Kendali Biaya Kebijakan Jaminan Persalinan(JAMPERSAL) di Rumah Sakit Umum Daerah Kota Yogyakarta

PERWITASARI, Pansunu, Ambar Widaningrum

2013 | Tesis | S2 Magister Administrasi Publik

ABSTRACT Delivery insurance policy (Jampersal ) is a development policy of the Community Health Insurance Program (Jamkesmas) with guaranteed delivery for all pregnancy or childbirth, especially for the people who do not have health insurance. As Regulation of the Minister of Health No. 631/MENKES/PER/III/2011 the governance and accountability of Jampersal done using package rates Indonesia Case Base Group (INACBGs), where the claims are paid based on fee for service is not appropriate hospital rates but based on Diagnostic Related Group (DRG) or Case Mix Group (CBG). Different rates Jampersal possible service with the claim could cause the price difference is beneficial or detrimental for hospitals; RSUD Kota Yogyakarta are currently use Major Regulation (Perwal) No. 104 Tahun 2009 that concern the higher the difference between the real cost of the claim Jampersal considering inflation continues to rise and increases in the price of medical drugs. This study aims to determine how the implementation of Jampersal cost control in RSUD Kota Yogyakarta, the extent to which managed care process is done by finding the cause of the slow claims process and to evaluate the possibility of human error ranging from stage accuracy and completeness of patient file, claims administration, and clinical pathways. The leadership aspects greatly affect the success of cost control for any structural officials in carrying out control over the source of funds. Further managerial aspects are also reflected an understanding of cost control and coordination process between the units/areas; thus will continue in the performance of duties of the staff under him (operational aspects). The results showed that not all structural officials in RSUD Kota Yogyakarta appreciate about cost control and still have a the lack of control for the source of funds. Direct supervision of directors was also not carried out continuously. That places the classic recurring problem is the slow process of verification of claims administration as well as to result in the accumulation of debt claims. This problem must be overcome given the closer the implementation of National Health Insurance (universal coverage) on 1 January 2014, which all health service will be implemented by health insurance. Keywords : Health Policy, Jampersal, managed care, leadership, costs control

Kata Kunci : Jaminan Kesehatan