ANALISIS BIAYA RAWAT JALAN HEMODIALISIS DAN PERITONEAL DIALISIS MANDIRI BERKESINAMBUNGAN PADA PESERTA ASKES DI PT. ASKES (PERSERO) DIVISI REGIONAL VI

IKA ERI HARYANI, dr. Ari Probandari, MPH, Ph.D.

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Gagal Ginjal Terminal membutuhkan Terapi Pengganti Ginjal (TPG). Gagal Ginjal Kronis (GGK) menjadi masalah kesehatan karena prevalensi yang terus naik dan menyerapan biaya kesehatan yang sangat tinggi. Terdapat dua macam TPG yang sering dipakai yaitu Hemodialisa (HD) dan Peritoneal Dialisis Mandiri Berkesinambungan (PDMB). Pada beberapa penelitian PDMB memiliki keunggulan yang lebih banyak dari pada HD. Namun hasil penelitian tersebut masih banyak kontroversi karena hasilnya sangat dipengaruhi oleh latar belakang negara dan sistem pembayaran pelayanan kesehatan. Tujuan: Mendiskripsikan biaya rata-rata rawat jalan yang dikeluarkan penjamin (asuransi) dan pasien pada terapi HD rutin dibandingkan dengan PDMB pada model pembiayaan tarif paket di PT. Askes (Persero) Divisi Regional VI. Metode: Penelitian ini penelitian observasional komparatif dengan rancangan diskriptif analitik. Data biaya diambil retrospektif melalui aplikasi Askes dan kuesioner. Rekam Medis dipakai untuk melacak penyebab GGK. Penelitian dilakukan pada 59 pasien HD dan 50 pasien PDMB di tiga pusat dialisis RS Pemberi Pelayanan Kesehatan (PPK) PT. Askes (Persero) Divisi Regional VI. Sampling dilakukan secara acak dengan sistem sampling konsekutif. Hasil dan Pembahasan : Median biaya medis asuransi HD Rp. 5.949.234,-/pasien/bulan sementara PDMB Rp.5.023.792,-/pasien/bulan. Median biaya medis dan non medis yang dikeluarkan oleh pasien HD adalah Rp. 287.208,-/pasien/bulan sementara pada pasien PDMB adalah Rp. 323.000,-/pasien/bulan. Hanya 30,5% pasien HD dan 22% pasien PDMB yang mengalami penurunan penghasilan. Hanya 10% pendamping pasien HD dan 6% pendamping PDMB yang mengalami penurunan penghasilan. Median penurunan penghasilan pasien dan pendamping pasien HD adalah Rp. 2.250.000,-/pasien/bulan sedangkan PDMB Rp.2.125.000,- /pasien/bulan. Kesimpulan: Median biaya medis asuransi pasien HD lebih tinggi dari PDMB. Median pengeluaran biaya pasien lebih rendah pada HD dari pada PDMB. Pada kelompok pasien dan pendamping pasien yang mengalami penurunan penghasilan, median penurunan penghasilan pasien dan pendamping pasien HD lebih tinggi dari pada PDMB.

Introduction: End Stage Renal Diseases (ESRD) becomes a serious healthcare problem because of the increasing prevalence of RRT and healthcare costs. ESRD patients need Renal Replacement Therapy (RRT). There are two types of RRT : Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Several previous studies showed that CAPD has more advantage than HD, but it was still debated. The treatment results were influenced by the background of the country and the healthcare cost system. Aims: The aim of the study was to compare between HD costs and CAPD cost covered by PT. Askes (Persero) or known as the insurance medical cost and out of pocket cost from the patients. Methods: This study was an observational comparative study with descriptive analytical design. The data of insurance cost was obtained from Askes data base, whereas the patient cost was taken by questionnaires. The subjects were 59 patients undergoing HD and 50 patients undergoing CAPD in the center of HD provided by PT. Askes (Persero) Regional Division VI. Random sampling was conducted with consecutive sampling system. Results: The median of HD insurance medical expense was Rp. 5.949.234/person/month, while CAPD was Rp. 5.023.792/person/month. There were also medical and non-medical cost paid by the patients. these median were Rp. 287.208/person/month for HD patients and Rp. 323.000/person/month for CAPD patients. 30,5 % of HD patients and 22 % of CAPD patients got their income decreased, whereas the patient family that got decreased their income were 10 % of HD patient family and 6 % of CAPD patient family. The median of the income reduction among HD patients and HD patient family was Rp. 2.250.000/person/month, whereas CAPD patients and CAPD patient family was Rp. 2.125.000/person/month. Conclusion: The median of HD insurance medical cost was higher than that of CAPD. Compared to CAPD, the median patient expense (medical and nonmedical) was lower in HD. The median of the income deduction among HD patients and HD patient family was bigger than the one in CAPD patient and CAPD patient family.

Kata Kunci : Hemodialisis, Peritoneal Dialisis Mandiri Berkesinambungan, Biaya Pelayanan Kesehatan, Analisis Biaya Kesehatan; Hemodialysis, Continuous Ambulatory Perytoneal Dialysis, Healthcare Costs, Cost-minimization Analyses