Description Of Characteristics, Diagnosis And Financing Of BPJS Patients In ENT Poly Health Service Facility Level 2

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Andi Roesbianto
Budhi Setianto
Agus Aan Adriansyah
Akas Yekti Pulih Asih
Eppy Setiyowati
Difran Nobel Bistara
Nikmatus Sa'adah

Abstract

The application of tariff applied in handling BPJS patients references the INA- CBGs and the payment model used by BPJS Kesehatan to replace the total bill by the hospital. Hospitals receive payments based on the INA- CBGs rate, which is the average cost spent by a group of diagnoses. It is expected to improve the quality and efficiency of hospitals. The benefit of implementing INA -CBGs in JKN is the tariffs in the form of packages cover all components of hospital costs. Cost efficiency efforts must be made. That is no deficit from the applicable INA-CBGS tariff. Quality and cost control efforts are very important in the implementation of ENT specialist poly services. This study aims to analyze the demographic characteristics of the patient, the patient's diagnosis, the difference in rates between INA CBGS payments and RSIS rates, the composition of financing and the Unit Cost of ENT Polyclinics. The research type is quantitative observational with cross-sectional design. The research location is at the Surabaya Islamic Hospital with BPJS TXT data, processing in January-December 2019. The results showed, the demographic characteristics of most patients were > 50 years old, and most of them were diagnosed with minor chronic diseases. The difference between Ina-CBGS payments and RSIS rates is Rp. 60,174 which means that each patient contributes a profit of Rp. 60,174. The composition of the financing for implementation of the ENT Polyclinic is the cost of consulting services. The unit cost of ENT Polyclinic patients is Rp. 132,774 per patient.

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How to Cite
Roesbianto, A., Budhi Setianto, Adriansyah, A. A., Pulih Asih, A. Y., Setiyowati, E., Bistara, D. N., & Sa’adah, N. (2022). Description Of Characteristics, Diagnosis And Financing Of BPJS Patients In ENT Poly Health Service Facility Level 2. Medical Technology and Public Health Journal, 6(2), 169–176. https://doi.org/10.33086/mtphj.v6i2.3081

References

  1. Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. (2015). Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 2 Tahun 2015 tentang norma penetapan besaran kapitasi dan pembayaran kapitasi berbasis pemenuhan komitmen pelayanan pada fasilitas kesehatan tingkat pertama. Animal Genetics, 39(5), 561–563.
  2. Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. (2016). : Koding Ina CBGS PMK 75, 2016 (Vol. 1, pp. 1–28). BPJS Kesehatan.
  3. Basuki. (2016). Implementasi Kebijakan Jaminan Kesehatan Nasional oleh BPJS Kesehatan di Kota Semarang. Diponegoro Journal Of Social And Political Of Science Tahun 2016, 5(4), 1–11.
  4. BPJS Kesehatan. (2014a). Panduan Praktis Teknis Verifikasi Klaim. Menteri Kesehatan Republik Indonesia, 1–11.
  5. BPJS Kesehatan. (2014b). PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 59 TAHUN 2014.
  6. BPJS Kesehatan. (2015). Siaran Pers Pahami Lebih Dalam tentang Sistem Rujukan Berjenjang dan Pola Pembayaran BPJS Kesehatan ke Faskes. Departemen Komunikasi Dan Hubungan Masyarakat BPJS Kesehatan Kantor Pusat, 2015.
  7. Fitriani, A. (2017). Analis Unit Cost Puskesmas di Era Jaminan Kesehatan Nasional (JKN) Studi pada Puskesmas Kedung kandang Kota Malang. Jurnal Ilmiah Mahasiswa FEB, 5(1).
  8. Indonesia, K. K. (2012). STANDAR KOMPETENSI DOKTER INDONESIA (Konsil Kedokteran Indonesia (ed.); Kedua).
  9. Indrianingrum, I., & Handayani, O. W. K. (2017). Input Sistem Rujukan Badan Penyelanggara Jaminan Sosial ( BPJS ) Kesehatan di Fasilitas Kesehatan Tingkat Pertama ( FKTP ) Kabupaten Jepara STIKES Muhammadiyah Kudus , Indonesia Abstrak. Scientific Journal of Unnes, 2(2).
  10. Kementerian Kesehatan Republik Indonesia. (2004). UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 40 TAHUN 2004 TENTANG SISTEM JAMINAN SOSIAL NASIONAL.
  11. Kementerian Kesehatan Republik Indonesia. (2013). Permenkes No 71 Tahun 2013 (Vol. 53, Issue 9).
  12. Ministry of Health Republic Indonesia, 2016. (2016). Indonesian Case Based Groups (INA-CBG’s) dan non Indonesian Case Based. Peraturan Menteri Kesehatan Republik Indonesia Nomor 52 Tahun 2016 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan.
  13. Perpres No. 12 tahun 2013. (2013). Perpres No. 12 tahun 2013 (p. 39). Kementrian Kesehatan.
  14. Racmayanti, L. (2017). GAMBARAN PELAKSANAAN SISTEM PELAYANAN PASIEN RUJUKAN RAWAT JALAN PELAYANAN TINGKAT II PADA PASIEN PESERTA BPJS DI RUMAH SAKIT AL ISLAM BANDUNG. Universitas Islam Negeri Syarif Hidayatullah.
  15. Romliyadi, & Oxyandi, M. (2018). Indeks Kepuasan Pasien BPJS Kesehatan di Instalasi Rawat Jalan Tahun 2018. Babul Ilmi Jurnal Ilmiah Multi Science Kesehatan, 8, 1–13.
  16. Setiawati, M. E., & Nurrizka, R. H. (2019). Evaluasi Pelaksanaan Sistem Rujukan Berjenjang dalam Program Jaminan Kesehatan Nasional. Jurnal Kebijakan Kesehatan Indonesia : JKKI, 8(1), 35–40.
  17. Suharmiati, S., Handayani, L., & Roosihermiatie, B. (2019). Analisis Biaya Obat Unit Rawat Jalan pada Rumah Sakit Badan Layanan Umum (BLU)/ Badan Layanan Umum Daerah (BLUD) di Indonesia. Jurnal Kefarmasian Indonesia, 126–139. https://doi.org/10.22435/jki.v9i2.1369 DOI: https://doi.org/10.22435/jki.v9i2.1369