Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit di bawah sistem pembayaran INA-CBGs. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INA-CBGs dan global budget yang mulai diujicobakan. Penelitian ini dilakukan dengan tujuan untuk menganalisis capaian dan determinan indikator casemix, casemix index dan hospital baserate RSPG Cisarua Bogor selama tahun 2017 – 2022. Penelitian akan dilakukan selama bulan Mei – Juni 2023 oleh peneliti langsung di RSPG Cisarua Bogor. Analisis capaian indikator casemix, casemix index dan hospital baserate rumah sakit menggunakan data sekunder yang didapatkan dari rekapitulasi data pada elektronik klaim (e-klaim) Kementerian Kesehatan. Determinan yang berpengaruh terhadap ketiga indikator yang dihitung dalam penelitian ini akan dianalisis secara crossectional melalui pendekatan analitik kuantitatif dari data sekunder berupa e-klaim dan laporan rumah sakit. Uji statistik berupa uji korelasi dan regresi linier sederhana digunakan untuk melihat determinan yang berkaitan dengan indikator casemix, casemix index dan hospital baserate. Hasil penelitian menunjukkan tren casemix rawat jalan dan rawat inap tahunan RSPG mengalami penurunan dari 2017 hingga 2021 seiring dengan penurunan jumlah kasus. Penurunan pada tahun 2020 dan 2021 diakibatkan adanya penurunan jumlah kasus yang signifikan selama pandemi Covid-19. Nilai casemix di tahun 2022 kembali naik seiring membaiknya kondisi pandemi di Indonesia. Capaian casemix index rawat jalan dan rawat inap RSPG Cisarua lebih rendah bila dibandingkan dengan rata-rata capaian casemix index RS Pemerintah Kelas A di regional I. Terjadi kenaikan casemix index saat pandemi Covid-19 dikarenakan masyarakat berobat dalam keadaan lebih parah di saat pandemi. Hospital baserate rawat jalan RSPG tahun 2017 dan 2021 masih berada di bawah tarif nasional, sedangkan tahun 2018, 2019, 2020, dan 2022 hospital baserate lebih tinggi dibandingkan tarif nasional. Hospital baserate rawat inap RSPG secara konasisten lebih tinggi dibandingkan tarif nasional. Artinya biaya yang dikeluarkan rumah sakit lebih tinggi dibandingkan tarif yang dibayarkan oleh BPJS dalam menangani kasus dengan nilai cost weight=1. Terdapat 5 variabel yang bernilai signifikan dengan p<0,05 terhadap casemix rawat jalan, yakni jumlah kasus, jumlah klinik rawat jalan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Variabel yang berkorelasi secara statistik terhadap casemix rawat inap adalah jumlah kasus, severity level II dan III, lama hari perawatan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Jumlah klinik rawat jalan dan proporsi beban pegawai memiliki hubungan dengan capaian casemix index rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, serta jumlah dokter spesialis yang praktek di rumah sakit secara statistik berpengaruh terhadap capaian casemix index rawat inap. Hospital baserate di rumah sakit dihitung dengan membagi total biaya dengan casemix. Jumlah klinik rawat jalan, jumlah dokter spesialis, dan proporsi beban pegawai memiliki hubungan (p<0,05) terhadap hospital baserate rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, dan proporsi beban pegawai merupakan determinan yang teridentifikasi terhadap hospital baserate rawat inap.
Casemix, casemix index and hospital baserate are important indicators to evaluate hospital performance under the INA-CBGs payment system. These indicators are the basis for the INA-CBGs tariff rates, the instrument for assessing the performance of BPJS Kesehatan partner hospitals and the constructing instrument of mixed method global budget claim payments for INA-CBGs which has begun to be trialled. This research was conducted to analyze the achievements and determinants of casemix, casemix index and hospital baserate RSPG Cisarua Bogor from 2017 to 2022. The research conducted on May - June 2023 at RSPG Cisarua Bogor. Analysis of the achievement indicators for casemix, casemix index and hospital base rate uses secondary data obtained from Ministry of Health's electronic claims (e-claims). The determinants that affect the indicators will be analyzed cross-sectionally through a quantitative analytical approach from secondary data form e-claims and hospital reports. Correlation and simple linear regression were used to see whether the determinants related to the casemix, casemix index and hospital baserate indicators. The results showed that the casemix trend for outpatient and inpatient at RSPG had decreased from 2017 to 2021 along with the number of visits. The decline in 2020 and 2021 was due to a significant decrease in the number of visits during the Covid-19 pandemic. The casemix in 2022 increased as the pandemic conditions improved in Indonesia. The casemix index for outpatient and inpatient care at RSPG Cisarua were lower than the average casemix index for Class A Government Hospitals in regional I. RSPG outpatient hospital baserate in 2017 and 2021 is still below the national rate, while the other years are higher. RSPG's hospital base rate of inpatient care is consistently higher than the national rate. This means that the costs incurred by the hospital are higher than the rates paid by BPJS in handling cases with cost weight = 1. There are 5 variables that have significant value with p <0.05 for outpatient casemix; the number of visits, the number of outpatient clinics, the number of specialist doctors, the ratio of staff expenses, and the ratio of depreciation expense. Variables that correlate statistically with inpatient casemix are number of visits, severity level II and III, length of stay, number of specialist doctors, ratio of staff expenses, and ratio of depreciation expense. The number of outpatient clinics and the ratio of staff expenses have a relationship with the outpatient casemix index. The number of visits, severity levels I and III, length of stays, and the number of specialists practicing at the hospital statistically affect the achievement of the casemix index hospitalization. The number of outpatient clinics, the number of specialist doctors, and the ratio of staff expenses had a relationship (p<0.05) to the outpatient hospital base rate. The number of visits, severity level I and III, length of stay, and the ratio of staff burden are the identified determinants of the hospital base rate of hospitalization.
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