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The INA-CBG payment system is a paymend basd on the rate of grouping diagnoses that have clinical closeness and homogeneity of the resources used. Hospitals will be paid based on the average cost spent by a diagnostic group. This system has been implemented by the Ministry of Health of the Republic of Indonesia in order to improve service quality. This study aims to determine the description of the calculation of hemodialysis service rates using the Activity Based Costing method. The research is a quantitative research with a descriptive design. The results of this study indicate that in the hemodialysis service there is a difference between the average unit cost using the Activity Based Costing method on the Nipro machine and the Fresenius machine. Costs with this methods are known to be lower when compared to HD BPJS rates and hospital rates. This shows that using the Activity Based Costing method provides a advantage for the hospital.
Percutaneous Coronary Intervention is a nonsurgical intervention procedure byusing a catheter to dilate or open coronary vessels that are narrow with balloons andfollowed by stent replacement to keep blood vessels open. The process of narrowing ofthese coronary arteries can be due to the process of atherosclerosis or thrombosis. PCI isan procedure that is relatively expensive. It is related to the human resources involved,the consumabled used and the used of medical devices. This study aims to analyse thefactors associated with patient care costs with PCI procedure at Fatmawati GeneralHospital. This cross sectional study was conducted quantitatively through hospitalinformation system, billing and unit cost, and qualitatively through in-depth interview.The results show that the average cost for PCI procedure at Fatmawati General Hospitalin 2017 was Rp53,629,532 and the largest cost component of total PCI cost was the costof PCI intervention measure of 82,8%. The statistic results showed that the variablesseverity level, length of stay, use of ICCU and number of stents are correlated with totalcosts of procedure PCI, but variable room class, blood vessel occlusion and electivecases is not correlated to total cost of PCI.Keywords:Percutaneous Coronary Intervention, Cost of Percutaneous Coronary Intervention,Hospital PCI cost, Coronary stent.
Penelitian bertujuan untuk mendapatkan pembiayaan kamar operasi dan tingkat pemulihan biaya dari hasil kamar operasi untuk tiap jenis operasi di Rumah Sakit Umum Puri Raharja berdasarkan activity based costing. Studi ini bersifat deskriptif analitik dengan pendekatan kualitatif dan kwantitatif. Hasil perhitungan dengan menggunakan ABC system terhadap 54 jenis pembedahan di Rumah Saakit Umum Puri Raharja diperoleh nilai perhitungan tertinggi pada jenis operasi Extended Pyelolithomy dengan nilai Rp 581,190.- sedangkan nilai perhitungan terendah pada jenis tindakan EKEK+IOL sebesar Rp 298,726.- dan nilai rata-rata penghitungan berdasrkan jenis operasi adalah sebesar Rp 456,018.-.Hasil perhitungan Activity Based Costing dibandingkan dengan hasil pendapatan didapatkan tingkat pemulihan biaya perjenis tindakan rata rata 286,4% atau hasil pendapatan yang didapatkan dari kamar operasi sudah dapat munutupi biaya opersional kamar operasi berdasarkan jenis operasi. Disarakan agar dilakukan perhitungan kembali pada beban untuk tenaga kerja, pembaharuan peralatan, dan evaluasi pada beberapa tindakan yang memiliki nilai CRR dibawah 100%, untuk menghasilkan profit untuk pengembangan rumah sakit ke depan.
This research was carried out on the operating room cost and cost recovery level of operating room resulted for each kind of operation at Puri Raharja General Hospital based on activity based costing. This study is in analytic descriptive with qualitative and quantitative approaches. The research result for 54 kind of surgery based on activity based costing shows highest calculated values obtained on the Extended Pyelolithomy operation with a value of Rp 581.190, while the lowest value calculated on the EKEK+IOL is Rp 298.726. - and the average value calculation based on type of operation is Rp 456.018. -. The result of cost calculation with Activity Based Costing compared with the average revenue is in average 286.4% or the revenue which is gained from operating room can cover the operational cost of operating room based on the kind of the operation. It is suggested to do the recounting on the burden of the workers, renewal the equipments and evaluation on some activities, which have CRR value fewer than 100%, so that the operating room can function properly and can be revenue centre which results profit to the development of the hospital in the future.
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
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