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Hernowo
awo.hernowo@gmail.com
Alumni Pascasarjana Perbanas Institute
Imam Wahyudi
imamwahyudi1959@gmail.com
Dosen Pascasarjana Perbanas Institute
ABSTRACT
This study is classified as ethnographic research is a type of research that is
qualitative in assessing a problem. This study is in-depth and the researchers
directly tangent to the problems studied by looking for informants from the
environment involved with the problem.
This study aims to determine whether Dr. Sismadi hospitals uses a method
of unit cost calculation to determine its health care tariff, and how to set service
rates to anticipate health BPJS patients with INA-CBGs tariff package
The currently used clinical pathway is the concept of an integrated health
service plan that summarizes every step taken in patients from entry to exit based
on medical service standards, nursing care standards and other evidence-based
healthcare standards (diagnostics) with measurable results in the long term
certain time during the hospital. Activity based costing (ABC) is one method of
unit cost calculation using activity as a reference in tariff determination. The
purpose of this study is to provide an alternative in the preparation of outpatient
and inpatient tariffs, as well as an alternative that can be used to manufacture
tariff packages clinical pathway concept.
The results showed that clinical pathways for BPJS health patients made by
Dr. Sismadi hospitals still provide subsidies especially for surgical patients who
use general anesthesia to BPJS patients, but for non-surgical cases with up to 3
(three ) day, the relative does not provide subsidies.
The result of unit cost calculation with activity based costing (ABC)
analysis for polyclinic outpatient and nursing service tariff shows a very varied
result, so that the profit margin for each service tariff is very varied as well. The
result of unit cost calculation shows that the hospital has not conducted maximum
supervision on the cost of the activities of each service unit.
The level of service efficiency by minimizing unit cost with the counselor on
the quality and cost of BPJS patient health will be very beneficial for the hospital,
so the possibility of subsidy or cost recovery can be minimized
Key Notes: Tarif of INA-CBGs, RS Tarif, Clinical Pathway, Unit Cost Method
ABC.
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Gambar 1.1
Konsep Tarif Paket BPJS Kesehatan ( INA-CBGs)
FIXED
COST
JASA OPRS RS
SARANA
VARIABLE
COST
TARIF
PAKET JKN
JASA Jasa
JASAPELA Jasa MGT
DOKTER Laborat
YANAN JASAPELA
Jasa Jasa
YANAN
Lainya
JASA Jasa Jasa
PERAWAT Farmasi Radiologi
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Gambar 2.1
Kerangka Pemikiran Penelitian
METODE
ABC
MUTU EFISIE
TARIF
TARIF PELAYA NSI
PAKET
UMUM N& BIAYA
INA-CBGs
RS BIAYA PELAY
ANAN
TARIF
PAKET CP
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Tabel 3.1
Subsidi Biaya Layanan Tarif Umum VS paket tarif INA-CBGs
SUBSIDI SUBSIDI
JML PAKET PAKET
BULAN TARIF TARIF
KASUS RS. UMUM INA-CBGs
(Rp) (%)
-
JANUARI 116 470.544.339 374.776.800 -20,35%
95.767.539
-
FEBRUARI 94 382.735.517 328.301.200 -14,22%
54.434.317
-
MARET 150 558.759.222 495.686.700 -11,29%
63.072.522
-
APRIL 109 504.969.842 367.541.500 -27,22%
137.428.342
-
MEI 118 533.679.876 385.895.300 -27,69%
147.784.576
-
JUNI 66 288.270.537 199.251.700 -30,88%
89.018.837
-
TOTAL 653 2.738.959.333 2.151.453.200 -21,45%
587.506.133
Sumber data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.2
Subsidi Paket Tarif Rawat Jalan INA-CBs VS Tarif Umum RS
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Sekunder -
18.11 Prosedur Otoscopy
Paket tarif INA-CBGs 185.500
Paket tarif RS 416.570
Cost Recovery/Subsidi
231.070 55,47%
RS
Fllow - up after other
3 Z09.8 Utama
treatment for condition
Chronic obstructive
J44.9 Sekunder pulmonary diseases,
unspecified
Diagnostic ultrasound of
88.76 Prosedur of abdomen and
retroperitoneum
Paket tarif INA-CBGs 533.600
Paket tarif RS 743.045
Cost Recovery/Subsidi
209.445 28,19%
RS
Fllow - up exam after
4 Z09.8 Utama other treatment for
condition
Hypertensive heart
I11.9 Sekunder diasease without heart
fallure
Paket tarif INA-CBGs 185.000
Paket tarif RS 259.855
Cost Recovery/Subsidi
74.855 28,81%
RS
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.3
Klaim Tagihan Rawat Jalan Paket Tarif INA-CBs VS Tarif Umum RS
TARIF
JML TARIF SELISIH
BULAN UMUM %
KASUS INA-CBGs TARIF
RS
JAN 778 149.279.100 112.135.336 37.143.764 33,12%
FEB 770 147.694.100 103.907.486 43.786.614 42,14%
MAR 932 178.937.500 138.013.806 40.923.694 29,65%
APR 880 171.646.700 127.045.148 44.601.552 35,11%
MEI 898 178.793.100 130.970.314 47.822.786 36,51%
JUNI 788 153.972.400 111.182.915 42.789.485 38,49%
TOTAL 5.046 980.322.900 723.255.005 257.067.895 35,54%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
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Tabel 3.4
Besarnya Subsidi Yang Diberikan Tarif Umum VS INA-CBGs
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Tabel 3.5
Komparasi Tarif Clinical Pathway VS INA-CBGs
DIAGNOSA : APENDIC & LAPARATOMY
KETERANGAN KELAS 1 KELAS 2 KELAS 3
CLINICAL PATHWAY 9.425.310 8.910.310 8.393.310
INA-CBGs 7.279.500 6.239.600 5.199.600
SUBSIDI PBJS (Rp) -2.145.810 -2.670.710 -3.193.710
SUBSIDI PBJS (%) -22,77% -29,97% -38,05%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.6
Komparasi Tarif Clinical Pathway VS INA-CBGs
DIAGNOSA : SECTIO
KETERANGAN KELAS 1 KELAS 2 KELAS 3
CLINICAL PATHWAY 6.872.800 6.177.700 5.842.800
INA-CBGs 6.191.300 5.306.800 4.422.400
SUBSIDI PBJS (Rp) 681.500 870.900 1.420.400
SUBSIDI PBJS ( %) -9,92% -14,10% -24,31%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.7
Komparasi Tarif Clinical Pathway VS INA-CBGs
DIAGNOSA : KURETASE
KETERANGAN KELAS 1 KELAS 2 KELAS 3
CLINICAL PATHWAY 4.650.450 4.063.350 3.692.550
INA-CBGs 2.084.700 1.786.900 1.881.000
SUBSIDI PBJS (Rp) -2.565.750 -2.276.450 -1.811.550
SUBSIDI PBJS ( %) -55,17% -56,02% -49,06%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.8
Komparasi Tarif Clinical Pathway VS INA-CBGs
DIAGNOSA : THYPOID
KETERANGAN KELAS 1 KELAS 2 KELAS 3
CLINICAL PATHWAY 1.926.100 1.771.600 1.617.100
INA-CBGs 3.017.400 2.586.400 2.155.300
SUBSIDI PBJS (Rp) 1.091.300 814.800 538.200
SUBSIDI PBJS ( %) 56,66% 45,99% 33,28%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
Tabel 3.9
Komparasi Tarif Clinical Pathway VS INA-CBGs
DIAGNOSA : DHF
KETERANGAN KELAS 1 KELAS 2 KELAS 3
CLINICAL PATHWAY 1.724.500 1.569.800 1.415.220
INA-CBGs 1.509.800 1.294.200 1.078.500
SUBSIDI PBJS (Rp) -214.700 -275.600 -336.720
SUBSIDI PBJS ( %) -12,45% -17,56% -23,79%
Sumber Data : Bagian BPJS RS. XXX Yang Diolah
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Tabel 3.10
Komparasi Paket Tarif Clinical Pathway VS INA-CBGs
Untuk lebih dapat diketahui berapa besarnya subsidi yang diberikan untuk
masing-masing kelas. Dibawah ini alokasi subsidi dari masing-masing kelas
sebagai berikut :
Tabel 3.11
Subsidi Biaya Paket Tarif Clinical Pathway VS INA-CBGs
KELAS
TOTAL
1 2 3
KASUS 82 328 243 653
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Tabel 3.12
Klaim Paket Tarif Clinical Pathway VS Paket Tarif INA-CBs
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Tabel 3.13
Komparasi Hasil Perhitungan Metode ABC VS Tarif RS
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