ANALISIS BIAYA PENGOBATAN GAGAL JANTUNG SEBAGAI PERTIMBANGAN DALAM PENETAPAN PEMBIAYAAN KESEHATAN BERDASARKAN INA-DRGs DI RSUD Dr. MOEWARDI SURAKARTA

VIVIN ROSVITA, Prof. Dr. Zullies Ikawati, Apt.

2011 | Tesis | S2 Mag.Manaj.Farmasi

Implementasi sistem INA-DRG bagi pasien kelas III Jamkesmas di rumah sakit diharapkan mampu meningkatkan akses dan mutu pelayanan kesehatan kepada seluruh masyarakat miskin dan tidak mampu dalam rangka mewujudkan tercapainya pelayanan kesehatan di rumah sakit yang optimal secara efektif dan efisien. Tujuan penelitian ini adalah menganalisis rata-rata biaya perawatan pasien gagal jantung di rumah sakit, mengetahui pengaruh faktor pasien (usia dan jenis kelamin), jumlah comorbid, tingkat keparahan dan LOS terhadap biaya perawatan gagal jantung serta untuk mengetahui perbedaan rata-rata biaya perawatan pasien gagal jantung sesuai tarif RSUD Dr. Moewardi dengan tarif paket INA-DRG. Jenis penelitian adalah deskriptif menurut prespektif rumah sakit. Metode pengambilan data dilakukan secara retrospektif. Subjek penelitian adalah pasien rawat inap kelas 3 peserta Jamkesmas di RSUD Dr. Moewardi periode tahun 2009 yang menderita gagal jantung dan memenuhi kriteria inklusi. Analisis data dilakukan secara cross tab dan linear regression, serta perbandingan rata-rata biaya dan LOS. Nilai p dari hasil uji statistik antara jenis kelamin, usia, jumlah comorbid, tingkat keparahan dan lama waktu perawatan terhadap biaya perawatan adalah 0,851, 0,960, 0,694, 0,621 dan 0,000. Rata-rata biaya perawatan gagal jantung berdasarkan tarif RSUD Dr. Moewardi pada tingkat keparahan I sebesar Rp. 1.870.231 ± Rp. 1.506.661, sedangkan pada tingkat keparahan II sebesar Rp. 2.382.737 ± Rp. 2.132.236 dan pada tingkat keparahan III sebesar Rp. 2.513.826 ± Rp. 1.664.057. ALOS riil pada tingkat keparahan I sebesar 6,92 hari, sedangkan pada tingkat keparahan II sebesar 7,35 hari dan pada tingkat keparahan III sebesar 8,10 hari. Hasil penelitian yaitu bahwa tidak ada hubungan antara karakteristik pasien, jumlah comorbid, dan tingkat keparahan terhadap biaya perawatan di RS, sedangkan lama waktu perawatan mempunyai korelasi dengan biaya perawatan. Rata-rata biaya perawatan gagal jantung pada tingkat keparahan I, II, dan III lebih rendah dibandingkan terhadap tarif paket INA-DRG, selisih biaya yang diklaimkan menjadi keuntungan bagi rumah sakit karena telah berhasil memberikan pelayanan optimal secara efisien. Perbedaan ALOS riil dan ALOS INA-DRG selisih tertinggi pada tingkat keparahan III. Hal tersebut menunjukkan bahwa rumah sakit telah melakukan efisiensi sehingga mampu menurunkan lama rawat inap pasien gagal jantung di rumah sakit.

The implementation of INA-DRG for patient of Jamkesmas Class III at the hospital was expected to be able to increase the access and quality of health service to the entire poor and unable community in order to realize the optimal health service effectively and efficiently. The aim of this research was to analyze the medical cost of heart failure patients at the hospital, to investigate the affect of patient’s factors (age and sex), number of comorbid, severity level and the duration of treatment on the cost of heart failure treatment and to investigate the difference of average cost for the heart failure patient’s treatment based on the rate of RSUD Dr. Moewardi with the rate of INA-DRG package. This research was descriptive according to the hospital perspective. The data collecting method was conducted retrospectively. The research subject was the patients who were hospitalized in class 3 and the member of Jamkesmas at RSUD Dr. Moewardi the period of 2009 who suffered from heart failure and fulfilled the inclusive requirement. The data analysis was done with cross tab and linear regression, the cost averate comparison and LOS. P value of statistic result test among sex, age, number of comorbid, severity level and treatment duration on the medical cost was 0.851, 0.960, 0.694, 0,621 and 0.000. The average of heart failure medical cost based on RSUD Dr. Moewardi rate on the level of severity I was Rp. 1,870,231 ± Rp.1,506,661, while on the level of severity II was Rp. 2,382,737 ± Rp. 2,132,236 and on the level of severity III was Rp. 2,513,826 ± Rp. 1,664,057. Riil ALOS on the level of severity I was 6.92 days, while on the level of severity II was 7.35 days and on the level of severity III was 8.10 days. The research result was that there was no relation between the patient’s character, number of comorbid, and severity level on the hospital medical cost, while the treatment duration had corelation with the medical cost. The average of heart failure treatment cost on the level of severity I, II, and III was lower compared to INA-DRG package rate. It shows that the hospital succeeds to use medical facilities efficiently so that the tarrif will not surpass it of INA – DRG. The cost gap becomes hospital’s income since it has succeeded to do an efficiency. While the difference of riil ALOS and ALOS INA-DRG was the highest on the level of severity III. It has showed that the hospital has done efficiency and has been able to decrease the duration of the heart failure inpatient treatment at the hospital.

Kata Kunci : INA-DRG, Gagal Jantung, Jamkesmas