PELAKSANAAN INDONESIA DIAGNOSIS RELATED GROUP (INA-DRG) DI RUMAH SAKIT PANTI WALUYO SURAKARTA

Sarah Pitaloka, Dr. drg. Julita Hendrartini, M.Kes.

2011 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Program asuransi kesehatan masyarakat (Jaminan Kesehatan Masyarakat) diluncurkan di Indonesia sejak beberapa tahun yang lalu. Secara simultan sistem pembayaran INA-DRG dikembangkan sebagai kendali mutu dan kendali biaya dalam pelayanan kesehatan masyarakat miskin. Pelaksanaan INA-DRG di rumah sakit Panti Waluyo Surakarta menunjukkan terjadi selisih negatif antara biaya berbasis tarif rumah sakit dengan tarif INA-DRG. Karenanya, diperlukan evaluasi mengenai mekanisme pengendalian biaya dan pengendalian mutu sesuai tujuan INA-DRG. Tujuan: Tujuan penelitian ini adalah (1) mengidentifikasi perbedaan ALOS antara pasien jamkesmas dengan ALOS INA-DRG, khususnya pada kasus comotio cerebri dan stroke non haemorhagic, (2) mengidentifikasi kepatuhan dokter terhadap formularium, mengidentifikasi pola peresepan dokter, (3) mengetahui komitmen manajemen dan mekanisme pengendalian di rumah sakit Panti Waluyo Surakarta. Metode: Rancangan penelitian ini adalah studi kasus. Subyek penelitian ini sesuai dengan tujuan, terdiri dari dokter bedah umum, dokter saraf, ketua komite medik, petugas koding, petugas keuangan, kepala divisi pelayanan medis, kepala divisi keuangan dan umum. Data sekunder dengan melihat berkas rekam medis, resep, dan dokumen dari instalasi farmasi. Hasil dan pembahasan: Ditemukan 52,2% kasus comotio cerebri dan 61,9% kasus stroke non haemorhagic memiliki ALOS yang lebih panjang dibandingkan standar INA-DRG. Biaya berbasis tarif rumah sakit lebih besar dibanding biaya INA-DRG pada 91,3% kasus comotio cerebri dan 76,2% kasus stroke non haemorhagic. Delapan puluh sembilan persen dokter patuh pada formularium pada kasus comotio cerebri dan 88% patuh pada formularium pada kasus stroke non haemorhagic. Pola peresepan 93% menggunakan obat generik, 86% peresepan dengan antibiotik, 100% peresepan dengan obat injeksi. Berdasarkan dokumen instalasi farmasi 82% peresepan sesuai dengan formularium rumah sakit. Sementara itu komitmen manajemen kurang dan mekanisme pengendalian biaya belum ada. Kesimpulan dan saran: Pelaksanaan INA-DRG di rumah sakit Panti Waluyo Surakarta belum dapat menjadi kendali mutu dan kendali biaya. Lebih jauh, edukasi bagi staf rumah sakit yang terlibat dalam pelaksanaan INA-DRG dan evaluasi yang terus-menerus diperlukan dalam pelaksanaan INA-DRG di rumah sakit.

Background: People’s Health Assurance (Jaminan Kesehatan Masyarakat) program has been launched in Indonesia since some years ago. Concurrently, Indonesia Diagnosis Related Group (INA-DRG) payment system has been developed, to control quality and expenditure of the suburban people’s health services. The operation of INA-DRG in Panti Waluyo Hospital showed that there is a negative divergence between payments based on hospital cost with INA-DRG cost. Therefore, evaluation on cost control mechanism and quality control so the purpose of from INA-DRG is needed. Objective: This research aimed (1)to identify the difference between Average Length of Stay among patients using People’s Health Assurance INA-DRG payment systems particularly among comotio cerebri and non haemoragic stroke cases, (2)to identify doctors’ obedience to the formularies, to identify doctors’ prescription patterns, (3)to explore on management’s commitment and control mechanism in Panti Waluyo Hospital. Method: The research design was a case study. The research subjects were selected purposively, who consisted of surgeons, neurological doctor, the chief of medical committee, coding officer, financial officer, the head of services division, the head of financial and general division. In addition to that, the data were taken from medical records, prescription, and the print out from pharmacy installation. Result and discussion: The findings showed that 52.2% of comotio cerebri cases and 61.9% of non-hemorrhagic stroke cases have longer ALOS than the standard of INA-DRG. Moreover, hospital costs are larger than the standard cost of INA-DRG among 91.3% comotio cerebri cases and 76.2% non-haemorhagic stroke cases. Eighty nine percent of physicians obey the formularies for comotio cerebri and 88% of them follow the formularies for non-haermorhagic stroke case. The prescription pattern was 93% genericdrug prescription, 86% antibiotic prescription, 100% injection prescription. Among the reviewed print out from pharmacy installation, 82% of prescriptions fit into the hospital formularies. Meanwhile, commitment from the management was low and less control to patient cost. Conclusion and recommendation: The implementation of INA-DRG in Panti Waluyo Hospital, Surakarta has not been able to control the quality and the cost. Further education for hospital staffs who responsible for INA-DRG implementation and continuous evaluation of INA-DRG implementation in the hospital are needed.

Kata Kunci : INA-DRG, Length of stay (LOS), kepatuhan, komitmen, pengendalian.