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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.
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.
ABSTRAK Obat merupakan salah satu kornponen penting dan memeriukan biaya besar dalarn pelayanan kesehatan. Harganya relatif mahal dan tidak berpihak kepada konsumen, sehingga bisa menyebabkan temjadinya moral hazard pada para pelaku kesehalan. Pasien tidak bisa memilih sesuai dengan kebutuhan dan kemampuan bayarnya karena mempunyai kctcrbatasan kemampuan. Salah satu pengendalian biaya kesehatan yaitu melalui jaminan pelayanan kesehatan sosial yang ditangani oleh PT Askes. Pelayanan yang dibenikan seharusnya bersifat komprehensif, tetapi kenyataannya jaminan ditekankan pada pcnycmbuhan dan pemulihan dengan iur biaya (cost sharing), ini berlaku untuk pelayanan obat. Pengendalian biaya obat askes melalui penggunaan DPHO. Penulisan resep dokter diluar DPI-I0 dapat membcratkan pasicn askes, apalagi pada penderita penyakit kronis seperti hipertensi. Di RSUD Gunung Jati tahun 2006 penyukit hipertensi merupakan peringkat empat kelornpok penyakil di instalasi rawat jalan dcngan kunjungan 470 pasien per bulan. I Pcnclitian ini dilakukan untuk mengetahui pola peresepan dan biaya obat pasien askes sosial penderita hiperlensi Instalasi Rawat Jalan RSUD Gunung J ati dan perbedaan biaya obat gcncrik pcngganti obat bermerk di luar DPI-I0 yang ditulis dokter. Jenis penelitian kuantitatif dengan metode survey, dan dilakukan analisis data dengan Wilcoxon's Signed Rank Test, Mann-Whitney Test, Kruska!-Wallis Test. Hasil pcnelitian diketahui bahwa penderita hipertensi lebih banyak yang mempunyai penyakit lainfpenyerta, dan terbanyak diabetes mellitus (49%). Resep dokter untuk penderita hipertensi pescrta askes sosial semua obatnya masuk DPI-IO.. Obat antihipertensi yang terbanyak ditulis dokter adalah Amlodipin scbanyak SI R/ (2l,34%) dari total obat antihipertensi. Dari hasil analisis diketahui jumlah item obat (R/) rata-rata = 2,8lR/, besar rata-rata biaya obat pada penulisan rescp_dokter Rp 70.167 dan pelayanan apotik Rp 5. 128, dengan nilai p = 0,000 menunjukan adanya perbedaan ra1a~rala besar biaya obat amara keduanya. Hasil perbandingan rata-rata besar biaya obal pada pcnulisan resep doktcr, ada perbedaan (p < 0,05) pada penulisan resep antar dokter, antar poliklinik, antar kelompok umur pasien dan anlar penyakit pcnycrta serta tidak ada perbedaan antar kelompok tempat tinggal dan antar jenis kelamin pasien. Hasil perbandingan rata-rata jumlrtth item obat ada perbedaan (p < 0,05), pada pcnulisan resep amar poliklinik dan antar penyakit penyerta serta tidak ada perbedaan (p > 0,05) untuk penulisan resep antar dokter, antar jenis kelamin , antar umur dan antar kota tempat tinggal pasien. Kesimpulan dari pcnelitian ini adalah tidak ada obat di luar DPHO yang ditulis dokter untuk pasicn askes sosial penderita hipertensi. Rata-rata jumlah item obat pcrlcmbar resepnya 2,81 dan biaya penulisan resepnya sebcsar Rp 70.l67. Sebagai saran kcpada rumah sakit agar terus melakukan pemantauan terhadap para dokter tentang pcnulisan resep dalam DPI-IO untuk pasicn askes. Sedangkan untuk P.T Askes dan Apotik Askes agar selalu rnenyedial-can obat yang diresepkan dokter dan dapat mcmberikan obat kepada pasien sesuai resep dokter dan kctentuan DPI IO (maksimal untuk 30 hari).
ABSTRACT Medication is one of important component and needs great cost in health service. The prices are relatively expensive and not stand for consumer, so that it could cause moral hazard to health agent. Patient could not choose appropriate with needs and ability to pay because has limited ability. One of the health cost restriction is through social health service guarantee that handled by PT Askcs. Given service should comprehensive, but apparently guarantee stressed to heal and curing with cost sharing, it prevails for medication service. Cost control of medication health assurance through using DPHO. Doctor prescription outside DPHO could against health assurance patient, especially on chronic diseases patient such as hypertension. In RSUD Gunung Jati year 2006 hypertension disease is forth level disease group in outpatient installation with visitation of 470 patients per month. This research conducted to recognize prescription design and medication cost of social health assurance patient with hypertension. RSUD outpatient installation Gunung Jati and difference of genetic medication as substitute of branded medication outside DPHO that written by doctor. Quantitative research type conducted with survey method, and conducted data analysis by Wi1coxon?s Signed Rank Test, Mann- Whitney Test, and Kruskal-Waillis Test. Research result known that more hypertension patient has other disease/participate: and the most is diabetes mellitus (49%). Doctor prescription for hypertension patient of social health assurance participant all of the medication included in DPHO. The most anti-hypertension medication that written by doctor is Amlodipin as much as Sl R/(21 ,34%) from total medication of anti-hypertension. From analysis result known that average medication item (Rf) = 2,8lR/, average medication cost on doctor prescription is Rp 70.167 and pharmacy service is Rp. 5.128, with p value = 0,000 shows a difference of average medication cost between both. Equivalent result of average medication cost on doctor prescription there is difference (p < 0,05) on prescription between doctor, between polyclinic, between patient age group and between disease participator and there is no difference between residence groups and between patient gender. There is a difference of average equivalent result of total medication item (p < 0,05) for prescription between doctor, between gender, between ages and between patient town. Conclusion from this research is not medication outside DPHO that written by doctor for social health assurance hypertension patient. Total average of medication item prescription sheet is 2,81 and prescription cost is Rp. 70. 167. Suggested hospitals constantly do monitoring toward doctor about prescription in DPHO for health assurance patient. While suggested both PT Askes and Askes Pharmacy to give medication for patient appropriate with doctor prescription and DPI-IO regulation (maximally 30 days).
cost for treatment HIV/AIDS is expensive. PLHIV spent high cost for treatment (out-of-pocket). This research analized cost for treatment in outpatient with HIV/AIDS, usedcross sectional design. The sample in this research was 144 outpatient HIV/AIDS inRSKO, taken by simple random sampling. Out-of-Pocket for treatment was Rp100.763,35/visit consists of physician Rp41.557,31, medical (non-ARV) Rp5,administration Rp4.563,56, and laboratorium test Rp13.833,03. The mean for patientwith no insurance Rp999.755,10/year and with insurance Rp268.116,50. There issignificant relationship between payment and number of visit to expense (p value0,0005). Hope government could insure PLHIV for avoiding financial burden.Key words: cost for treatment, HIV/AIDS, Out-of-Pocket, RSKO
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.
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.
Perubahan pengelolaan rumah sakit pemerintah dari orientasi sosial manjadi orientasi sosial bisnis, hal initeljadi karena perubahau turrtumn dari konsumcn sebagai pengguna dan juga oleh pembcri pelayanamselain itu menyongsong era Globalisasi, perkembangan ilmu dan tehnologi di bidang kesehatan, persaingn antar rumah sakit dan kondisi keuangan pmnerintah yang terbaias dalam pembiayaan rumah sakit. Peningkatan mutu yang baik dan terjangkau oleh ekonomi Kousumen secara umum. RSUD dr.H.Abdul Moeloek Propinsi Lampung merupakan salah satu rumah sakit swadana pemerintah yang mcngemban misi sosial danjuga merupakan rumah sakit pusat rujukan dipropinsi Lampung, sejakmeningkatnya kebutuhan masyarakat akan Mesin cuci darah atnu hacmodialisa fahun I999,telah berperan untuk mengadakan alat tersebut dengan melakukan Outsourcing dengan pihak ketiga dengan pezjanjian Pinjam pakai mesin dan pembclian haemodilaisa set kepada perusahaan tersebut. Paket haemodialisa tersebut seharga Rp.549.350 untuk yang baru dan Rp.454.350 untuk yang Reuse. Dengan lmif Perda Rp. 729.350 baru dan R.p. 634.350 untuk yang Reuse. Tujuan dari penelitian ini adalah untuk mcndapat berapa Cost yang harus dikcluarkan unit Haemodialisa clan berapa Revenue yang didapat dari tindakan tersebut tahun 2007, penelitian ini bcrsifat Operasional Research melalui pcndekatan Kualitatif. Dari hasil penelitian didapatkan hasil bahwa, Revenue yang didapat unit haemodialisa setelah dikurangi Cost ada Surplus. Dari basil penelitian , maka disimpulkan bahwa unit hacmodialisa RSUD Dr. H. Abdul Moeloek Propinsi Lampung, dengan sistem Outsourcing mempunnyai potensi umuk mcndapatkan Surplus lebih besar apabila dilakukan dengan investasi sendiri mesin Haemodialisa., mensosialisasikan kcpada Dinsksi dan Jajaranya,melakukan penalitian lehih lanjut tezhadap unit lain yang akan melakukan Out Sourcing.
Change of management of governmental hospital of social orientation of social orientation of business, matter of initeijadi because change of demand of consumer as consumer as well as by giver of that pelayananselain welcome Globalimtion era, growth of and science of tehnologi in health area, emulation between monetary condition and hospital of limited govemment in defrayal of hospital. top notch Improvement and reached by Consumer economics in general. RSUD Dr.H.Abdul Moeloek Lampung Province to represent one of the hospital of innate governmental which is carry of social mission as well as representing hospital center province reference Float, its of requirement of Blood washing machine society will or year haernodialisa 1999, sharing to perform a the the appliance by doing/conducting Outsourcing with third patty with agreement Borrow to wear machine and purchasing of haemodilaisa set to company package of Haemodialisa the at the price of Rp.549.350 for the things newly and Rp.454.3S0 for the things Reuse. With tariff of Perda Rp. 729.350 newly and Rp. 634.350 for the things Reuse Intention of this research is to get how much/many Cost which must be released by unit of Haemodialim and how much/many got Revenue of action of year 2007, this research have the character of Operational of Research pass approach Qualitative. From result of research got by result of that, got by Revenue is unit of haemodialisa after lessened by Cost there is Surplus. From result of research , hence concluded that unit of haemodialisa RSUD Dr. H. Abdul Moelock Province Float, with system of Outsourcing potency mernpunnyai to get bigger Surplus if Done/conducted with invesment alone machine of Haemodialisa, socializing to Board of directors and of Sta5` only, Melakukan furthermore advance research to other unit to do/conduct Out Sourcing.