Abstrak: Rumah Sakit ABC Jakarta yang mulai bekerjasama dengan BPJS Kesehatan padaMei 2017, melihat kebutuhan untuk merekrut dokter spesialis full timer untuk menunjangpelayanan spesialistik pada era JKN. Dengan belum siapnya sistem tunjangan yang baikdi Rumah Sakit ABC Jakarta, maka diperlukan adanya suatu rancangan remunerasisebagai sistem tunjangan dokter spesialis di Rumah Sakit ABC Jakarta pada era JKN.Metode penelitian yang digunakan merupakan kombinasi antara penelitiankuantitatif dan kualitatif dengan menggunakan data primer dan sekunder. Data primerdidapat dari wawancara mendalam dan survey, sementara data sekunder diambil dari hasiltelaah dokumen. Penelitian ini menghasilkan rancangan sistem remunerasi untuk dokterspesialis yang diadaptasi dari Keputusan Menteri Kesehatan No. 625/Menkes/SK/V/2010dan Buku Panduan Remunerasi IDI tahun 2016, yang memperhatikan prinsip-prinsipremunerasi serta tiga komponen remunerasi (Pay for Position, Pay for Performance danPay for People).Kata kunci : rancangan remunerasi, remunerasi dokter, remunerasi di era JKN,remunerasi di rumah sakit swasta, prinsip remunerasi, komponenremunerasi.

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ABC Hospital Jakarta, which began to have an agreement with BPJS HealthInsurance in May 2017, saw the need to recruit full timer specialists to support specialistservices in the NHC era. With the absence of a good allowance system at ABC HospitalJakarta, it was necessary to have a design on remuneration for medical specialist as anallowance system at ABC Hospital Jakarta in the NHC era.The research method used was a combination of quantitative and qualitative studyusing primary and secondary data. Primary data obtained from in-depth interviews andsurveys, while secondary data was taken from the results of document review. This studyresulted in the design of a remuneration system for specialists adapted from the Ministerof Health Decree No. 625/Menkes/SK/V/2010 and IDI Remuneration Guidebook of2016, which taken into account the principles of remuneration and three components ofremuneration (Pay for Position, Pay for Performance and Pay for People).Keywords : remuneration design, remuneration for doctor, remuneration in NHC era,remuneration in private hospital, principles of remuneration, component ofremuneration.

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ABSTRAK Keberhasilan universal health coverage di Indonesia sangat ditentukan oleh utilisasi sumber daya yang efisien di rumah sakit. Variasi biaya yang tinggi untuk perawatan tertentu menunjukkan indikasi bahwa rumah sakit belum cukup efisien dalam memanfaatkan sumber dayanya untuk menyediakan pelayanan. Length of stay (LOS) adalah salah satu faktor penting penentu biaya yang banyak digunakan sebagai indikator efisiensi rumah sakit dalam penggunaan sumber daya. LOS dan biaya perawatan dipengaruhi oleh banyak faktor, baik yang merupakan karakteristik pasien maupun faktor terkait manajemen di rumah sakit. Penelitian ini bertujuan untuk mengidentifikasi seberapa besar hubungan antara karakteristik pasien dengan variasi LOS dan biaya perawatan,dan mengetahui gambaran penerapan clinical pathway sebagai upaya kendali mutu dan biaya pada pasien JKN rawat inap di RSUP Fatmawati dari tahun 2015 – September 2017. Hasil penelitian menunjukkan bahwa variasi usia, jumlah diagnosis, jumlah prosedur dan kelas rawat hanya dapat menjelaskan sedikit variasi LOS dan biaya perawatan (R 2 <34%). Sementara itu clinical pathway sebagai salah satu pendekatan manajemen untuk kendali mutu dan biaya belum diterapkan secara optimal. Berbagai upaya kreatif perlu dilakukan manajemen antara lain implementasi care plan, difungsikannya kembali case manager, pengisian CP secara elektronik dan identifikasi inefisiensi dalam pelayanan menggunakan data unit cost rumah sakit. Kata kunci: Length of stay (LOS), biaya (costs), efisiensi, clinical pathway, CMG

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ABSTRACT Efficient use of resources in hospitals will contribute to successful implementation of universal health coverage in Indonesia. Substantial variation in hospital costs for certain diagnosis or procedure is an indication of resource use inefficiency. Length of stay is a well-accepted measure of resource utilization and a key driver to hospital costs. Variation in LOS and costs can be influenced by patient demographic and clinical factors that are outside a hospital’s control, in the meanwhile there are also factors within the control of a hospital. This research focuses on five Casemix Main Groups and aims to identify how patient characteristic factors contribute to variation in LOS and costs, and to investigate qualitatively the implementation of Clinical Pathway as a management approach to control LOS as well as hospital costs for JKN patients at RSUP Fatmawati, a class-A teaching hospital in Jakarta, from 2015 to September 2017. The result indicates that the variance in LOS and cost is not significantly correlated to patient’s age, number of diagnoses, number of procedures and room types as independent variables. The hospital has numerous clinical pathways that have not been optimally implemented yet for LOS and cost control. This research provides information for hospital management team to improve LOS performance by implementing care planning, intensive case management and to use cost data for identification of inefficiency of certain types of care. Keywords: Length of stay (LOS), costs, efficiency, clinical pathway, CMG

Abstrak: Tesis ini membahas kelayakan dan kesiapan Rumah Sakit (RS) Awal Bros Panam di Pekanbaru menjadi RS Kelas B di era Jaminan Kesehatan Nasional (JKN). Standar pelayanan, SDM, peralatan dan sarana prasarana yang dimiliki RS saat ini telah melebihi standar RS kelas C. Perubahan sistem pembayaran fasilitas kesehatan menjadi prospective payment dengan Indonesian Case based group (INACBG), menetapkan tarif INACBG RS kelas B lebih tinggi daripada RS kelas C. Desain penelitian adalah operasional (operational research) dengan mengumpulkan data primer dan sekunder dari RS Awal Bros Panam, RS Awal Bros Pekanbaru dan Badan Penyelenggara Jaminan Kesehatan (BPJS) Cabang Pekanbaru. Tahap pertama penelitian adalah penilaian kelayakan perubahan kelas RS dengan menggunakan standar Permenkes no 56 tahun 2014. Kemudian tahap kedua menilai kesiapan rumah sakit melalui analisis situasi era JKN dengan membandingkan jumlah kasus dan klaim INACBG antara RS Kelas C dan Kelas B. Hasil penelitian menunjukkan RS Awal Bros Panam telah layak dan siap untuk berubah menjadi RS kelas B berdasarkan standar pelayanan, SDM, peralatan dan bangunan serta sarana prasarana. Namun masih tetap harus melengkapi beberapa kekurangan pada standar-standar tersebut. Ruang lingkup analisis situasi masih berfokus pada aspek internal sehingga perlu dipertimbangkan lebih lanjut analisis kondisi eksternal RS seperti kebijakan Pemerintah dan Kebijakan BPJS Cabang Pekanbaru untuk benar-benar memastikan kelayakan dan kesiapan RS. Kata kunci : Rumah sakit, kelayakan dan kesiapan, Rumah sakit kelas C, Rumah sakit kelas B, Jaminan Kesehatan Nasional. This thesis discusses the feasibility and ability of Awal Bros Panam Hospital to become class B hospital by considering National Health Insurance era. The current standard of services, human resources, equipment and infrastructure owned by hospital has exceeded the standard of class C hospital. Changes in payment system with prospective payment known as INACBG, determine INACBG rate for class B Hospital is higher than the class C hospital. This study is an operational research, by collecting primary and secondary data from Awal Bros Panam Hospital, Awal Bros Pekanbaru Hospital and Badan Penyelenggara Jaminan Kesehatan (BPJS) Pekanbaru branch. The first stage of the study is by assessing the feasibility of the changes using the regulation from Ministry of Health number 56, 2014. The second stage is by assessing the ability of hospitals through the situational analysis which comparing the number of cases and claims INACBG between Class C hospital and Class B hospital. The results showed Awal Bros Panam hospital has been feasible and able to become class B hospital based on the standard of services, human resources, equipment, buildings, and infrastructure. However there are some standards that still must be completed. The further analysis of external conditions such as the Government and BPJS policies must be considered to ascertain feasibility and ability of Awal Bros Panam Hospital to become class B hospital. Keywords: Hospitals, feasibility and ability, class C Hospital, class B Hospital, the National Health Insurance.