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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.
Hasil penelitian menunjukkan adanya penyebab pending claims yang disebabkan oleh faktor input (Man, Method, Money, Material, Machine), proses dan output. Salah satu penyebab adalah pengisian resume medis yang tidak sesuai (output), disebabkan karena pengisian resume medis terlambat dan ketidaksesuaian isi resume medis (proses) yang diakibatkan oleh faktor input (Man, Method, Money, Material, Machine). Gambaran pending claims (output) di RSUD Jati Padang adalah karena ketidaksesuaian Administrasi Klaim (17.89%), pengisian resume medis (57.51%), ketidaklengkapan berkas penunjang klaim (13.42%), konfirmasi coding diagnosa dan prosedur (8.95%) dan konfirmasi grouping (2.24%). Pengajuan klaim kepada BPJS Kesehatan selalu dilakukan diatas tanggal 5, dengan rata- rata keterlambatan 6.6 hari. Total jumlah berkas klaim BPJS Kesehatan bulan Januari-September 2018 yang disetujui pada tahap 1 adalah sebesar 3759 berkas (92.36%) dengan total tagihan yang disetujui Rp 1.180.532.000 (74.38%). Diperlukan strategi dari manajemen rumah sakit untuk dapat mencegah dan mengurangi pending claims. Salah satunya dengan pemberian remunerasi kepada dokter spesialis, penyusunan Panduan Praktik Klinis dan kelengkapan SOP terkait adminitrasi klaim, adanya monitoring evaluasi berkala mengenai permasalahan proses klaim BPJS
Kata Kunci: rumah sakit, penyebab, penundaan klaim, BPJS Kesehatan
The Indonesian Act No. 40 of 2004 mandates that everyone has the right to social security through the Indonesian National Health Insurance (JKN) in achieving Universal Health Coverage (UHC) in 2019. On JKN, the payment system to hospitals on JKN is set with Indonesian-Case Based Groups (INA- CBGs) tariff, through claim management system where each problem can cause delays in claim payments by National Health Care Security and affect hospital income. The financial sustainability of health facilities is highly dependent on an effective claim management system. Rumah Sakit Umum Daerah Jati Padang as a Regional Public Service Agency needs to manage financial management effectively so that health services delivery is well-provided. One of financial source for RSUD Jati Padang is through National Health Care Security claims payment. Every pending claim will be resulted in disrupted hospital revenue. This research objective was to analyze causes factors of National Health Care Security pending claims using the system approach, which are input factors (Man, Method, Money, Material, Machine), process factors, output (pending claims). This research is a qualitative study. Data is collected with document review and in-depth interviews.
The results showed that there were causes of pending claims caused by input factors (Man, Method, Money, Material, Machine), process and output. One of the causes is improper medical resume filling (output), caused by delay in filling in medical resume and incompatibility of medical resume content (process) and triggered by input factors (Man, Method, Money, Material). The description of pending claims (output) at Jati Padang Hospital is due to discrepancies in claim administration (17.89%), filling in medical resumes (57.51%), incomplete claim support documents (13.42%), confirmation of diagnostic diagnoses and procedures (8.95%) and grouping confirmation (2.24%). National Health Care Security claims are submitted to National Health Care Security verificator pass the 5th, with an average delay of 6.6 days. The total number of National Health Care Security claim files for January- September 2018 approved firstly is 3759 files (92.36%) with the total bills approved at Rp. 1,180,532,000 (74.38%). Strategies are needed from hospital management to be able to prevent and reduce pending claims. One of them is by giving remuneration to specialists, preparation of Clinical Practice Guidelines and SOPs related to claim administration is conducted, hold periodic monitoring evaluations to monitor the claim managemant process.
Keywords: hospital, causes, pending claims, National Health Care Security
Tujuan penelitian ini adalah untuk mengetahui hubungan stres kerja dan kepuasan kerja terhadap kinerja pada perawat rawat inap RSUD Koja. Desain penelitian menggunakan metode cross-sectional dengan uji chi square dan regresi logistik. Pengambilan data melalui penyebaran kuesioner skala likert kepada 134 responden. Perhitungan sampel menggunakan rumus perhitungan jumlah sampel simple random sampling. Hasil penelitian ini menunjukkan bahwa terdapat hubungan antara stress kerja (p=0,006) dan kepuasan kerja (p=0,001) terhadap kinerja.
Hasil multivariat menunjukkan bahwa komponen dari variabel stres kerja dan kepuasan kerja yang paling besar pengaruhnya terhadap kinerja pada perawat . Peneliti menyarankan untuk melakukan maintenance sarana dan prasarana secara rutin, mengadakan pelatihan/acara yang bersifat meningkatkan rasa kebersamaan dan penguatan psikologi, melakukan Employee Opinion Survey (EOS), dan menghitung kembali kebutuhan tenaga keperawatan.
Kepatuhan adalah sikap mentaati peraturan dan ketentuan yang telah ditetapkan tanpa pamrih. Rendahnya tingkat kepatuhan dokter spesialis terhadap kebijakan dan aturan di rumah sakit penting untuk segera ditangani oleh manajemen. Tujuan penelitian obsevasional ini, dengan pendekatan rancangan penelitian cross sectional, adalah mengetahui faktor-faktor internal dan eksternal yang mempengaruhi kepatuhan dokter spesialis terhadap kebijakan dan aturan di RS Hermina Daan Mogot.
Populasi penelitian: seluruh dokter spesialis di RS Hermina Daan Mogot. Analisis statistik yang digunakan: analisis bivariat dengan uji Chi Squre. Uji statistik Chi Square menghasilkan variabel yang memiliki hubungan bermakna dengan kepatuhan dokter spesialis yaitu p-value ≤ 0,05 adalah motivasi (p-value = 0,043). Dari analisis diperoleh pula nilai OR=2,4, artinya dokter yang motivasinya lebih mempunyai peluang 2,4 kali lebih baik dalam kepatuhan dibanding dokter yang motivasinya kurang. Perlu upaya mempertahankan motivasi kerja para dokter agar tetap di level yang tinggi, sehingga akhirnya berdampak positif bagi perkembangan rumah sakit kedepan.
Compliance is the attitude of obeying the rules and conditions set unconditionally. Low levels of compliance specialist in the policies and rules of the hospital is important to be addressed by management. The purpose of this observational research, with cross-sectional study design approach, is to know the internal and external factors affecting the specialists adherence to policies and rules in Hermina Daan Mogot Hospital.
Study population: all specialists in Hermina Daan Mogot Hospital. Staristical analysis used: bivariate analysis with Chi squre test. Chi Square statistical test results in variables that have a significant relationship with compliance specialists where p-value ≤ 0.05 is motivation (p-value = 0.043). Obtained also from the analysis of the value of OR = 2.4, meaning that physicians with more motivation have greater odds 2.4 times better adherence than physicians with less motivation. Necessary efforts are to maintain the motivation of doctors to remain at a high level, so that ultimately have a positive impact on the future development of the hospital.
