PERBANDINGAN KAJIAN TARIF RIIL RUMAH SAKIT DENGAN TARIF INA CBG'S UNTUK KASUS THYPOID PADA PESERA BPJS DI RSUD DR. SOEDIRMAN KEBUMEN DAN RS PKU MUHAMMADIYAH SRUWENG

I Gusti Ayu Mirah Sutrisni, Dr. drg. Yulita Hendrartini, M.Kes, AAK;Dr. dr. Andreasta Meliala, DPH, M.Kes, MAH

2016 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang Jaminan Kesehatan Nasional merupakan bentuk komitmen pemerintah terhadap pelaksanaan jaminan kesehatan masyarakat Indonesia yang diselenggarakan oleh Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) Kesehatan Permasalahan yang sering dirasakan dalam implementasi dari JKN adanya perbedaan antara biaya riil dengan tarif paket INA-CBG's pada instalasi rawat inap. Penelitian ini bertujuan untuk mengetahui perbedaan antara biaya riil dengan tarif paket INA-CBG's pada pasien tifoid rawat inap. Metodologi penelitian Metode penelitian ini merupakan Cross sectional. Data diambil dari berkas klaim JKN dan catatan medik pasien. Subyek penelitian adalah pasien tifoid yang menjalani rawat inap dan objek penelitian meliputi berkas klaim dan catatan medik pasien tifoid periode Desember 2015-Januari 2016 dengan kode Ina CBG's: A-4-14-I, A-4-14-II dan A-4- 14-III. Analisis data dilakukan secara deskriptif dan statistik non parametrik (distribusi data tidak normal). Analisis data menggunakan Wilcoxon Signed Ranks Test, Kruskal Wallis dan Mann Whitney Test. Hasil (1) Pada RSUD Dr Soedirman Kebumen, median Tarif RS Rp 1.803.456 dan INA CBG'S Rp 3. 449.050 , Wilcoxon Signed Ranks Test Z-10,476 p<0,05; (2) Pada RSUD Dr PKU Muhammadiyah Sruweng, median Tarif RS Rp 2.613.067 dan INA CBG'S Rp 3.568.700 (selisih 136,57%), Wilcoxon Signed Ranks Test Z -2,070 p<0,05; (3) Tarif INA CBG's antara RSUD Dr Soedirman dengan RS PKU Muhammadiyah Sruweng, Mann Whitney Z -4,155 p<0,05; dan (4) Chi Square Kruskal Wallis test antar ALOS ditinjau dari Severity Level sebesar 9,933 p<0,05. Kesimpulan: Kesimpulan penelitian ini: (1) Ada perbedaan yang signifikan (p<0,05) antara tarif riil rumah sakit dengan tarif INA CBG's pada rawat inap tingkat lanjut kasus thypoid di RSUD Dr Soedirman Kebumen; (2) Ada perbedaan yang signifikan (p<0,05) antara tarif riil rumah sakit dengan tarif INA CBG's pada rawat inap tingkat lanjut kasus thypoid di RS PKU Muhammadiyah Sruweng; dengan selisih 136,57%; (3) Tidak ada perbedaan yang signifikan (p>0,05) tarif INA CBG's antara RSUD Dr Soedirman Kebumen dengan RS PKU Muhammadiyah Sruweng; dan (4) Ada perbedaan yang signifikan (p<0,05) ALOS ditinjau dari severity level pada kasus rawat inap tingkat lanjutan thypoid di RSUD Dr Soedirman Kebumen.

Background The National Health Insurance (JKN) is a government commitment to implementation of Indonesia public health insurance that organized by the Social Security Agency of Health (BPJS). The problems of JKN implementation are difference between the real cost of hospital rates with the INA-CBG's package on inpatient. The study aims to determine the difference between the real cost of hospital rates with the INA-CBG's package of hospitalized typhoid patients. Research methodology This research method is cross sectional. The data were taken from JKN claim file and medical records of patients. The subjects were typhoid patients that hospitalized and the objects of research were the claim file and medical records of typhoid patients with period December 2015-January 2016 that CBG's Ina code are A-4-14-I, A-4-14-II and A-4-14-III. The Data was analysized by descriptive and non-parametric statistics (the distribution data is ubnormal). The Data analysis use Wilcoxon Signed Ranks Test, Kruskal Wallis and Mann Whitney Test. Result (1) The Dr Sudirman Kebumen Hospital rates, median were Rp 1,803,456 and the INA'S CBG rates were Rp 3. 449 050 (the difference of rates were 191.25%), the Wilcoxon Signed Ranks Test were Z-10.476 and p <0.05; (2) the result of PKU Muhammadiyah Hospital Sruweng the median of real hospital rates were Rp 2,613,067 and INA'S CBG rates were 3.568.700 (the difference of rates were 136.57%), the Wilcoxon Signed Ranks Test were Z -2.070 and p <0.05; (3) the compare of INA CBG's rates between Hospital Dr Sudirman with PKU Muhammadiyah Hospital Sruweng were the Mann Whitney result Z -4.155 and p <0.05; and (4) Chi Square Kruskal Wallis test of the ALOS based on Severity Level were 9.933 and p <0.05. Conclusion: The conclusion of this study: (1) There was a significant difference (p <0.05) between the hospital real rates with CBG's INA rates on inpatient advanced cases of typhoid in the Dr Sudirman Hospital Kebumen; (2) There was a significant difference (p <0.05) between the real hospital rates with CBG's INA rates on inpatient advanced cases of typhoid in PKU Muhammadiyah Hospital Sruweng; with a difference of 136.57%; (3) There is no significant difference (p> 0.05) INA CBG's rates between Dr Sudirman hospital Kebumen with PKU Muhammadiyah Hospital Sruweng; and (4) There is a significant difference (p <0.05) ALOS based on severity level at advanced level inpatient of typhoid in Dr Sudirman Hospital Kebumen.

Kata Kunci : JKN, Tarif riil, tarif paket INA CBG's, LOS.,JKN, the real hospital rates, packages INA CBG's, LOS