Upaya efisiensi pemeriksaan penunjang diagnosis pada pasien rawat jalan peserta ASKES Sosial di RSUP Dr. Soeradji Tirtonegoro Klaten

Suharyanto, dr. Sigit Riyarto, M.Kes

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Upaya efisiensi pemeriksaan penunjang diagnosis bagi pasien askes sosial rawat jalan di rumah sakit sangat diperlukan karena klaim yang didapat umumnya lebih rendah dari biaya pemeriksaan. Order pemeriksaan perlu dikendalikan agar biaya yang dikeluarkan rumah sakit berkurang. Upaya pengendalian telah dilakukan oleh RSUP. dr Soeradji Tirtonegoro, upaya itu perlu dinilai efektifitasnya. Tujuan: Mengukur efektifitas upaya efisiensi dan menjelaskan faktor yang menghambat upaya efisiensi pemeriksaan penunjang diagnosis. Metode : Jenis penelitian adalah penelitian quasi experimental study dengan rancangan pretest dan posttest (one group pretest - posttest design). Penelitian dilakukan dengan mengamati order pemeriksaan penunjang diagnosis sebelum dan sesudah intervensi upaya efisiensi kepada 40 dokter poliklinik. Bentuk intervensi berupa pemberian: Surat Edaran Manajer, Reminding Sheet di poliklinik, dan Feedback kepada dokter. Hasil: Penelitian dilakukan dengan melihat data 683 order pemeriksaan penunjang diagnosis pasien askes rawat jalan (243 laboratorium, 384 radiodiagnosis, 56 USG) sebelum dan sesudah intervensi. Ternyata tidak terjadi penurunan biaya yang dikeluarkan rumah sakit untuk total order pemeriksaan setelah intervensi, sehingga dikatakan tidak terjadi efisiensi walaupun uji statistik dengan t-test menunjukan p-value sebesar (laboratorium 0,009, radiodiagnosis 0,000, USG 0,040) lebih kecil dari 0,05. Faktor yang menghambat upaya efisiensi adalah: 1) Tingkat pemahaman dokter terhadap aturan askes masih rendah 2) Adanya order pemeriksaan yang belum diakomodir di dalam PKS. 3) Indikasi medis mengharuskan pemeriksaan dilakukan walaupun biaya tidak semua ditanggung. 4) Dokter merasa terganggu otoritasnya dalam meminta pemeriksaan penunjang diagnosis. 5) Tidak melibatkan dokter secara aktif membuat guideline baru.6) Ketidakpatuhan dokter.

Background: Efforts to achieve efficiency in diagnostic support examination for outpatient health insurance service is needed because the claimed received is generally lower than the cost of examination. Order of diagnostic support examination has to be controlled to minimize hospital expenditure. Efforts to control has been done by dr. Soeradji Tirtonegoro hospital and its effectiveness needs to be assessed. Objective: To assess effectiveness of efforts to maintain efficiency and identify factors that inhibited efforts to maintain efficiency in diagnostic support examination. Method: The study was a quasi experiment that used one group pre test- post test study design. Study is done by watching the order of supporting diagnosis examination before and after intervention to maintain efficiency made to 40 doctors polyclinics. Intervention is given in the form of distribution of circular issued by the manager, reminder sheet at the polyclinic and feedback to the doctor. Results: Study is done by watching the 683 orders of supporting diagnosis examination of outpatient (243 laboratory, 348 radiodignostics, 56 USG) before and after intervention. Evidently, there is no decreasing examination cost totally so it cannot be called as efficiency althogh statistical test using t-test showed p-value (laboratory 0,009, radiodiagnostic 0,000, USG 0,040) less than 0,05. Factors inhibiting efforts for efficiency are 1) The understanding of doctors to the health insurance rules is low; 2) The order for examination that has not been accommodated in the agreement; 3) Medical indication requires that examination is done altough not all of the cost is freely charged; 4) Doctors are disturbed in their authority to ask for diagnostic support examination;5) Doctors are not actively involved in the making of new guideline; 6) Disobidience of doctors. Conclusion: Interventions in the form of distribution of circular issued by manager, reminder sheet at polyclinics, and feedback to the doctor didn’t work effectively. It needs another intervention or renegotiation with insurance company.

Kata Kunci : efisiensi- penunjang- diagnosis- askes