Selisih pembiayaan pelayanan kesehatan peserta wajib Askes di RSUP Fatmawati Jakarta Selatan

ISA, Maemun, Drg. Julita Hendratini, M.Kes

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang : RSUP Fatmawati dalam melaksanakan pungutan biaya pelayanan kesehatan kepada pasien umum mengacu pada Surat Direktorat Pelayanan Medik Depkes No.KU.03.01 .1.3.192 tan~gal 28 Januari 2006 tentang pola tarif rumah sakit umum pemerintah 1 • Dalam melayani pasien peserta Askes, digunakan pola tarif PT Askes yang berupa paket. Sistem pembayaran dari PT Askes, rumah sakit dalam bentuk klaim artinya setiap bulan rurnah sakit mengajukan klaim kepada PT Askes, yang disertakan dokumen yang memuat jenis tindakan atau rincian biaya pasien yang dilakukan oleh rumah sakit. Penelitian bertujuan untuk mengetahui selisih biaya pelayanan kesehatan bagi pasien wajib peserta askes dan pendapat para pengambil kebijakan (stake holder) baik internal maupun eksternal. Metode : Jenis penelitian ini adalah studi kasus. Rancangan penelitian yang digunakan adalah holistik tunggal (Yin, 1996). Pendekatan penelitian ini adalah dengan metode penelitian dilaksanakan kuantitatif dan kualitatif. Unit analisis penelitian ini adalah RSUP Fatmawati Jakarta Selatan. Perhitungan selisih biaya pelayanan kesehatan berdasarkan jumlah kunjungan dengan menggunakan pola tarif RSUP Fatmawati, PT. Askes dan unit cost. Hasil Penelitian : Hasil penelitian menunjukkan bahwa selisih rata-rata biaya pelayanan berdasarkan: Pola tarif RSUP Fatmawati pada lnstalasi rawatjalan sebesar Rp 21 .131 ,per kunjungan, lnstalasi rawat darurat Rp 54.014,- per kunjungan dan lnstalasi rawat inap sebesar Rp 179.875,- per hari. Secara keseluruhan selisih biaya/subsidi pelayanan kesehatan oleh RSUP Fatmawati berjumlah Rp 9.357.173.022,-. Pola tarif unit cost pada lnstalasi rawat jalan sebesar Rp 86.606,43,-per kunjungan, lnstalasi rawat darurat Rp 107.153,27- per kunjungan dan lnstalasi rawat inap sebesar Rp 241 .952,33,- per hari. Secara keseluruhan selisih biaya/subsidi pelayanan kesehatan Pemerintah ikut menyumbang sebanyak Rp 14.716.289.695,: . Stakeholder berpendapat untuk mengurangi selisih/ subsidi didapatkan penyesuaian tarif kesepakatan yaitu iur biaya( cost aharing) dan perfuasan persediaan obat DPHO. Kesimpulan : selisih pembiayaan pelayanan kesehatan bagi pasien peserta wajib PT. Askes merupakan subsidi RSUP Fatmawati dan Pemerintah. Subsidi tersebut disebabkan pola tarif yang berbeda walau pasien sudah membayar iur biaya(cost shsring), tetapi rnasih belum dapat menutupi selisih pembiayaan pelayanan tersebut.

In collectiing medical service costs from general patients, RSUP Fatmawati applies regulation based on letter from Directorate of Medical Services (Direktorat Pelayanan Medik), Department of Health, No. KU.03.01 .1.3.192, dated January 28, 2006 regarding Tariff Pattern for Public Hospital. Whereas for patients under Government medical insurance (ASKES), RSUP Fatmawati applies Tariff Pattern issued by PT Askes in form of medical packages. Payment from PT Askes to the hospital is done by daims. Every month the hospital advances claims to PT Askes some amount of money, including corresponding documents explaining details of medical services provided to ASKES patients for that period. This reserach intends to reveal gaps between medical service costs paid by ASKES patients and the costs perceived by both internal dan external decision makers. This research utilises case study analysis, using RSUP Fatmawati Jakarta Selatan as the model. Designed research employes a single hollistic model as suggested by (Yin, 1996). Both quantitative and qualitative approaches are applied in this research. The gaps between medical service costs by ASKES patients and the perceived costs are evaluated using tariff pattern of RSUP Fatmawati, as the model, combined by tariff pattern of PT Askes, as a unit cost. The research reveals that the average gap varies based on treatment provided. For medical visits, the average gap accounts for Rp 21 .131 ,- per visit. For intensive care unit, the gap is Rp 54.014,- per visit. For medical stay, the gap is Rp 179.875,- per day. In total, the amount of medical cost gaps or the subsidy by RSUP Fatmawati reaches Rp 14.716.289.695,- . Utilising unit cost as guidance, the average gap also varies based on treatment provided. For medical visits, the average gap accounts for Rp 86.606,43,- per visit. For intensive care unit, the gap is Rp 107.153,27- per visit. For medical stay, the gap is Rp 241 .952,33,- per day. In total, the amount of medical cost gaps or the subsidy by RSUP Fatmawati reaches Rp 9.357.173.022,- Stakeholder argue that for decreasing the subsidy could take the tariff agreement from the cost sharing and extention of drugs stock DPHO. The gap of medical cost for every ASKES patients is a subsidy from both RSUP Fatmawati and The Government. The subsidy emerged because of the tariff path has a different path from the normal path even the patients already paid the cost sharing (cost sharing could not cover the gap of medical cost from the real cost of medical treatment).

Kata Kunci : Pelayanan kesehatan,Biaya pelayanan,PT Askes,Selisih biaya pelayanan