ANALISIS BIAYA MEDIS LANGSUNG PADA PASIEN KATARAK ONE DAY CARE DI RUMAH SAKIT MATA "Dr. YAP" YOGYAKARTA

ANNIDA AULIA AYU K, Dr. apt. Tri Murti Andayani, Sp.FRS., PhD.

2021 | Skripsi | S1 FARMASI

INA-CBGs merupakan sistem pembayaran kesehatan dengan sistem paket yang didasarkan pada diagnosis akhir dan prosedur yang diterima pasien. Dalam penerapannya, tidak jarang ditemukan bahwa terdapat perbedaan antara biaya riil dengan tarif paket INA-CBGs. Penelitian ini bertujuan untuk mengetahui besarnya biaya medis langsung intraoperasi dan pascaoperasi, perbedaan biaya medis langsung intraoperasi dan pascaoperasi berdasarkan jenis kelamin, usia, dan jumlah komplikasi akibat operasi fakoemulsifikasi one day care (ODC), serta kesesuaian biaya medis langsung intraoperasi dengan tarif paket INA-CBGs pada pasien katarak ODC yang melakukan pembedahan katarak dengan metode fakoemulsifikasi di Rumah Sakit Mata "Dr. YAP" Yogyakarta. Penelitian ini merupakan penelitian analitik non-eksperimental. Pengambilan data dilakukan secara retrospektif melalui rekam medis pasien dan rincian biaya perawatan pasien. Subjek penelitian adalah pasien katarak peserta JKN yang melakukan ODC pada periode Juli-Desember 2019 dengan kode INA-CBGs 13.41 yaitu kode untuk tindakan fakoemulsifikasi dan pemasangan IOL bagi rumah sakit tipe B. Data yang digunakan meliputi daftar biaya medis langsung intraoperasi dan pascaoperasi. Untuk mengetahui perbedaan biaya medis langsung intraoperasi dan pascaoperasi berdasarkan jenis kelamin, usia, dan jumlah komplikasi dilakukan uji Kruskall-Wallis dan Mann-Whitney, sedangkan One Sample T-test digunakan untuk mengetahui komparasi biaya medis langsung intraoperasi dengan tarif paket INA-CBGs. Hasil penelitian menunjukkan 99 pasien dengan 305 episode kunjungan kontrol 1 hari hingga 3 bulan pascaoperasi. Total biaya medis langsung intraoperasi pasien katarak berdasarkan perspektif rumah sakit adalah Rp737.240.800,00 dengan 40,95% terbanyak biaya adalah komponen biaya operasi dan rata-rata biaya Rp7.518.346,57 per operasi. Sedangkan untuk total biaya medis langsung pascaoperasi pasien katarak yaitu sebesar Rp58.084.119,00 dengan 47,45% terbanyak biaya adalah komponen biaya pemeriksaan dan rata-rata biaya Rp207.252,41 per kunjungan kontrol. Jenis kelamin dan usia tidak berbeda signifikan dengan biaya medis langsung intraoperasi maupun pascaoperasi, namun jumlah komplikasi berbeda signifikan dengan biaya medis langsung pascaoperasi. Terdapat selisih positif antara tarif paket INA-CBGs dengan biaya medis langsung intraoperasi sebesar Rp48.621.200,00 untuk total 99 pasien, terdapat perbedaan signifikan (p<0,05) antara tarif paket INA-CBGs 13.41 dengan biaya medis langsung intraoperasi (p = 0,000).

INA-CBGs is a health payment system with a package system based on the final diagnosis and procedures received by the patient. In its application, it is not uncommon to find that there is a difference between the real cost and the INA-CBGs package cost. This study aims to determine the amount of direct intraoperative and postoperative medical costs, differences in direct intraoperative and postoperative medical costs based on gender, age, and number of complications due to one day care (ODC) phacoemulsification surgery, as well as the suitability of direct intraoperative medical costs with INA-CBGs package rates for ODC cataract patients who underwent cataract surgery using the phacoemulsification method at "Dr. YAP" Hospital Yogyakarta. This research is a non-experimental analytical research. Data were collected retrospectively through patient medical records and details of patient care costs. The research subjects were cataract patients who were JKN participants who performed ODC in the period of July-December 2019 with the code INA-CBGs 13.41, which is the code for phacoemulsification and IOL installation for type B hospitals. The data used includes a list of direct intraoperative and postoperative medical costs. Kruskall-Wallis and Mann-Whitney tests were used to determine the difference between direct intraoperative and postoperative medical costs based on gender, age, and number of complications, while the One Sample T-test was used to compare direct intraoperative medical costs with INA-CBGs package rates. The results showed there were 99 patients with 305 episodes of control visits 1 day to 3 months postoperatively. The total direct intraoperative medical cost for cataract patients based on the hospital's perspective is IDR 737,240,800.00 with 40.95% of the cost being the operating cost component and the average cost is IDR 7,518,346.57 per operation. Meanwhile, the total direct medical costs of postoperative of cataract patients is IDR 58,084,119.00, with 47.45% of the highest cost is the examination fee component and the average cost is IDR 207,252.41 per control visit. Gender and age were not significantly different from direct intraoperative and postoperative costs, but the number of complications was significantly different from direct postoperative costs. There is a positive difference between the INA-CBGs package rates and direct intraoperative medical costs of IDR 48,621,200.00 for a total of 99 patients, and there is a significant difference (p<0.05) between the INA-CBGs package rates of 13.41 and direct intraoperative medical costs (p = 0.000).

Kata Kunci : fakoemulsifikasi, INA-CBGs, intraoperasi, pascaoperasi / INA-CBGs, intraoperative, phacoemulsification, postoperative