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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.

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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)

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ABSTRAK Penelitian ini bertujuan untuk mengetahui gambaran  pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap pasien multiguna di RSU Kabupaten Tangerang, mengetahui factor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan, dan untuk mengetahui estimasi nilai rata-rata pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap di RSU Kabupaten Tangerang bagi pasien peserta multiguna. Dan akan dihasilkan suatu nilai estimasi yang menjadi standard acuan untuk melakukan utilisasi review. Dilakukan dengan rancangan cross sectional dan pendekatan kuantitatif. Populasi penelitian adalah seluruh pasien peserta multiguna yang memanfaatkan pelayanan kesehatan rawat jalan dan rawat inap di RSU Kabupaten Tangerang. Dari hasil penelitian dapat terlihat bahwa  visite rate rawat jalan pasien peserta multiguna di RSU Kabupaten Tangerang adalah 1,3 kali yang mana hampir sama dengan visite rate pasien peserta Jamkesda di Kota/Kabupaten lain. Visite rate rawat inap pasien peserta multiguna di RSU Kabupaten Tangerang hanya 0,03 kali, dan ini masih rendah dibandingkan dengan visite rate rawat inap peserta Jamkesda Kota/Kabupaten lainnya. Rata-rata biaya rawat jalan dan ALOS pasien peserta multiguna hampir sama dengan tariff rawat jalan dan ALOS INADRG RS Tipe B, Kelas 3 dan Poli Biasa. Pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap pasien peserta multiguna di RSU Kabupaten Tangerang di pengaruhi oleh umur, jenis kelamin, status perkawinan dan diagnose penyakit pasien. Peneliti menyarankan agar di dalam menyusun anggaran untuk peserta kartu multiguna bidang kesehatan ini hendaknya diperhatikan factor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan tersebut. Kata Kunci : pemanfaatan pelayanan kesehatan, utilisassi review, standard acuan, visite rate, alos.

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ABSTRACT The goal of this research is to describe of utilization of health service outpatient and inpatient by Multiguna’s patient in The General Hospital of Tangerang, knowing the factors associated with utilization of health services, and to determine an average value of health care utilization of outpatient and inpatient in The General Hospital of Tangerang for Multiguna’s patient that will be estimate the gold standard to conduct the  utilization review. Performed with a cross-sectional design using quantitative approach. Population  was all Multiguna’s patients who utilize health care outpatient and inpatient at The Genaral Hospital of Tangerang. The result of research showed visite rate of outpatient is 1,3 times which is almost the same  visite rate outpatient of Jamkesda participants in the other city. Visite rate of hospitalization  only 0,03 times, still low compared with visite rate of hospitalization Jamkesda participants in the other city. The average cost of outpatient care and ALOS  multiguna’s patient almost equal with rates of outpatient and ALOS of INA-DRG Type B Hospital, Class 3 and ordinary clinic. The results showed that the utilization of outpatient health services and inpatient care by the multiguna’s patient in the general hospital of Tangerang influenced by age, sex, marital status and diagnosis of patient illness. From this study obtained a standard of reference for utilization review. The research suggested that in preparing the budget for  health sector of Multiguna are to be considered factors related to the utilization of health services. Key words: utilization of health services, utilization review, reference standard, visite rate, average length of stay.

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Masih tingginya preskripsi obat paten yang telah mempunyai generik di salah satu bagian Rumah Sakit Umum Pusat Hasan Sadikin (RSHS) Bandung telah mendorong dilakukannya penelitian Beban Biaya Yang Timbul Akibat Ketidakpatuhan Pemberian Obat Generik Pada Pasien Rawat Inap di RSHS - Bandung Tahun 2001. Biaya ketidak-patuhan pemberian obat generik adalah biaya masyarakat yang tidak perlu yang menjadi ruang lingkup penelitian ini. Penelitian dilakukan selama bulan April sampai Juni 2002 dengan desain Comparative Non Eksperimental Study secara Ex Post Facto terhadap data sekunder pasien rawat inap di RSHS Tahun 2001. Sampel yang diambil sebanyak 323 buah dengan sumber data terdiri dari resep, kartu status, dan rekam medik tahun 2001. Hasil penelitian menyatakan bahwa beban biaya tambahan yang harus ditanggung pasien/keluarga pasien karena ketidak-patuhan pemberian obat generik secara financial mencapai Rp 10,6 juta atau 55,46% dari belanja obat pasien. Variabel lama kerja dokter dan keparahan penyakit ternyata merupakan variabel yang dominan yang mempengaruhi ketidak-patuhan pemberian obat generik. Estimasi biaya ini pada pasien rawat inap selama tahun 2001 mencapai Rp 13 miliar atau sekitar Rp 600 ribu per pasien rawat inap. Disarankan perlunya tambahan materi pengenalan obat generik bagi dokter maupun calon dokter serta melakukan trial klinik obat generik baik di universitas maupun di rumah sakit dengan melibatkan para dokter maupun calon dokter. Saran berikutnya adalah perlunya memberdayakan Permenkes nomor 085/MEN/KES/PER/I/1989 yaitu dengan memberikan penghargaan pada dokter yang patuh memberikan obat generik dan memberikan pembinaan pada dokter yang tidak patuh memberikan obat generik.

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The heightening of branded medicine prescribing in one department of RSHS - Hasan Sadikin Central Public Hospital motivated the study of Cost Implication of Non-compliance of Generic Medicine Prescribing of Hospital Care Patient in Hasan Sadikin Central Public Hospital - Bandung 2001. The non-compliance cost implication of generic medicine prescribing is a community unnecessary cost that being this study scope. The study was carried out during April -- June 2002 on Comparative Non Experimental with Ex Post Facto Design to the secondary data of hospital care patients in RSHS - Bandung in 2001. The amount of sample is 323 consist of prescriptions, condition state cards of patient, and medical records. The result showed that the cost implication bad to be loaded by the patient or their family caused non-compliance of generic medicine prescription financially are Rp 10,6 million or 55,46% from their medicines cost. Physician length of work and severity of disease are dominant variables in influencing of non-compliance generic medicine prescribing. Estimation of the non-compliance cost on hospital care patient in 2001 reaches Rp 13 billion or about Rp 600 thousand per patient. Suggestion is having addition of genetic medicine introducing to both physicians and their candidates and its clinical trial in universities or hospitals. The further suggestion is law enforcing of Permenkes 085/MEN/KES/PER/I/1989 by giving reward to the doctors compliance generic medicine prescribing and pay attention to the others to establish compliance generic medicines prescribing.

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Latar belakang: Program Jaminan Kesehatan Nasional (JKN) meningkatkan utilisasi dan pendapatan pasien dari prosedur operasi rawat inap di RS Jakarta. Namun, peningkatan ini justru menurunkan laba rumah sakit akibat tarif JKN yang relatif rendah. Prosedur operasi bedah umum merupakan prosedur terbanyak yang dilakukan, tetapi memiliki utilitas kamar operasi terendah. Untuk itu, perlu dilakukan analisis efisiensi biaya prosedur ini sebagai dasar strategi pengembangan layanan untuk kesinambungan bisnis rumah sakit ke depan. Tujuan: Diketahui perbandingan tingkat efisiensi biaya prosedur operasi agar dapat memberikan rekomendasi strategi efisiensi dan pengembangan prosedur operasi bedah umum JKN di RS Jakarta agar tercapai kesinambungan bisnis rumah sakit yang baik. Metode: Penelitian menggunakan data prosedur operasi bedah umum pasien JKN tahun 2023. Biaya satuan dihitung menggunakan metode activity-based costing, mencakup biaya langsung dan tidak langsung. Efisiensi dinilai dengan membandingkan biaya aktual dengan biaya normatif berdasarkan clinical pathway. Total biaya diperoleh dari penjumlahan biaya prosedur dan akomodasi rawat inap. Skor efisiensi teknis dan skala dihitung dengan pendekatan Data Envelopment Analysis (DEA). Hasil: Rata-rata biaya satuan prosedur aktual di kamar operasi sebesar Rp3.515.894,65 dengan skor efisiensi 103,0%, yang idealnya ada di bawah 100%. Komponen biaya jasa medis dan obat serta bahan medis habis pakai (BMHP), menjadi pemicu utama inefisiensi. Rata-rata biaya total aktual, yaitu biaya satuan prosedur aktual di kamar operasi ditambah biaya akomodasi adalah Rp4.678.032,01 dengan skor efisiensi 108,4%. Biaya akomodasi menyumbang 24,8% dari biaya total dan berkontribusi besar pada inefisiensi. Prosedur paling efisien adalah hemoroidektomi kelas 3 dan insisi abses perianal (satu kelas). Kesimpulan: Biaya satuan prosedur operasi bedah umum di kamar operasi untuk pasien JKN tahun 2023 belum efisien karena penggunaan obat, BMHP, dan lama rawat inap yang tidak sesuai clinical pathway. Diperlukan penerapan clinical pathway yang ketat, perubahan sistem pembayaran jasa medis berbasis kinerja, serta optimalisasi metode dan jenis anestesi. Rumah sakit juga perlu meningkatkan kompetensi, khususnya di bidang bedah digestif, untuk menghadapi kebijakan kelas standar dan klasifikasi rumah sakit berbasis kompetensi.

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Background: The National Health Insurance (JKN) program has led to increased inpatient utilization and revenue at RS Jakarta, particularly through surgical procedures. However, this increase has paradoxically reduced hospital profit margins due to the relatively low reimbursement rates under JKN. General surgery accounts for the highest number of procedures but demonstrates the lowest operating room utilization. Therefore, a cost-efficiency analysis of these procedures is essential to inform service development strategies that ensure long-term hospital sustainability.  Objective: This study aims to compare the cost efficiency of general surgical procedures for JKN patients, providing strategic recommendations to improve efficiency and develop general surgery services to support sustainable hospital operations.  Methods: The study used data on general surgical procedures performed on JKN patients in 2023. Unit costs were calculated using an activity-based costing method, incorporating both direct and indirect costs. Efficiency was assessed by comparing actual costs to normative costs based on clinical pathways. Total costs included both procedural and inpatient accommodation expenses. Technical and scale efficiency scores were calculated using the Data Envelopment Analysis (DEA) approach.  Results: The average unit cost for actual surgical procedures in the operating room was IDR 3,515,894.65, with an efficiency score of 103.0%, indicating inefficiency as ideal scores should be below 100%. Direct operating costs—particularly medical services, medications, and consumables—were the main contributors to inefficiency. The average total actual cost, including accommodation, was IDR 4,678,032.01, with an efficiency score of 108.4%. Accommodation costs accounted for 24.8% of the total and were a significant source of inefficiency. The most efficient procedures were Grade 3 hemorrhoidectomy and perianal abscess incision (single class).  Conclusion: The unit costs for general surgical procedures under JKN in 2023 remain inefficient relative to clinical pathway standards, primarily due to inappropriate use of medications, consumables, and extended length of stay. Improvements are needed through stricter clinical pathway implementation, performance-based physician remuneration, and optimization of anesthetic techniques. The hospital must also enhance competencies, particularly in digestive surgery, in anticipation of standard class policies and competency-based hospital classifications.