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Ario Tejosukmono
Master of Hospital Management Postgraduate Program
University of Muhammadiyah Yogyakarta
Yogyakarta, Indonesia

National Social Security System, Act Number 40 Year 2004 mandated that National Social Security
System as National Health Insurance starting January 1, 2014. As a private hospital that follow the
program, PKU Muhammadiyah Gamping Hospital has to prepare strategies for it. This study aims
to analyze the strategy of PKU Muhammadiyah Gamping Hospital facing National Health
Insurance. The analysis used a quantitative SWOT analysis to determine the actual position of the
hospital so it can choose the right strategies. Data collection using in-depth interview method,
quesioner, and document review. The sample of the research are 4 people who are the directors of
PKU Muhammadiyah Gamping Hospital. Quantitative SWOT analysis puts the hospital in quadrant
III, which means that the hospital is in a position of having many weaknesses but has many
opportunities, then they have to make a strategy changes. In this research there are many strategies
that can be done. Some strategies are making Clinical Pathway, recalculate unit cost and utilization
Hospital Information Technology and bridging with BPJS system. This study show that PKU
Muhammadiyah Gamping Hospital has to make a strategy changes according to the position of
hospital in quadrant III.

Keywords: SWOT analysis; Hospital strategy; National Social Security; NHI

Introduction implementation, it is expected that by

2019 all Indonesian people already have
National Social Security System, Health Insurance. So if the entire
Act No. 40 of 2004 mandated that the community already has a guarantee for
National Health Insurance of the health, fee for service system or out of
National Social Security System started pocket is not much applied again.
January 1, 2014. Hospitals as a provider Private Hospitals have to prepare for
of facilities and services in the Universal Coverage if they existence do
implementation of the program are not want to be disturbed. Hospital is
required to be ready. With the expected to prepare themselves,
effectiveness of this program will have implementation of the program must be
an impact on the hospital, both in the successful, benefiting the entire people
financial field, terms of service and other of Indonesia.
related areas. The target market of PKU Muhammadiyah Gamping
hospitals will increase with the Hospital is one of the Private Hospital
enactment of the Program, with that located on Special Region of
increased visits expected to improve Yogyakarta. As a new private hospital
financial performance, if hospital can that facing National Health Insurance, it
provide efficient and effective services. (1) is necessary to have a good strategy. So
Private hospitals are given the it is very interesting to see how The
freedom to choose whether to join the Hospital prepare themselves to face
National Health Insurance program or National Health Insurance 2014. Based
not. With the target of gradual program on the above problems, the authors
consider it necessary to conduct
research on it. The authors will analyze From SWOT analysis result
the strategy of hospitals in facing the according to strategic plan of PKU
National Health Insurance and Muhammadiyah Gamping Hospital is in
determine the strengths, weaknesses, position categorized enter into quadrant
opportunities and disturbances of the I, at this position RS have perfect
Hospital related to it. strategic position.
From SWOT analysis of the
Research Method study, the calculation shows the total
strength value is 1.8506 while the
This research uses qualitative weakness is 1.9215, from the reduction
research method with descriptive of strength score with the weakness, that
analytic design. The subjects of this is -0.0709. This means that hospitals
study amounted to 4 people have weaknesses. For external factors,
the value of opportunity amounted to
who are the board of directors 2.5875 and the threat of 1.2008, so from
and managerial hospitals the reduction of the value of opportunity
Stages of the study started from with the threat, obtained value of
in-depth interviews, questionnaire 1.3866. From the results of SWOT
making and document review. The analysis shows that the hospital is in a
interview stage started from the position to have weaknesses and
selection of informants to be opportunities that can be categorized
interviewed, ie from the board of into the quadrant III
directors and the managerial line of The strengths of the Hospital in
policy makers in the hospital. The next facing the National Health Insurance
stage, the researchers compose or design are: (1) having great teamwork from
questions that reveal all matters relating staff and employees. (2) The strategic
to the program and the Hospital. The location of the hospital is on the main
second meeting begins with specific road. (3) grand new buildings and large
questions regarding hospital strategy, areas for expansion plans. The
and also includes the strengths and weaknesses are: (1) Bureaucracy is long
weaknesses of the hospital, as well as and tiered, (2) Still status RS type C, (3)
hospital opportunities and barriers Good facilities cause maintenance cost
Data obtained from interviews increases, operational costs can increase
will be categorized into internal and as well. Some Opportunities are: (1) the
external factors. Internal factors are the opportunity to raise the class type RS
strengths and weaknesses of the from C to B, because the facility has been
hospital, while external factors are fulfilled, just need to meet the existing
opportunities and obstacles owned by requirements, (2) Opportunity to raise
the hospital. From these factors, a the status to type B education, with the
questionnaire was developed which aims increasing number of patients, especially
to assess the weight and rating of each the 3rd grade, (3) NHI program can be
factor. The weight and rating will be as media of socialization to public and
filled by the respondent based on patient about PKU Muhammadiyah
whether or not a factor is important and Gamping Hospital. Some threats are: (1)
whether or not it is affected. After the Many primary health facilities dont
quantitative data is obtained, the data know that Hospital are already working
will be processed with SWOT analysis to with NHI programs, it may be possible
determine the Hospital is in a particular to refer to other health facilities, (2)
quadrant. Underprivileged commitments from
Related documents will be medical worker to stay in the hospital,
studied and reviewed such as Hospital (3) Residents around (Bantul) are not
Strategy Plan, Hospital profile, Service included in the region of Hospital
performance and other related data. services, which covered only Sleman and
Kulonprogo only.
Table 1. Score difference of each factor in SWOT analysis

Strength score 1,8506

Weakness score 1,9215

Difference of strength and weakness score -0,0709

Opportunity score 2,5875

Threat scores 1,2008

difference of opportunities and threats score 1,3866

Figure 1. SWOT matrix/quadrant of PKU Muhammadiyah Gamping Hospital

Discussion the major focus difference in the making

of the analysis.
SWOT analysis conducted by the The quantitative SWOT analysis of
authors is a SWOT analysis related to PKU Muhammadiyah Gamping Hospital
Hospital strategy facing the National performed showed that RS was in
Health Insurance in particular. While quadrant III, meaning that the hospital
SWOT analysis conducted PKU had to change the strategy to overcome
Muhammadiyah Gamping Hospital is a the weakness and maximize the
general analysis that is not directly opportunity that is still very open.
related to National Health Insurance, There are some differences from
and not a spesific analysis to deal with it. the strategy of the hospital and the
So the result can be different because of strategies derived from the SWOT
analysis, therefore, the authors will try
to discuss some of the strategies that 1. Making Clinical Pathway (CP), at
need to be changed and strategies that least for 10 cases that are often
can still be maintained to overcome the obtained, so there are instruments
problems associated with the National for quality control and cost control.
Health Insurance as follows: Clinical pathway is an integrated
service planning concept that
summarizes every step given to
patients based on evidence-based
medical standards and evidence-
based nursing care with measurable
results and within a certain
timeframe during hospitalization. (2)
Clinical pathway combines the
standard of care of every health
worker systematically. The actions
given are uniformed in a standard of
care, but still pay attention to the
individual aspects of the patient.
There are four main
components of Clinical Pathway (3)
a. Timeframe, describes the
steps based on the day of care
or the stages of service,
b. The framework contains the
entire healthcare team's care
activities, and the activities
are grouped according to the
type of action,
c. The Results Criteria,
containing the results of the
given care standard, include
long-term criteria (describing
the overall outcome criteria
of care), and short-term
d. The Variance Recording
Sheet, taking notes and
analyzing the deviations from
the standard set out in the
Clinical Pathway, the
patient's condition is not in
accordance with the standard
of care or standard can not
be performed, all of which
are recorded in this variant
With the CP, it can be A public hospital study
ascertained the actions undertaken discusses the INA CBG's payment
by the doctor in accordance with claim system. The study found that
standard operating procedures. So public hospital management felt
the health services to patients will that the new system generated
be further improved. The quality of more financial surplus. That
health care is defined as perception is not in line with
'consistently satisfying the patient' accounting principles. Based on the
By providing health services that concept of accounting, surplus is
are efficacious, effective and determined by comparing income
efficient according to the latest and expenses, while the surplus
clinical guidelines and standards, perception raised is based on the
which meet patient needs and comparison between the old and
satisfy service providers. '' Patient new health insurance claim rates.
satisfaction and patient needs Furthermore, public hospitals reach
fulfillment can be considered as a a surplus because they receive
priority peak in achieving hospital donations from the government for
service quality. "(4) salary and investment related costs.
This strategy is still well suited Public hospitals do not take into
by hospitals in the hope of account and incorporate salary and
producing instruments for quality investment related costs into the
control and cost control. With the determination of their financial
existence of these instruments, the performance (6).
actions taken by the hospital will be 3. Utilization of information
more effective and efficient technology for a more optimal
2. Determine unit cost to know the service, using semipaperless and
real cost of service. bridging systems with health
Unit cost is the cost per product insurance claims system.
unit or cost per service. Unit cost is Each service to the patient in the
defined as the result of the division hospital will be issued SEP namely
between the total cost required Participant Eligibility Letter. With
divided by the number of units of the issuance of this SEP, is expected
products produced goods and to cut the queue of health insurance
services. (5) participants in advanced health
The benefit of unit cost in facilities such as public hospitals or
outline is to measure the private. With the development of
performance and the level of this information and technology,
efficiency and quality of health participants can register themselves
services, so that the quality control in the SEP machine at the hospital,
and cost control can run optimally. no need to queue at the health
With unit cost, hospitals can insurance office in the hospital.
compare the cost of hospital Previously enacted this system,
procedures with tariffs on INA registration is done by the
CBG's. If there is a gap between participants manually. Participants
hospital tariff and INA CBG's tariff must be queued at the existing
then the hospital can adjust to cost health insurance counters in the
efficiency without sacrificing hospital and health insurance
service to the patient. participants who have received a
referral letter from primary health
care facility (Puskesmas) must pass
through four stages of queue.
Semipaperless systems that are The solutions are providing
imposed in hospitals will improve training to physicians regarding the
the quality of care for patients. In a EMR shared system and adding
study of the use of shared EMR officers for electronic medical
(Electronic Medical record), data record data input. The most
and information in the system can immediate solution is to add a
efficiently be taken and combined special officer in charge of filling
with new data and information to out electronic medical records, but
make a resume about further its weakness will facilitate the
knowledge of patient illness, history occurrence of input if the officer is a
of disease, treatment. The stored person who is outside the medical
data will be preserved and not environment.
easily lost, but the data presented 4. Recruitment of human resources
should be interpreted further by the both medical and non medical.
doctors, in order to understand the In accordance with the PMK No.
description of patient travel more 56 year 2014 about the
detailed. Some systems are made classification and licensing of
sometimes difficult because hospitals, hospital type / class B has
programmers are often people requirements that must be met
outside the medical environment. related to human resources
So the doctor should be more From the article obtained
observant and critical related form information that the number of
of data presented in the shared nursing personnel at least in
ERM (Electronic Medical Record). accordance with the number of
beds. It can be concluded that with
At PKU Muhammadiyah the number of beds in the hospital
Gamping Hospital, medical record as many as 105 and will be added
writing has been using electronic / again to 220 with the construction
computerized. Many obstacles faced of new buildings and blocks, then
with this system. In poly specialist, the nursing personnel should have
recording is often not done alone by at least added a number of existing
the doctor concerned, but with the beds. It is necessary as a
help of nurses. This can cause a requirement to raise the class of
little trouble if there is poor hospital to class B. If still a Class C
communication. Wrong diagnosis then the ratio of nurses with beds is
and treatment can happen. 1: 3. This is what the management
In poly specialists, doctors in needs to study further.
charge are the majority of senior With the implementation of INA
doctors who are still difficult to use CBG's, it is necessary to find the
the computer. When this is forced it person who understand claim
will take a long time because of payment and coding. People who
difficulty in typing complaints or will enter coding (coder) must be
diagnosis of patients. understand about the diagnosis of
In the emergency room, the disease. Often a coder is a person
majority doctors are still young, so who is not familiar with the medical
there is no problem in using the world or even not at all from a
computer. Only the problem is medical background. Then this will
when the emergency room patient increase the incidence of incorrect
increases, the time required to coding, which leads to unpaid
enter patient data related to the payment.
disease and the complete history
becomes insufficient and narrower.
So it could be the data entered is
not too complete.
As suggestion, the coder is a Socialization is something that
doctor too so can understand the must be done if the new system is
coding and what it does. But the running, because the new system
cost of recruitment of medical definitely requires different
personnel will surely be higher than handling. Hospital staff are front-
if recruiting workers outside the line in receiving questions from
medical environment. patients on matters relating to the
5. Cooperate with primary health National Health Insurance. Here
facilities for the referral system. the party of the executing agency
Collaboration with primary also has an obligation to socialize
health care facilities and the program and related
networking must be owned by the requirements of payment claims.
hospital as primary health care Sharing of knowledge in
facilities are the main "suppliers" of hospitals has a major role in
patients with health insurance.A improving the quality of care in
few moments ago it was initiated to terms of accuracy of diagnostic
establish a primary health facility in coding in hospitals.(8) By sharing
cooperation with health insurance, knowledge between health
and finally it was done with the personnel in the hospital, it can
establishment of the Firdaus Clinic help minimize any error of coding
located in the Wirobrajan region. diagnosis, because this error leads
With the clinic, the patient's to not claimed payment properly.
referral to advanced level can be The form of sharing knowledge
directed to PKU Muhammadiyah that has been implemented in PKU
Gamping Hospital. Muhammadiyah Gamping Hospital
6. Overcoming the bureaucratic flow at this time is routinely held
that is still tiered. morning report. The morning
The bureaucracy at PKU report is not only to know what
Muhammadiyah limestone hospital patient is being treated in the
is still quite complicated and long, hospital, but also to increase the
because it is still on the PKU knowledge to the related medical
Muhammadiyah Yogyakarta personnel, whether specialist
Hospital, while the working area of doctor, ward doctor, nursing staff
the hospital is far in the city of and pharmacy. This knowledge
Yogyakarta, while Gamping into concerning patient therapy,
Sleman region. But this problem diagnosis and also possible follow-
has been resolved because the PKU up actions. In addition to improving
Muhammadiyah Gamping Hospital knowledge and service performance
has been separated and stand alone for the better, wrong coding can be
as a private hospital type C. So the inevitable.
flow of bureaucracy will be shorter By ensuring the continuity of
than before. training both internal and external
7. To socialize the program, internal to the employees, will improve the
training and knowledge sharing to service to the patient, so that the
all medical personnel in the services provided more efficient. (9)
hospital. With a more efficient service,
quality control and cost control can
be accomplished and costs can be
reduced in such a way that it is
more efficient. Then the financial
performance of the hospital will be
good in facing this era of national
health insurance.
8. Service differentiation and
expansion of service coverage.
With the target of raising the Procurement of class 3 should
type / class of the hospital to type B be considered, because as an
education, the scope of service educational hospital, a Class 3 ward
needs to be expanded in accordance must be available and sufficient, but
with the requirements stated in the not to excessive because it is also
Minister of Health Regulation no. associated with fees and claims of
56 year 2014 on the classification payment. Claims for class 3 wards
and licensing of hospitals, also on are lower than the upper class.
Government Regulation no. 93 of While the service costs tend to be
2015 on Educational Hospital. the same, so if not managed
Hospitals must complete the properly will harm the financial of
scope of services in accordance with the hospital.(10)
the Minister of Health Regulation. 10. Procurement of facilities and health
By increasing the scope of services, equipment to adjust to the target of
the target market is wider, this will raising the Hospital class to type B.
impact the more service used by the To complete the facilities and
community, the higher the income medical devices, must refer to the
of the hospital, provided that the rules written in the Minister of
service can be done effectively and Health No. 56 year 2014 on hospital
efficiently.(1) classification and licensing.
What needs to be considered is Procurement of this facility
to increase the type of service should consider the ability of the
without offset the ability to absorb Hospital in managing the existing
strong market and financial it facilities, do not merely pursue the
would be a boomerang for the requirements to raise the type of
Hospital. So it is better if the Hospital, because with more
hospital that has the weakness is facilities, the cost of maintenance
rethinking in taking this and maintenance of goods will be
opportunity. It's wiser to have higher too. What needs to be
hospitals rely on existing services considered is the benefits of these
first. Then the strategy for tools in supporting the service to be
extending the coverage of these better and efficient. It's better to
services can be considered overcome the weaknesses of the
inappropriate with current hospital Hospital than to take an uncertain
conditions. chance as to whether it benefits the
9. Review for new space and building hospital or not.
procurement. The authors recommend that
The type of hospital is some existing strategies need to be
determined by the availability of reviewed by the hospitals in the face
space, especially the existing beds of the National Health Insurance
in the hospital, to raise the class / such as Human Resource
type of hospital, it must be Recruitment, Service Differentiation
considered its availability is and the extension of service coverage,
adjusted with the Minister of new space and building procurement.
Health Regulation no. 56 year 2014 As well as the provision of facilities
on hospital classification and and medical devices to adjust to the
licensing. target of hospital type B. Vision of the
hospital is to become the primary
education hospital, but with the
circumstances and positions
Hospitals in quadrant III then the
strategy needs to be changed. The
authors suggest held Internal
Training for health workers in the
hospital as a motivation as well as
increasing the commitment of
hospital employees.

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