Abstrak: POSTGRADUATE PROGRAM PUBLIC HEALTH SCIENCE STUDIES HEALTH ECONOMIC AND INSURANCE THESIS, August 2005 Roxanna Kuswandhani SELF-EXPENSE (OUT-OF-POCKET) VARIATION DETERMINANT OF IN-PATIENT SERVICES FOR COMPULSORY HEALTH INSURANCE MEMBERS IN CILEGON GENERAL HOSPITAL IN 2004 xv + 77 pages + 12 tables + 1 appendix ABSTRACT Based on the Government Regulation No. 69/91, PT (Persero) Askes is permitted to charge cost sharing to health insurance (Askes) members. The mistake in financing system implemented is that all premiums are carried on by the members. However, in practice, guarantees provided for the members are emphasized more on medical treatment and recovery by charging quite lots of cost sharing, though the services are delivered in Health Service Provider (PPK) net appointed. Consequently, civil servants still have to pay quite lots of self-expense (out-of-pocket). This causes chronic problem for social health insurance in Indonesia, which lead to complaints and blasphemies. Cilegon General Hospital implements health service tariff based on Cilegon Administrative Regulation. The tariff is higher than tariff packet released by PT (Persero) Askes based on a Joint Decree. To avoid more subsidies, compulsory health insurance members who utilize health services in the hospital have to pay by themselves (out-of-pocket) amounting the rest of health service tariff reduced by expense guaranteed by Askes plus Non-DPHO drug cost. This research was carried out in Cilegon General Hospital. The research object is Self-expense (Out-of-Pocket) Variation Determinants of In-Patient Services for Compulsory Health Insurance Members in Cilegon General Hospital in 2004. Data are from the 2004 in-patient register of compulsory health insurance members of Cilegon General Hospital, the 2004 compulsory health insurance member in-patient payment bill, at Cilegon General Hospital finance division, and the 2004 drug usage and prescription report of compulsory health insurance member in-patients of Cilegon General Hospital This research is an analytical survey using quantitative cross sectional approach. Dependent and independent variables are measured simultaneously. The result indicates that of 240 patient populations, self-expense (out-of-packet) variable has an average value of 671,719 rupiahs, with deviation standard 842,414 rupiahs and median 265,143 rupiahs. Meanwhile, the lowest self-expense (out-of-pocket) is 0 rupiahs and the highest is 5,683,925 rupiahs. Using bivariate analysis, variables related to self-expense (out-of-pocket) are age, officialdom level, education level, medical treatment pattern, medical care class choice, and length of care. The last modeling in multivariate analysis using double linear regression analysis yielded self-expense (out-of-pocket) =4.908+0.06*length of care + 0.156*local administration subsidies – 0.683*medical treatment pattern + 0.579*medical care class choice + 0.472*education 2(D3)-0.323 level (officialdom level II). It is recommended that PT Askes evaluate the determination of packet tariff and DHPO drugs periodically, disseminate medical treatment packets and medical care classes appropriate for their level/right and advocate PPK the proportional medical treatment days. It is also recommended for the next research to obtain more complete information on how much the expense for non-DHPO drugs is from respondents. It is hoped that Cilegon General Hospital provide qualified services in spite of different medical service class, upgrade their data so that they can help education, research and development of health. References: 42 (1985—2005)

Abstrak:

Sakit merupakan suatu kejadian yang tidal: dapat diduga kapan akan menimpa seseorang. Biaya yang harus dikeluarkan juga cukup bcsar khususnya untulc rawat inap. Untuk rnengurangi beban biaya yang dilimbulkannya, salah satu cara untuk mcntransfer resiko biaya dengan memiliki asuxansi kesehatan. PT. Askes merupakan salah satu asuradur yang wajib dimiliki oleh pcgawai negeri sipil tetapi dalam pelaksanaannya, peserta masih harus mengeluarkan beban biaya sencliri (our ofpocket) karena adanya perbcdaan antara biaya sesuai tarif rumah sakit dengan tarif paket Askes. Beberapa penelitian membuktikan kondisi tersebut, sepeni di RS PMI Bogor, RSUD Kota Cilegon dan RS Persahabatan Jakarta. Sedangkan di RSUD dr. Achmad Diponegoro - Putussibau, Kabupatcn Kapuas Hulu - Kalimantan Barat belum pernah diteliti. Studi ini dilakukan untuk mengetahui gambaran, faktor-faktor apa yang mempengaruhi dan faktor mana yang paling mempengaruhi serta model prcdiksi beban biaya sendiri (our of packcl) pasien rawat inap pegerla Askcs di RSUD dr. Achmad Diponegoro-Putussibau, Kabupatcn Kapuas Hulu, Propinsi Kalimantan Barat, tahun 2005. Rancangan penelitian ini cross sectional dengan sampel sebesar 257 pasien rawat inap di RSUD dr. Achmad Diponegoro - Putussibau, Kabupaten Kapuas I-lulu - Kalimantan Barat tahun 2005. Rata-rata beban biaya sendiri (out of pocket) pasien rawat inap pcserta Askes di RSUD dr. Achmad Diponegoro sebesar Rp. 2l5,472,76 atau 20,84 % dari rata-rata pengeluaran biaya perawatan sesuai tariff RSUD. Bcban minimum sebesar Rp. 25.000,- penyakit penyulit, obat-obatan, pesertal (peserta), peserta3(isteri), pegawail(golongan I), interaksi antara lama hari rawat dengan penyakit penyulit dan interaksi antara penyakit penyulit dengan obat-obatan dimana interaksi antara lama hari rawa dengan penyakit penyulit merupakan faktor yang paling mempengaruhinya (nilai B yang tcrtinggi yakni sebesar 0,624). Setelah dilakukan uji asumsi dan uji interaksi, maka diperoleh model prediksi beban biaya sendiri = 5,743 + 0,3l3*|ama hari rawat - 0,785*tidak ada penyakit penyulit + 0,8l9*obat~obatan (Non DPHO) + 67,39'7*peserta1 + 0,179*peserta3 + l,489*pegawail + 0,26O*Interaksi penyakit penyulit dengan Obat-obatan + 37,353*Imeraksi Iama hari mwat dengan Penyakit Penyulit. Diharapkan pihak manajemen RSUD dapat menghitung tarif RSUD sesuai kondisi riil sehingga dapat digunakan sebagai bahan masukkan ke Pemda Kabupaten Kapuas Hulu untuk menetapkan kebijakan tarif dan pcmberian subsidi ke RSUD khususnya untuk golongan 1, melakukan advokasi pada PT. Askes, menyarankan penggunaau obat-obatan DPI-10 dan diharapkan juga PT. Askes dapat mempenimbangkan untuk menyesuaikan pemberian manfaat kepada. pescrta khususnya untuk pcserta dengan status kepegawaian golongan 1 yaitu bcrupa penyesuaian tarif PT. Askes sesuai dengan situasi dan kondisi rumah sakit.

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No ones could predict when they would get sick. There will be some significant amount of expenses to be paid during the time of being hospitalized. In order to reduce the amount of expenses a patient should pay, to minimalize risk of cost by having health insurance is a way of working it out. PT Askes is one of the health insurance providers which its membership is a mandatory for every public service officers in Indonesia. Yet, in the reality, a patient still have to cover some oi' his or her expenses hom his or her pocket, due to the differences between hospital fare and the expenses that is covered by Askes. Some researches bring forward eveidenoes regarding this issue, in example researched conducted in PMT hospital in Bogor, District Hospital of Cilcgon City, and Persahabatan hospital in Jakarta. While in Kapuas I-lulu District, dr. Achmad Diponegoro Hospital in Putussibau, West Kalimantan Province, such research has not been conducted yet. This researched is to find out the influence factors, the most influence factor, and the prediction model of out of pocket of hospitalized patient with Askcs membership at dr. Achmad Diponegoro Hospital in Putussibau, Kapuas I-lulu District, West Kalimantan Province in 2005. This researched design is cross sectional, using 257 sample of hospitalized patients in dr. Achmad Diponcgoro Hospital in Putusibau, Kapuas Ilulu District, West Kalimantan Province during the year of 2005. The average amount of out of pocket self cost of each patient is Rp 215,472.76 or 20.84 % out of the total expenses in the district hospital. the minimum fare id Rp 25,000.- and the maximum one is Rp 2,784,000.-, depend on the number of days in hospitaL the kind of illness, medications, memberl (the person with the membership), mernber3 (the spouse), level 1 employee, thc interaction between long of stay with the type of illness, and the interaction between the complicated illness and the drugs are the most influence factor( the 6 value are the highest, which is 0,624). The assumption and interaction test, result the model of self expenses prediction model = 5,743 + 0,3 l3*long of stay - 0,785*no complicated illness + 0,8l9*drugs (Non DPHO) + 67,397*memberl + 0,179*member3 + l,489*employeel + 0,260*interaction between complicated illness and drugs + 0,260*Interaction between long of stay and complicated illness. It is necessary for the District Hospital management to calculate the fare according to the real expenses as an advocacy for the Kapuas Hulu District government for the titre and subsidiary to District Hospital policies making especially for the base level oflicer, advocacy to the PT Askes, awareness to use DPHO drugs and it's necessary for PT Askes to consider adjustment in providing the benefits for its members especially for the base level oflicer to be more in line with the current situation of the hospital.

Abstrak:

Pembangunan kesehatan bertujuan untuk meningkatkan kesadaran, kemauan dan kemampuan untuk hidup sehat bagi setiap orang sehingga dapat mewujudkan derajat kesehatan yang optimal. Rumah Sakit sebagai sarana pelayanan kesehatan, meskipun dengan dana terbatas dituntut tetap survive dan siap melayani masyarakat umum dan peserta Askes. Untuk menjaga kelangsungan pelayanan Rumah Sakit menyesuaikan tarif yang harus dibayar oleh pasien. Tarif pasien Askes lebih rendah dari tarif pasien umum.Data RS Persahabatan menunjukkan bahwa pendapatan sesuai tarif umum tahun 2001 meningkat cukup bermakna sebesar 52% dari tahun 2000, pendapatan terbesar dari Rawat Inap yang meningkat 39%. Meskipun pendapatan Rawat Inap meningkat, namun terdapat kesenjangan dimana pendapatan yang diterima (sesuai tarif Askes) hanya 32%. Hal ini terjadi akibat tarif pasien Askes lebih rendah dari tarif pasien umum. Akibat kesenjangan tersebut Rumah Sakit menanggung subsidi cukup besar, sehingga dapat mengganggu likuiditas dan terjadi deficit anggaran Rumah Sakit. Untuk itu perlu dikaji lebih lanjut perhitungan pendapatan berdasarkan tarif Askes. Hal inilah yang melatarbelakangi penelitian ini.Penelitian ini bertujuan mendapatkan gambaran seberapa besar kesenjangan pendapatan dan besarnya subsidi sesuai hasil perhitungan kembali serta distribusinya pada Unit Instalasi Rawat inap, akibat perbedaan tarif Askes dengan tarif umum dan bagaimana kebijakan penetapan tarif dimana yang akan datang. Penelitian ini bersifat kualitatif dengan cara observasi dan evaluasi dengan melakukan estimasi perhitungan data sekunder dan diskusi/wawancara.Dari hasil penelitian ini dapat disimpulkan (1) terdapat perbedaan hasil (output) antara perhitungan pendapatan dan subsidi oleh rumah sakit, dengan hasil perhitungan yang dilakukan pada penelitian ini, dimana kesenjangan menurut Rumah Sakit sebesar 68%, sedangkan menurut hasil perhitungan kembali sebesar 54%; (2) terdapat pasien Askes yang menggunakan kelas perawatan melebihi haknya tanpa membayar selisih tarif secara penuh, akibatnya Rumah Sakit menanggung biaya bagi pasien tersebut, dan seharusnya Rumah Sakit membukukannya sebagai beban pasien bukan Subsidi Askes; (3) subsidi bagi pasien Askes terjadi secara progresif yaitu makin tinggi golongan PNS dan Penerima Pensiun makin besar subsidi yang dinikmati; atau subsidi Rumah Sakit saat ini dinikmati oleh siapapun yang dirawat, baik pasien miskin maupun mampu; (4) kelemahan pembukuan terdapat pada sistem akuntansi, dimana rekening (account) yang ada belum menjangkau jenis tindakan yang jumlahnya banyak (comprehensive), seperti tindakan pelayanan pasien Askes belum seluruhnya dibukukan dalam akuntansi Rumah Sakit; (5) Pola tarif RS Perjam sampai saat ini belum ditetapkan oleh Menteri Kesehatan.Saran yang dapat diberikan adalah agar Rumah Sakit dapat mengembangkan jenis pelayanan luar paket, karena tarifnya mendekati tarif Rumah Sakit. Secara aktif memberikan masukan kepada PT. Askes agar dilakukan peninjauan kembali tarif paket. Pengolahan dan pencatatan transaksi keuangan agar dilakukan secara terintegrasi antara Bagian Keuangan dan Bagian Akuntansi sehingga laporan keuangan dapat diuji kelayakannya dan wajar. Selanjutnya perlu dilakukan percepatan penagihan (klaim) biaya pelayanan kepada PT. Askes, karena akan membantu likuiditas Rumah Sakit. Depkes perlu segera menetapkan Pola Tarif Rumah Sakit Perjam dan mengupayakan penambahan premi peserta Askes.

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Analysis of Service Subsidies to Obligatory Participating Patients in PT. (Persero) Asuransi Kesehatan Indonesia at the In-Patient Installation Unit of Persahabatan Hospital Jakarta Year 2001 Health development aims to improve individual awareness, willingness and ability to lead a healthy-life in order achieve an optimum status of health. Hospital as the facility of health care service is required, although in limited funds, to survive and get ready to serve general public and members of Askes. To keep it survive, the hospital should adjust the rate to be paid by patients. Well, the rate charged on the Askes-member patients is usually lower than that on general patients.Data collected from the Persahabatan Hospital of common rate-based income in 2001 show that the income raised significantly on to 52% from that in the previous year (2000), and the largest income is drawn from In-Patient service, raised 39%. Although In-Patient Income raised, less difference still occurred since the income (according to the rate of Askes) is only 32%. This is because lower rate of Askes-member patients than that of general patient. Such a thing makes the Hospital bear relatively larger subsidies and thus troubles its liquidity and leads to budget-deficit. Therefore, further review of the income needs an Askes-based estimation. It is this which underlies the research.This research aims at revealing the picture of difference between income and amount of subsidies according to its re-estimation and distribution at the In-Patient Installation Unit due to the different rate of Askes from that of general patient and considering rate policies in the future. This research is qualitative in manner carried out through observation and evaluation by reviewing secondary data estimates and discussion/interview.From results of research, one may come to the following conclusions that (1) difference of output exists between income and subsidy estimates by the hospital party and that in this research; 68% in the former and 54% in the latter, respectively (2) Askes patients using service facilities extend their rights without paying any full different rate. It becomes, therefore, a subsidy charged on the Hospital whereas the hospital should, otherwise, impose this charge on the patients rather than Askes subsidies, (3) Subsidy for Askes patients occurs progressively, viz., the higher level of Civil Servant and Pension receiver, the greater the subsidy he or she enjoys and that it draws a conclusion that hospital subsidy are currently received by any patient, be poor or able patients, (4) weak book-keeping entries occur in the accounting system in which the existing account does not yet record comprehensively such as Askes-patient care service. Rate schemes for Public-Owned Hospital have not been determined by the Minister for Health.A suggestion that may be proposed is to get the Hospital develop services included in the fist of external package, since rate of the Askes approaches that of the Hospital. Another suggestion is to provide active input to PT. Askes in order to have rate of package reviewed. Financial data processing and account should be integrated between Finance Department and Accounting Department and therefore financial statement is allowable to test its reasonable feasibility. Further, claim for service costs should be accelerated to PT. Askes for it would help the hospital liquidity. The Department of Health should really determine the Rate Schemes for Public-Owned Hospital and exert to increase premium for Askes-members.

Abstrak: Dalam era globalisasis saat ini, pertumbuhan rumah sakit di kota besarmenyebabkan terjadinya kompetisi yang tinggi dalam sektor kesehatan sehinggapersaingan rumah sakit menjadi semakin keras segingga dibutuhkan peranan pembiayaanrumah sakit dalam menyediakan pelayanan yang optimal menjadi sangat penting agarrumah sakit dapat tetap bertahan. Penelitian ini betujuan untuk melakuakan analisisi biayasatuan dan biaya total pelayanan rawat inap sakura berdasarkan metode simpledistribution di RS X Kota Bekasi Tahun 2016. Penelitian ini merupakan analisisdeskriptif, bertujuan untuk menganalisis biaya satuan di rawat inap sakura yang dilakukanselama satu tahun dengan menggunakan perspektif dari rumah sakit dan biaya yangdihitung adalah biaya yang terkait pada pemakaian tempat tidur atau biaya akomodasipasien saja. Berdasarkan perhitungan dengan metode simple distribution, studimenghasilkan informasi biaya pada kamar rawat inap sakura RS X berupa biaya satuanpada kamar VVIP sebesar Rp 982.374, VIP sebesar 904.215, Kelas 1 sebesar Rp 549.480,Kelas 2 sebesar Rp 502.368. Kelas 3 sebesar Rp 436.181 dan Isolasi sebesar Rp 744.699dan biaya tidak langsung yang dihitung menggunakan metode Full Time Equivalent FTE berupa biaya gaji direksi direksi dan staf RS X perhari sebesar Rp 36.001.
Kata Kunci : rumah sakit, metode simple distribution, rawat inap sakura