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Mengapa penelitian ini penting di teliti
a.
Tata kelola INA DRGS belum ada kesesuaian
pendapat
departemen
kesehatan dan
lembaga perguruan tinggi
Indonesia
b.
Metode INA DRGs belum dikelola dengan sistematis
c.
Pedoman pembayaran INA DRGs di rumah sakit baik
tingkat provinsi,
kabupaten dan kota tidak
mengikuti
metode
sistem prosedur SOP di RS
d.
Belum ada metode dari Kementerian Kesehatan yang
cocok untuk penerapan pembayaran INA DRGs
e.
Bagaimana implikasi sistem kesehatan pembayaran INA
DRGs di dalam mutu pelayanan di rs
Tujuan Penelitian
Mengetahui sistem kesehatan berdasarkan Clinical
pathway, case mix, INA DRGs apakah sudah berjalan sesuai yang
diharapakan oleh pengambil kebijakan dan kesehatan di
Indoinesia.
Mengetahui apakah laporan sistem kesehatan Nasional pusat
dan daerah tentang jaminan kesehatan nasioanal didukung oleh
hasil penelitian yang dilakukan oleh lembaga penelitian atau
perguruan tinggi di Indonesia.
Mengetahui metode yang tepat digunakan aplikasi sistem
kesehatan clinical pathway,case mix dan INA DRGs di Indonesia.
Mengetahui berapa besar pembiayan bedah sesar per pasien
berdasarkan clinical pathway,case mix dan INA DRGs
Bagaimana implikasi kebijakan pembiayaan tentang jaminan
kesehatan nasional dan daerah ( JAMKESMAS) berdasarkan
Keputusan Menteri Kesehatan No.989 / MENKES / SK / IX / 2007
tentang perubahan INA DRGs dalam bentuk paket pelayanan
kesehatan per pasien di rumah sakit.
Manfaat Penelitian
Hasil yang diharapkan dari penelitian ini bahwa Metode
Metode Penelitian
Rancangan / desain penelitian
Analisa Data
Analisis data yang digunakan di dalam penelitian
14
Gender Conflict
96 OZ
962 Z
Unacceptable
Obstetric DX
(Caesarean delivery)
Unacceptable obstetric
DX(Caesarean Delivery)
Caesarean Delivery
962 Z
Severe
Complicati
n Dx
Multiple
Complcating DX
Oo1B
Multiple
complicating
DX
Sumber: Australian
Refined Diagnosis Related
Groups versi 4.1
Definition manual,volume
Oo1A
Oo1Cc
Oo1D
CLINICAL PATHWAY
EMERGENCY
NON KOMPLIKASI
No
Diagnosa DRG's
Penyulit + Penyerta
BAYI PREMATUR
BAYI BBLR
Persentase (N)%
1
Bekas SC + Daibetes
14.3
Bekas SC + Asma
6.7
Bekas SC + Hipertensi
13.3
13.3
6.7
6.7
Eclamsia + Hipartensi
26.7
13.3
Penyulit + Penyerta
TOTAL SAMPEL
KOMPLIKASI
Total Sampel
15
101.0
BAYI ASFIKSA
%
N
2
N
2
13.33
25
6.67
25
13.33
13.33
14.29
6.67
14.29
6.67
28.57
26.67
13.33
14.29
14.29
2.0
100
100
50
28.57
100.0
2.0
100.0
100.0
15.0
100.0
2
Penyulit Komplikasi Berat
Eclamsia
10
11.11
9.09
Pre-Eclamsia Berat
50
55.56
45.45
Plasenta Previa
30
33.33
27.27
100
Solusio Plasenta
10
10
100
11.1
Ruptura Uteri
44.4
Bekas SC
Komplikasi Sedang
Penyulit
100
100
100
18.18
11
100
11.1
11.11
44.4
44.44
44.4
44.4
44.44
100
100
100
62.5
62.5
62.5
37.5
37.5
37.5
100
100
100
3
Penyulit Komplikasi Sedang
O01C
Caesarean with Moderate
Complicating Diagnosis)
4
Tanpa Komplikasi
O01D
(
Caesarean with out complicating
diagnosis)
Biaya Telpon
Dasar Alokasi
Biaya ATK
Dasar Alokasi
Dasar Alokasi
Jumlah Pembicaraan/hari
Biaya Pemeliharaan
Dasar Alokasi
Jumlah Rim
Kertas/bulan
Penyusutan Gedung
Dasar Alokasi
Dasar Alokasi
Luas (m2)
Luas (m2)
1 Kamar Bersalin
1500
13,296,454.43
30
4,058,729.79
1,162,781.85
100.00
27,253,608.25
600
12,833,022.25
600
3,000,000.00
2 Perawatan Bayi
3000
26,592,908.87
676,454.97
1,162,781.85
60.00
16,352,164.95
940
20,105,068.20
940
4,700,000.00
3 Farmasi
1100
9,750,733.25
20
2,705,819.86
775,187.90
20.00
5,450,721.65
58
1,240,525.48
58
290,000.00
4 Laboratorium
1500
13,296,454.43
20
2,705,819.86
1,937,969.75
60.00
16,352,164.95
480
10,266,417.80
480
2,400,000.00
5 Rekam medis
750
6,648,227.22
15
2,029,364.90
15
5,813,909.24
800
17,110,696.34
800
4,000,000.00
6 ICU
1200
10,637,163.55
30
4,058,729.79
1,937,969.75
25.00
6,813,402.06
1,000
21,388,370.42
1,000
5,000,000.00
7 Bedah Sentral
5000
44,321,514.78
35
4,735,184.76
1,937,969.75
75.00
20,440,206.19
680
14,544,091.89
680
3,400,000.00
8 Front Office
500
4,432,151.48
25
3,382,274.83
20
7,751,878.98
100.00
27,253,608.25
940
20,105,068.20
940
4,700,000.00
9 Keuangan
750
6,648,227.22
10
1,352,909.93
25
9,689,848.73
30.00
8,176,082.47
50
1,069,418.52
50
250,000.00
10 Administrasi
750
6,648,227.22
25
3,382,274.83
35
13,565,788.22
50.00
13,626,804.12
50
1,069,418.52
50
250,000.00
11 Rumah Tangga
400
3,545,721.18
10
1,352,909.93
775,187.90
5.00
1,362,680.41
75
1,604,127.78
75
375,000.00
12 Dapur Umum
500
4,432,151.48
15
2,029,364.90
387,593.95
500.00
136,268,041.24
500
10,694,185.21
500
2,500,000.00
13 laundry
750
6,648,227.22
947,036.95
387,593.95
750.00
204,402,061.86
382
8,170,357.50
382
1,910,000.00
14 House Keeping
450
3,988,936.33
676,454.97
387,593.95
100.00
27,253,608.25
75
1,604,127.78
75
375,000.00
15 Perlengkapan
300
2,659,290.89
676,454.97
25
9,689,848.73
50.00
13,626,804.12
35
748,592.96
35
175,000.00
16 Direktur Utama
200
1,772,860.59
10
1,352,909.93
775,187.90
5.00
1,362,680.41
100
2,138,837.04
100
500,000.00
150
1,329,645.44
10
1,352,909.93
775,187.90
5.00
1,362,680.41
100
2,138,837.04
100
500,000.00
150
1,329,645.44
10
1,352,909.93
1,937,969.75
5.00
1,362,680.41
100
2,138,837.04
100
500,000.00
287
38,828,515.00
157
60,852,250.00
1,940.00
528,720,000.00
6,965
148,970,000.00
6,965
34,825,000.00
TOTAL
18950 167,978,541.00
1,162,781.85
1 Kamar Bersalin
13,296,454.43
2 Jumlah sampel
62.00
62.00
62.00
62.00
62.00
62.00
214,458.94
65,463.38
18,754.55
439,574.33
206,984.23
48,387.10
4,058,729.79
27,253,608.25
12,833,022.25
3,000,000.00
(2)
Biaya Honor
BMHP
Lab
Gizi
Gizi Bayi
(7)
(8)
Laundry
(9)
Peralatan
Peralatan
Penyusutan
Medis
Non Medis
Gedung
(10)
(11)
(12)
Listrik
(3)
(4)
(6)
(13)
183,274.24
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,940.11
1,118,927.04
54,124.95
133,491.91
74,999.10 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
176,293.60
1,118,927.04
54,124.95
133,491.91
25,997.73 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
183,274.24
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
176,293.60
1,118,927.04
54,124.95
133,491.91
25,997.73 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
182,582.37
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,940.11
1,118,927.04
54,124.95
133,491.91
74,999.10 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
176,148.44
1,118,927.04
54,124.95
133,491.91
25,997.73 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
176,148.44
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
176,148.44
1,118,927.04
54,124.95
133,491.91
25,997.73 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
251,096.82
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,330.69
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,330.69
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,330.69
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,330.69
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
174,330.69
1,118,927.04
54,124.95
133,491.91
24,275.00 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
183,274.24
1,118,927.04
54,124.95
133,491.91
16,731.39 12,000.00
12,000.00
21,828.37
7,502.37
48,387.10
214,458.94
Tarif
Telpon
ATK
Biaya Sanitasi
Biaya Pemeliharaan
Total Biaya
& Limbah
(14)
(15)
(16)
(17)
(18)
Profit margin
Profit margin
Tarif
(%)
(%)
(Rp)
(19)
(20)=(18)*(19)
(21)=(18)+(20)
65,463.38
18,754.55
439,574.33
206,984.23
2,553,502.80
20.00%
510,700.56
3,064,203.36
65,463.38
36,336.93
439,574.33
206,984.23
2,621,018.77
20.00%
524,203.75
3,145,222.52
65,463.38
36,336.93
439,574.33
206,984.23
2,573,370.88
20.00%
514,674.18
3,088,045.06
65,463.38
36,336.93
439,574.33
206,984.23
2,571,085.18
20.00%
514,217.04
3,085,302.22
65,463.38
36,336.93
439,574.33
206,984.23
2,573,370.88
20.00%
514,674.18
3,088,045.06
65,463.38
36,336.93
439,574.33
206,984.23
2,570,393.31
20.00%
514,078.66
3,084,471.98
65,463.38
36,336.93
439,574.33
206,984.23
2,621,018.77
20.00%
524,203.75
3,145,222.52
65,463.38
36,336.93
439,574.33
206,984.23
2,573,225.72
20.00%
514,645.14
3,087,870.87
65,463.38
36,336.93
439,574.33
206,984.23
2,563,959.38
20.00%
512,791.88
3,076,751.25
65,463.38
36,336.93
439,574.33
206,984.23
2,573,225.72
20.00%
514,645.14
3,087,870.87
65,463.38
36,336.93
439,574.33
206,984.23
2,638,907.76
20.00%
527,781.55
3,166,689.32
65,463.38
36,336.93
439,574.33
206,984.23
2,562,141.64
20.00%
512,428.33
3,074,569.96
65,463.38
36,336.93
439,574.33
206,984.23
2,562,141.64
20.00%
512,428.33
3,074,569.96
65,463.38
36,336.93
439,574.33
206,984.23
2,562,141.64
20.00%
512,428.33
3,074,569.96
65,463.38
36,336.93
439,574.33
206,984.23
2,562,141.64
20.00%
512,428.33
3,074,569.96
65,463.38
36,336.93
439,574.33
206,984.23
2,569,685.25
20.00%
512,428.33
3,074,569.96
65,463.38
36,336.93
439,574.33
206,984.23
2,571,085.18
20.00%
512,428.33
3,074,569.96
Kesimpulan
Pembayaran DRG O01A:
Proporsi tertinggi Eclamsi + Hipertensi 26,7% dengan
unit cost Rp. 2.569.685,-; Profit margin RS 20% Rp.
512.428,23 dan tarif SC Rp. 3.074.000, Proporsi terendah plasenta previa + asma 6,7% dengan
cost driver Rp. 2.553.502,
Saran
Implikasi Kebijakan
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