±
280,000 3,5
0
0
2,3
1,5
0
0
n medic
12.727
141.421
Nursing
136,000 1,7 113,000 1,7 75.500 ± 1,8 101.500 1,7
68,000
1,7
51
Medicine,
medical eq
Nutrition
Room
Administrati
on
Total
4,145,40
0
51,
3
0
0
2,000,00
0
24,
8
77,000
0,9
8.078.20
0
10
0
17.677
1.314.10
0±
4,332,30 64,
30,
1.234.04
0
7
7
2
6.250 ± 0,1
0
0
8.838
5
Direct Non Medical Cost
862.500 21,
13,
900,000
±
2
4
159.099
85.250 ±
2
91,500
1,4
8.838
6.695.60 10 4.275.40 10
0
0
0
0
± 19.091
2.575.75
0±
2.002.59
7
0
1.332.50
0±
696.500
78.050 ±
19.021
6.127.60
0
41,
8
42
1,626,10
0
0
0
0
21,
7
1,120,00
0
28,
8
1,3
91,600
10
0
3.893.70
0
2,4
10
0
Table 5. Details of Direct Medical and Non-Medical Cost Stroke Patient Treatment
class III with JKN Membership at PKU Muhammadiyah Yogyakarta Hospital
Intracerebral
Cerebral Infarction (I639)
Unspecified Stroke (I64)
Hemorrhage
(I619)
Cost
Real cost
Real cost (Rp.)
Real cost (Rp.)
Variable
Days
< 5 Days
≥ 5 Days
< 5 Days
≥ 5 Days
Mean
Mean
Mean
Mean
Mean
%
%
%
%
%
(Rp)
(Rp)
(Rp)
(Rp)
(Rp)
Direct Medical Cost
387.500
18. 210.000± 16,
20, 272.500± 19, 702.833±
Visit fee
775,000
24
±
5
75.608
8
2
96.393
8
277929
229.820
Electromedi
537.600
11.
42, 389.533±
380.450± 27, 437.044±
465.000
15
c & Rad
±
20,
4
9
259.984
189.628
7
281.118
48.400
Diagnostic
3
Laboratory
74.000 ±
180.500±
153.000± 11, 266.011±
193.000 4.7
5,9
9,4
9,1
analysis
2.000
112.690
71.498
1
173.553
Rehabilitatio
20.000 ±
66.666 ±
10.000±
75.555±
240.000 5.8
1,6
3,5
0,7
2,6
n medic
40.000
74.475
20.000
67.659
Nursing
110.000 2.7 14.000 ± 1,1 48.750 ± 2,5 25.500± 1,9 70.277±3 2,4
51
Medicine,
medical eq
Nutrition
Room
Administrati
on
Total
1.409.00
0
0
34.
6
0
825.000
20.
3
77.000
1.9
4.074.00
0
10
0
19.339
22.044
173.500 13, 429.783± 22,
± 89.302
9
218.512
4
0
0
Direct Non Medical Cost
150.000
337.500± 17,
12
± 61.237
155.523
6
73.125 ±
76.500 ±
4
5,8
7.750
1.224
1.252.22 10 1.916.73 10
5
0
2
0
16.114
270.050±
222.917
0
187.500±
43.301
76.275±
1.517
1.375.27
5
19,
6
0
13,
6
5,5
10
0
3.155
859.333± 29,
749.244 4
0
0
433.333± 14,
97.628
8
75.644± 2,6
4.179
2.920.03 10
0
0
The costs of medicine and medical equipment, visite fee, and electromedic and
radiology diagnostic cost were affected by the accuracy of diagnosis, treatment
selection, and stroke comorbidities factors [9] [17] [22] [23]. Those factors then
will directly affect the patient’s length of stay and treatment cost as seen on Table
2.
Other studies have concluded that the length of stay for ischemic stroke patient
in Sardjito Hospital was affected by stroke severity [9]. The difference in length
of stay of general disease was affected by the disease severity and comorbid factor
such as myocardial infarction and congestive heart failure [22] [24] [25] [26].
Some factors that might lengthen the hospitalization of acute ischemic stroke
patients were diabetes mellitus, atrial fibrillation, type of stroke, stroke treatment,
and stroke relaps [17].
The stroke therapy costs for all diagnose codes at PKU Muhammadiyah
Yogyakarta Hospital are not only affected by the type and number of drugs used
but also affected by other additional medications to treat the stroke comorbid
factors. The more type of drugs used for stroke treatment the higher the treatment
cost should be. Moreover, the more comorbid factors the higher the treatment
cost should be as well [9] [17] [22] [23].
As seen on Table 6, the most common comorbid factor in stroke, in diagnosis
code of I619, I639, and I64 was hypertension (50%, 67%, and 54%). It was
consistent with the theory stating hypertension were the most common comorbid
factors in ischemic stroke as well as in hemorrhagic stroke [4] [9] [25] [27].
51
Table 6. Stroke comorbid factors of Jamkesmas membership at PKU
Muhammadiyah Yogyakarta hospital during January–June 2014
Intracerebral
Cerebral
Unspecified
Hemorrhage (I619) Infarction (I639)
Stroke (I64)
Comorbid
Factors
(n=
(n=2 )
%
(n=21)
%
%
28)
Hypertension
1
50
14
67
15
54
Diabetes
4
19
6
21
Mellitus
Dyslipidemia
2
10
3
11
Sepsis
0
0
0
0
Vertigo/migrain
1
5
Cardiac
3
14
3
11
problem
Depression
Seizure
Hypertension might cause intracranial vessel rupture or become stenotic. The
ruptur vessel will cause intracranial haemorrhage, but when the the vessel become
stenotic it might disturb intracranial blood flow and, eventually, brain cellular
death. Moreover, the rise in blood pressure might faster the plaque formation
process, endothelial layer damage, and finally plaque would be prone to rupture
and causes thrombus. Thrombus then will occlude blood vessel locally, or become
emboly in blood stream into cerebrovascular system [12].
One sample t test result were used to find any significant discrepancy between
real stroke treatment coast and the amount of INA-CBGs cost when t-test were
not available due to abnormally distributed data. The analysis results can be seen
in Table 7.
51
Class
I
Table 7. Correlation Between Real Cost and INA-CBGs Cost
Tarif INABiaya Riil
Kode
Kode INACBG’s
Diagnostik
CBG’s
Mean
SD
Mean
SD
I639
G-4-14-I
6.175.260
3.641.107 5.158.795 0
164
G-4-15-I
10.260.320
7.107.732 4.021.093 0
164
G-4-15-II
7.692.475
2.339.329 4.799.193 0
164
G-4-15-III
11.318.550
9.457.199 6.851.464 0
II
I639
I64
III
I619
I639
I639
I64
I64
G-4-14-II
G-4-15-II
G-4-13-I
G-4-14-I
G-4-14-II
G-4-15-I
G-4-15-II
5.770.350
6.095.950
4.074.000
1.881.600
1.593.262
2.817.880
2.211.500
1.308.501
3.114.451
7.996.295
4.113.594
454.952
666.908
1.240.742
1.223.001
2.705.047
3.684.853
6.663.579
2.872.209
3.427.995
0
0
0
0
0
0
0
Sig.
0,566
0,121
0,090
0,625
0.180
0.655
0,180
0,000
0,500
0,026
The amount of real stroke treatment cost at PKU Muhammadiyah Yogyakarta
Hospital for diagnosis code of I639 and I64 in class I were averagely higher than
the amount of INA-CBGs cost for the same diagnosis code and the same class. In
class II the amount of real stroke treatment cost for diagnosis code of I639 were
were averagely lower than the amount of INA-CBGs cost, while it was higher for
diagnosis code of I64 for real stroke treatment. In class III the amount of real
stroke treatment cost for diagnosis code of I619 were higher than the amount of
INA-CBGs while it was lower for diagnosis code of I639 and I64 for real stroke
treatment cost. Moreover, One Sample t test analysis for class I diagnose code
I639 and I64 with p value was > 0.05, class II diagnose code I639 and I64 with p
value was > 0.05, and class III diagnose code I639 (G-4-14-I) and I64 (G-4-15-I)
with p value was > 0.05. That meant there was an insignificant discrepancies
between real stroke treatment cost and the corresponding INA-CBG’s cost. In the
other side One Sample t test analysis for class III diagnose code I639 (G-4-14-II)
and I64 (G-4-15-II) with p value was < 0.05, that meant there was a significant
discrepancies between real stroke treatment cost and the corresponding INACBG’s cost. According to the aforementioned analysis it was concluded that the
hospital was adequately capable of doing rate management determined by INACBGs. By doing so, the hospital did not have to bear too many cost deficits [9].
As seen on table 8 and 9 there are some losses need to be covered by PKU
Muhammadiyah Yogyakarta during 6 months of the study (January 2015 – June
51
2015) for all stroke diagnosis codes and severity class I and II as much as Rp
59.104.642 and Rp 2.882.777. The cost deficits might actually be anticipated if its
causes and solutions were known before. One of its possible causes were branded
medicine prescribing that might actually be substituted with generic medicine
eventhough some of the prescribing has already used generic medicine [9].
Table 8. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke class I
at PKU Muhammadiyah Yogyakarta Hospital during January-June 2014
Total Tarif
Kode
Kode INA- Jumlah Total Biaya Riil
INA-CBG’s
Diagnosis
CBG’s
Pasien
(Rp.)
(Rp.)
I639
G-4-14-I
6
30.876.300,00 25.793.975,00
I639
G-4-14-II
1
5.587.000,00
9.329.010,00
I639
G-4-14-III
1
17.726.200,00 11.665.308,00
I64
G-4-15-I
5
51.301.600,00 20.105.465,00
I64
G-4-15-II
5
30.769.900,00 19.196.772,00
I64
G-4-15-III
2
22.637.100,00 13.702.928,00
Total
158.898.100,00 99.793.458,00
Kerugian
59.104.642,00
Table 9. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke
class II at PKU Muhammadiyah Yogyakarta Hospital
during January-June 2014
Total Tarif
Kode
Kode INA- Jumlah Total Biaya Riil
INA-CBG’s
Diagnosis
CBG’s
Pasien
(Rp.)
(Rp.)
I629
G-4-13-II
1
8.078.200,00
4,502,470.00
I639
G-4-14-I
1
3.705.700.00
4,421,824.00
I639
G-4-14-II
2
11.540.700,00 15.992.590,00
I64
G-4-15-I
1
3.957.000,00
3.446.651,00
I64
G-4-15-II
2
12.191.900,00
8.227.188,00
Total
39.473.500,00 36.590.723,00
Kerugian
2.882.777,00
51
Table 10. Total Real Cost and INA-CBGs Rate for JKN Membership with Stroke
class III at PKU Muhammadiyah Yogyakarta Hospital
during January-June 2014
Kode
Kode INAJumlah
Total Biaya Riil
Total Tarif INADiagnosa
CBG’s
Pasien
(Rp)
CBG’s (Rp)
I629
G-4-13-I
1
4.074.000
2.705.047
I639
G-4-14-I
2
3.763.200
7.369.706
I639
G-4-14-II
8
12.746.100
53.308.632
I64
G-4-15-I
5
14.089.400
14.361.045
I64
G-4-15-II
8
17.692.000
27.423.960
Total
52.364.700
105.168.390
Selisih
Rp 52.803.690,The government-determined INA-CBGs code very depended with the
diagnosis code reported by hospital coding officers, thus diagnosis writing
accuracy and medical procedure writing completeness became the primary
factors due to the discrepancy of INA-CBGs rate for every code and severity
level determined by primary and secondary diagnosis and the medical
procedures [9] [19] [21] [28]. This rate difference became the main problem
in coding process. Management of PKU Muhammadiyah Yogyakarta
Hospital had to socialize to doctors regarding the coding process and the
importance of correct and detailed diagnosis writing that might cause
inaccurate rate deciding. Thus, solving this problem might be a step to
prevent hospital loss.
Based on the above discussion, there are some important factors to be
concerned for managing JKN rate effectively: the accuracy of diagnosis,
treatment decision and nursing care for the stroke’s treatment and also its
comorbid factors. They are also important issues to avoid hospital’s financial
loss. Hospital management is expected to demonstrate those important issues
to their medical staffs and paramedics to reach the same level of
understanding and commitment in the medical team at PKU Muhammadiyah
Yogyakarta Hospital.
KETERBATASAN PENELITIAN
Keterbatasan dari penelitian ini adalah
a. Penelitian ini dilakukan secara restrospektif menggunakan data rekam
medis pasien sehingga tidak diketahui secara pasti keadaan pasien yang
51
sebenarnya dan hanya bisa melihat dari data yang tertulis dalam rekam
medis.
b. Klasifikasi severity dan biaya penggantian pengobatan penyakit stroke
dalam sistem komputasi BPJS yang belum diketahui secara pasti.
KESIMPULAN DAN SARAN
1.
Kesimpulan
Tidak ada perbedaan signifikan antara rata-rata biaya riil terapi stroke dengan
pembiayaan kesehatan berdasarkan Permenkes Nomor 69 Tahun 2013,
sehingga rumah sakit mampu mengelola pembiayaan terapi dengan optimal.
2.
Saran
a. Perlu dilakukan penelitian lebih lama untuk mendapatkan jumlah sampel
yang lebih banyak sehingga data yang diuji dapat lebih valid.
b. Penelitian ini perlu dilakukan juga terhadap rumah sakit lain sehingga
data yang didapatkan akan berguna bagi pemerintah sebagai bahan
evaluasi terhadap kebijakan BPJS Kesehatan.
51
JADWAL KEGIATAN
No
Kegiatan
Bulan
I
1
II
III
IV
V
VI
√
√
√
√
√
√
√
√
VII
VIII
Tahap Persiapan
a. Pengurusan ijin
√
b. Persiapan lembar pencatatan
√
biaya pengobatan pasien
2
Tahap Pelaksanaan
a. Penelusuran biaya penggunaan
obat dan alat kesehatan dari
instalasi farmasi rumah sakit
b. Penelusuran
biaya
tindakan
√
medis, perawatan, pemeriksaan
penunjang, administrasidan sewa
ruangan dari bagian administrasi
keuangan
3
Tahap Penyelesaian
a. Rekapitulasi data penelitian
√
b. Pengolahan dan analisis data
√
c. Penyusunan laporan akhir
√
d. Pengumpulan laporan akhir
√
51
INDIKATOR KEBERHASILAN
Tuliskan indikator keberhasilan penelitian mengikuti tabel sebagai berikut :
Capaian yang Ditargetkan*
No.
Jenis Luaran
Tahun I
Tahun II
Tahun III
1
Pelayanan jasa (status:
pengembangan, uji coba,
penerapan, evaluasi)
Kerja sama (status: penjajakan,
pelaksanaan, evaluasi kerja sama)
Analisis data
Evaluasi hasil
penelitian
RS terkait
& BPJS
RS terkait
& BPJS
Masukan bagi
rumah sakit dan
BPJS
RS terkait
& BPJS
2
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