Analisis Case Mix Index FKRTL Kerja Sama BPJS Kesehatan di Provinsi Banten Tahun 2019 - 2022
Yuli Prihastutik, 1. Dr. drg. Yulita Hendrartini, M. Kes, A.A.K
2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN
Latar belakang: JKN
telah berjalan 1 dekade dan terjadi pertumbuhan jumlah peserta dan penambahan fasilitas
kesehatan yang meningkatkan pembiayaan JKN. Untuk menjaga suistanibilitas JKN maka
perlu dilakukan evaluasi dan monitoring secara berkala oleh seluruh ekosistem
yang terlibat dalam JKN khususnya RS dan BPJS Kesehatan. Evaluasi dapat
dilakukan dengan Case Mix Index (CMI). Hasil analisa CMI tersebut
penting untuk RS dan BPJS Kesehatan. Oleh karena itu perlu untuk dilakukan
analisis CMI RS Kerja Sama BPJS Kesehatan.
Tujuan: Menganalisis perbedaan nilai
CMI antara kelas, kepemilikan dan wilayah kabupaten kota RS, serta mengetahui
pengaruh proporsi kunjungan pasien tertentu di RS terhadap nilai CMI di
Provinsi Banten tahun 2019-2022.
Metode: Penelitian analitik nonexperimental.
Menggunakan data sekunder BPJS Kesehatan Provinsi Banten tahun 2019 - 2022
Hasil: Nilai CMI Rawat Jalan di
Provinsi Banten tahun 2019 – 2022 berbeda signifikan antara kelas RS,
kepemilikan RS serta dipengaruhi signifikan oleh proporsi kunjungan pasien
lanjut usia, hak perawatan kelas dan tiga. Adapun permodelan akhir CMI rawat jalan
ditentukan oleh Kelas RS dan Kepemilikan RS. Nilai CMI Rawat Inap berbeda signifikan
antar kelas RS dan dipengaruhi signifikan oleh proporsi kunjungan pasien lanjut
usia, segmen PBI-Non PBI dan hak perawatan kelas satu. Permodelan akhir CMI rawat
inap ditentukan oleh proporsi kunjungan pasien anak dan dewasa.
Kesimpulan: Nilai CMI sesuai
dengan tingkatan kelas. RS milik swasta memiliki nilai CMI rawat jalan lebih
tinggi, Usia Lansia dan sosial ekonomi pasien mempengaruhi nilai CMI di
Provinsi Banten Tahun 2019 - 2022.
Kata kunci: IBackground: JKN has been running for 1 decade and there has been a growth in the number of participants and the addition of health facilities that increase JKN financing. To maintain the sustainability of JKN, it is necessary to carry out periodic evaluation and monitoring by all ecosystems involved in JKN, especially hospitals and BPJS Kesehatan. Evaluation can be done with the Case Mix Index (CMI). The results of the CMI analysis are important for hospitals and BPJS Kesehatan. Therefore, it is necessary to conduct an analysis of the CMI Hospital in cooperation with BPJS Kesehatan.
Objective: To analyze the
difference in CMI values between classes, ownership and district areas of
hospitals, as well as to determine the influence of the proportion of certain
patient visits in hospitals on CMI values in Banten Province in 2019-2022.
Methods: Nonexperimental analytical
research. Using secondary data from BPJS Kesehatan Banten Province in 2019
- 2022
Results:
The value of Outpatient CMI in Banten Province in
2019 – 2022 differed significantly between hospital classes, hospital ownership
and was significantly influenced by the proportion of visits by elderly
patients, class and triple care rights. The final modeling of outpatient CMI is
determined by Hospital Class and Hospital Ownership. The value of CMI Inpatient
differed significantly between hospital classes and was significantly
influenced by the proportion of visits by elderly patients, the PBI-Non-PBI
segment and the right to first-class care. The final modeling of CMI inpatient
is determined by the proportion of pediatric and adult patient visits.
Conclusion: The CMI score
corresponds to the grade level. Privately owned hospitals have higher
outpatient CMI values, the age of the elderly and the socio-economics of
patients affect the CMI value in Banten Province in 2019 - 2022.
Keywords: INA CBG, JKN,
Hospital, Case Mix Index, CMII
Background: JKN has been running
for 1 decade and there has been a growth in the number of participants and the
addition of health facilities that increase JKN financing. To maintain the
sustainability of JKN, it is necessary to carry out periodic evaluation and monitoring
by all ecosystems involved in JKN, especially hospitals and BPJS Kesehatan.
Evaluation can be done with the Case Mix Index (CMI). The results
of the CMI analysis are important for hospitals and BPJS Kesehatan. Therefore,
it is necessary to conduct an analysis of the CMI Hospital in cooperation with
BPJS Kesehatan.
Objective: To analyze the
difference in CMI values between classes, ownership and district areas of
hospitals, as well as to determine the influence of the proportion of certain
patient visits in hospitals on CMI values in Banten Province in 2019-2022.
Methods: Nonexperimental analytical
research. Using secondary data from BPJS Kesehatan Banten Province in 2019
- 2022
Results:
The value of Outpatient CMI in Banten Province in
2019 – 2022 differed significantly between hospital classes, hospital ownership
and was significantly influenced by the proportion of visits by elderly
patients, class and triple care rights. The final modeling of outpatient CMI is
determined by Hospital Class and Hospital Ownership. The value of CMI Inpatient
differed significantly between hospital classes and was significantly
influenced by the proportion of visits by elderly patients, the PBI-Non-PBI
segment and the right to first-class care. The final modeling of CMI inpatient
is determined by the proportion of pediatric and adult patient visits.
Conclusion: The CMI score
corresponds to the grade level. Privately owned hospitals have higher
outpatient CMI values, the age of the elderly and the socio-economics of
patients affect the CMI value in Banten Province in 2019 - 2022.
Keywords: INA CBG, JKN,
Hospital, Case Mix Index, CMI
Kata Kunci : INA CBG, JKN, Hospital, Case Mix Index, CMI
