Perbandingan Tarif Rumah Sakit dan INA-CBG pada Pasien Diabetes Mellitus Tipe II Rawat Jalan di RSIJ Sukapura
DOI:
https://doi.org/10.47859/jmu.v10i02.491Keywords:
Diabetes Mellitus, INA-CBG, Comparison, CostAbstract
Background: The National Health Insurance Program helps patients pay for medical expenses and provides financial protection against unexpected health risks. INA-CBG system is used for healthcare payments, where the payment is determined based on type of disease the patient has. However, the rates set by INA-CBG are lower than hospital rates, causing financial losses and affecting the quality of service. Purpose: This research aims to compare rates to maintain hospital financial balance and fair access to services. Method: This study uses comparative quantitative research method with cross-sectional approach. The research was conducted at Rumah Sakit Islam Jakarta Sukapura. The sampling technique used was saturated sampling, with a sample of 374 claim data for type II diabetes mellitus patients from October to December 2023. Data were taken from Zi-Care system, which has been bridged with INA-CBG. The data collection tool used was a checklist. The analysis techniques included univariate and bivariate analysis using Wilcoxon Signed Rank Test. Results: The research results show that the total hospital cost is Rp265,805,506, with the highest value being Rp2,746,407 and the lowest value being Rp161,000. The total INA-CBG cost is Rp73,341,400. P-value of 0.0001 indicates a significant difference between both variables. Conclusion: The difference in rates resulted in the hospital experiencing a loss of IDR 192,464,106. Hospitals need to refer drug collection to external pharmacies, and BPJS must evaluate INA-CBG rates to match hospital expenditure to prevent losses.
References
Arofah, A. N., Noor, V. M. M., Setyawan, F. E. B., & Shihab, D. A. S. (2022). Dampak Akibat Implementasi Program JKN Terhadap Biaya Kesehatan di Fasilitas Kesehatan Tingkat Lanjutan. CoMPHI Journal: Community Medicine and Public Health of Indonesia Journal, 3(2), 64–72. https://doi.org/10.37148/comphijournal.v3i2.104
BPJS. (2014). Petunjuk Teknis Verifikasi Klaim BPJS Kesehatan. Badan Penyelenggara Jaminan Sosial.
Cahyono, A. D. (2020). Studi Kepustakaan Mengenai Kualitas Pelayanan Terhadap Kepuasan Pasien Rawat Jalan Di Rumah Sakit. Jurnal Ilmiah Pamenang, 2(2), 1–6. https://doi.org/10.53599/jip.v2i2.58
Kemenkes RI. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 85 Tahun 2015 Tentang Pola Tarif Rumah Sakit (pp. 1–239).
Kemenkes RI. (2021). Peraturan Menteri Kesehatan Republik Indonesia Nomor 26 Tahun 2021 Tentang Pedoman Indonesian Case Base Group (INA CBG) Dalam Pelaksanaan Jaminan Kesehatan (Vol. 151, Issue 2, pp. 10–17).
Kemenkes RI. (2022). Peraturan Menteri Kesehatan No. 24 Tahun 2022 tentang Rekam Medis.
Munawaroh, F., Aryani, D. N., & Pudjiastuti, W. (2022). Analisis Akuntabilitas Perbandingan Tarif INA-CBG’s Dan Tarif Rumah Sakit Pada Tindakan Kateterisasi Jantung Dengan Pemasangan Stent (Percutaneous Coronary Intervensi) Di RSI Aisyiah Malang. Journal of Educational and Language Research, 1(9), 1254–1262.
Negara, S. B. S. M. K., Octavia, D. R., & Utami, P. R. (2021). The Comparison of The Actual Cost to Case-mix of Type 2 Diabetes Mellitus Inpatient in Pandan Arang Boyolali Hospital. Pharmacy Education, 21(2), 269–274. https://doi.org/10.46542/pe.2021.212.269274
Pradnyantara, I. G. A. N. P., Susanti, M. Y., & Yulida, R. (2023). Analisis Selisih Biaya Antara Tarif riil Rumah Sakit Dengan Tarif INA CBG Pada Kasus Sectio Caesarean Di Rumah Sakit Panti Nugroho. Jurnal Manajemen Informasi Kesehatan Indonesia (JMIKI), 11(2), 91–95. https://doi.org/10.33560/jmiki.v11i2.406
Presiden RI. (2018). Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 Tentang Jaminan Kesehatan (Issue 42).
Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Health and Treatment of Diabetes Mellitus. International Journal of Health Sciences, 5(1), I–V. https://doi.org/10.53730/IJHS.V5N1.2864
WHO. (2019). Classification of Diabetes Mellitus. In World Health Organzation (Ed.), Clinics in Laboratory Medicine (2019th ed., Vol. 21, Issue 1). Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention. https://doi.org/10.5005/jp/books/12855_84
