Analysis of Differences Between Hospital Rates and INA-CBG's Claim of Sectio Caesarea

Afriliya Hayati; Savitri Citra Budi; Ika Aria Dani

doi:10.21070/pels.v6i1.1924

(1) * Afriliya Hayati Health Information Management Universitas Gadjah Mada Yogyakarta
Indonesia
(2) Savitri Citra Budi Health Information Management Universitas Gadjah Mada Yogyakarta
Indonesia
(3) Ika Aria Dani Bhayangkara Polda DIY Hospital Yogyakarta
Indonesia
(*) Corresponding Author

DOI: https://doi.org/10.21070/pels.v6i1.1924

Abstract

Hospitals as advanced referral facilities have an important role in implementing the National Health Insurance (JKN) programme. For payment of advanced health services for JKN participants at the hospital, BPJS makes payments based on the Indonesian case-based groups (INA-CBG's) package. However, the problem that is often found in hospitals is the difference between hospital rates and INA-CBG's claim. This study aims to determine and analyse the difference between hospital rates and INA-CBG's claim for sectio caesarea cases at Bhayangkara Polda DIY Hospital. This study was a descriptive quantitative study with a retrospective approach. The object of the study was the BPJS patient's inpatient claim file for sectio caesarea cases at Bhayangkara Polda DIY Hospital in the fourth quarter of 2023. The number of samples was 39 patients using the total sampling technique. The results showed a significant difference (p< 0,05) between hospital rates and INA-CBG’s claim for sectio caesarea cases at Bhayangkara Polda DIY Hospital. The difference between hospital rates and INA-CBG’s claim caused a negative difference of Rp.10,865,028,00. There is a negative difference between the hospital rates and the INA-CBG's claim for sectio caesarea cases at Bhayangkara Polda DIY Hospital, so the hospital suffers a loss.

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References

[1] Irwandy I. Kajian Literature: Evaluasi Pelaksanaan Program Jaminan Kesehatan Nasional di Indonesia. Jurnal Kebijakan Kesehatan Indonesia: JKKI 2016;5:110–4.
[2] Kementerian Kesehatan Republik Indonesia. Buku Panduan Jaminan Kesehatan Nasional (JKN) Bagi Populasi Kunci. Jakarta: 2016.
[3] Rahayuningrum IO, Tamtomo D, suryono A. Comparison Between Hospital Inpatient Cost and INA-CBGs Tariff of Inpatient Care in the National Health Insurance Scheme in Solo, Boyolali and Karanganyar Districts, Central Java. Journal of Health Policy and Management 2016;01:102–12. https://doi.org/10.26911/thejhpm.2016.01.02.05.
[4] Monica RD, Firdaus FM, Lestari IP, Suryati Y, Rohmayani D, Hendrati A. Analisis Perbedaan Tarif Riil Rumah Sakit dengan Tarif Ina-CBG’s Berdasarkan Kelengkapan Medis Pasien Rawat Inap pada Kasus Persalinan Sectio Caesarea guna Pengendalian Biaya Rumah Sakit TNI AU Dr. M. Salamun Bandung. Jurnal Manajemen Informasi Kesehatan Indonesia 2021;9:96. https://doi.org/10.33560/jmiki.v9i1.289.
[5] Sulistiadi W, Sangadji I. Strategi Atasi Perbedaan Unit Cost Sectio Caesaria dengan Klaim berdasarkan Tarif INA-CBG’s pada Pasien BPJS di Rumah Sakit Khusus Ibu Dan Anak Bunda Liwa. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) 2019;3:142–54.
[6] Munawaroh R, Sulistiadi W, Rachmad. Perbedaan Tarif INA–CBG’s Dengan Tarif Riil Rumah Sakit Pada Pasien BPJS Kasus Stroke Iskemik Rawat Inap Kelas I Di RS PON Tahun 2018. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI) 2019;3:155–64.
[7] Kismarahardja JS, Lorensia A, Suryadinata RV. Analysis of Differences in Riil Costs of Hospital with INA-CBG’S Rate in Sectio Caesarea. Teikyo Medical Journal 2021;44:2259–69.
[8] Aisyah N, Andayani TM, Puspandari DA. Analisis Biaya Kemoterapi Pada Pasien Rawat Inap Kanker Payudara Peserta JKN di RSUD Ulin Banjarmasin. Jurnal Ilmiah Ibnu Sina 2018;3:333–42.
[9] Utami YT, Fanny N. Faktor Penyebab Perbedaan Selisih Klaim Negatif Tarif Ina-Cbgs dengan Tarif Riil di RSUD Dr. Moewardi. Jurnal Sains Dan Kesehatan 2021;3:492–9. https://doi.org/10.25026/jsk.v3i3.605.
[10] Khoiriah A. Hubungan Antara Usia dan Paritas Ibu Bersalin dengan Bayi Berat Lahir Rendah (BBLR) di Rumah Sakit Islam Siti Khadijah Palembang. Jurnal Kesehatan 2017;8:310–4.
[11] Wahyuni R, Rohani S. Faktor-faktor yang berhubungan dengan riwayat persalinan sectio caesarea. Wellness And Healthy Magazine 2019;1:101–7.
[12] Agiwahyuanto F, Widianawati E, Wulan WR, Putri RB. Tarif rumah sakit dengan tarif Ina-CBGs pasien rawat inap. HIGEIA (Journal of Public Health Research and Development) 2020;4:520–32.
[13] Karminingtyas SR, Oktianti D, Furdiyanti NH. KEEFEKTIFAN PENGGUNAAN ANTIBIOTIK PROFILAKSIS PADA PASIEN BEDAH SESAR (SECTIO CAESAREA). Cendekia Journal of Pharmacy 2018;2:22–31. https://doi.org/10.31596/cjp.v2i1.14.
[14] Muslimah AT, Pinzon R, Endarti D. Perbandingan Biaya Riil Terhadap Tarif INA-CBG’s Penyakit Stroke Iskemik di RS Bethesda Yogyakarta [Comparison of Real Costs Against INA-CBG’s Ischemic Stroke Rates at Bethesda Hospital Yogyakarta]. Jurnal Manajemen Rumah Sakit Universitas Gajah Mada 2017;7.
[15] Kusuma AAMW, Ariawati K. Penelitian Perbedaan Tarif Riil dan INA-CBG’s Penyakit Talasemia di Ruang Perawatan Anak RSUP Sanglah Bali Tahun 2017. Jurnal Penelitian Dan Pengembangan Pelayanan Kesehatan 2018:95–101. https://doi.org/10.22435/jpppk.v2i2.171.
[16] World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision Volume 2 Instruction Manual Fifth Edition 2016. vol. 2. World Health Organization; 2016.
[17] Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 76 tahun 2016 tentang Pedoman Indonesian Case Base Group (INA CBG) dalam Pelaksanaan Jaminan Kesehatan Nasional. Jakarta: 2016.
[18] Nugraheni WP, Mubasyiroh R, Hartono RK. The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery services in Indonesia. PLoS One 2020;15:e0235176. https://doi.org/10.1371/journal.pone.0235176.
[19] Nilansari AF, Yasin NM, Puspandari DA. Analisis Tarif INA-CBGs Pasien Hipertensi Rawat Inap di Rumah Sakit Umum Daerah Panembahan Senopati. Indonesian Journal of Clinical Pharmacy 2021;10:22. https://doi.org/10.15416/ijcp.2021.10.1.22.
[20] Surya R, Gani A, Saroyo YB. Hospital Cost vs INA-CBGs Claim for Obstetrics Procedure In Soe Rural General Hospital, East Nusa Tenggara. Indonesian Journal of Obstetrics and Gynecology 2023.
[21] Astuti ND, Irmawati I, Apifah A. Analisis Tarif Rumah Sakit dan Tarif Ina CBGs Kasus Gagal Jantung Kongestif. Jurnal Rekam Medis Dan Informasi Kesehatan 2021;4:44–51. https://doi.org/10.31983/jrmik.v4i1.6788.