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Mega Dwi Rahayu; Pembimbing: Atik Nurwahyuni; Penguji: Pujiyanto, Ina Hirina
Abstrak:
Pada tahun 2014, BPJS Kesehatan memiliki angka rasio klaim mencapai 104,73% sedangkan di BPJS Kesehatan Kantor Cabang Depok memiliki angka rasio klaim lebih dari 100% setiap bulannya pada tahun 2015. Kondisi ini mengartikan bahwa biaya klaim yang dikeluarkan lebih besar daripada pendapatan premi yang diterima. Rawat Inap Tingkat Lanjut menjadi salah satu jenis pelayanan yang menerima biaya klaim paling besar untuk pemanfaatan pelayanan kesehatan. Penelitian ini bertujuan untuk menguji faktor-faktor yang berhubungan dengan besaran klaim rawat inap tingkat lanjut peserta Jaminan Kesehatan Nasional BPJS Kesehatan Kantor Cabang Depok Periode September 2014-September 2015. Penelitian ini bersifat kuantitatif deskriptif dengan desain studi crosssectional. Data yang digunakan berasal dari data sekunder register klaim. Hasil penelitian menunjukkan bahwa umur, lama hari rawat, diagnosis penyakit, severity level, kelas perawatan, tipe rumah sakit, jenis kepesertaan memiliki hubungan yang signifikan dengan besaran klaim rawat inap tingkat lanjut (p=0,0005), sedangkan jenis kelamin tidak ditemukan memiliki hubungan yang signifikan dengan besaran klaim rawat inap tingkat lanjut (p=0,579). Variabel yang paling berhubungan dengan besaran klaim rawat inap tingkat lanjut adalah variabel severity level 3. Kata Kunci: Besaran Klaim; Rawat Inap Tingkat Lanjut; Jaminan Kesehatan Nasional
In 2014, BPJS Kesehatan have claims ratios reached 104.73% while in BPJS Kesehatan Depok have claims ratios more than 100% per month in 2015. This condition means that the cost of claims incurred is greater than the premium income be accepted. Secondary Care Inpatient is one of the types of health services that receive the most claim costs for the utilization of health services. This research aims to examine the factors associated with the number of claims secondary care inpatient of participants National Health Insurance in BPJS Depok period September 2014- September 2015. This research is quantitative descriptive and applied cross-sectional design. Data were collect from secondary source, for example claims register data. The results showed that the age, length of stay, diagnosis of disease, severity level, care class, hospital type, the type of membership has a significant correlation with the number of the secondary care inpatient claims (p = 0,0005), whereas gender was not found to have a significant correlation with tthe number of the secondary care inpatient claims (p = 0,579). The variables most associated with the number of the secondary care inpatient claims are variable severity level 3. Keywords: Claims, Secondary Care Inpatient; National Health Insurance
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In 2014, BPJS Kesehatan have claims ratios reached 104.73% while in BPJS Kesehatan Depok have claims ratios more than 100% per month in 2015. This condition means that the cost of claims incurred is greater than the premium income be accepted. Secondary Care Inpatient is one of the types of health services that receive the most claim costs for the utilization of health services. This research aims to examine the factors associated with the number of claims secondary care inpatient of participants National Health Insurance in BPJS Depok period September 2014- September 2015. This research is quantitative descriptive and applied cross-sectional design. Data were collect from secondary source, for example claims register data. The results showed that the age, length of stay, diagnosis of disease, severity level, care class, hospital type, the type of membership has a significant correlation with the number of the secondary care inpatient claims (p = 0,0005), whereas gender was not found to have a significant correlation with tthe number of the secondary care inpatient claims (p = 0,579). The variables most associated with the number of the secondary care inpatient claims are variable severity level 3. Keywords: Claims, Secondary Care Inpatient; National Health Insurance
S-9028
Depok : FKM-UI, 2016
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Shamim Thahir Ahmad; Pembimbing: Kurnia Sari; Penguji: Mardiati Nadjib, Edu Parningotan Aritonang
Abstrak:
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Durasi penyelesaian klaim menjadi indikator penting dalam menilai efisiensi pelayanan asuransi, terutama pada produk santunan harian rawat inap. Keterlambatan dalam proses klaim dapat menurunkan kepuasan dan kepercayaan nasabah terhadap perusahaan asuransi. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan durasi penyelesaian klaim santunan harian rawat inap di PT. X berdasarkan data tahun 2023–2024. Penelitian menggunakan desain cross-sectional dengan pendekatan kuantitatif dan memanfaatkan data sekunder sebanyak 299 klaim. Analisis dilakukan secara univariat dan bivariat menggunakan regresi logistik ordinal. Hasil menunjukkan bahwa sebagian besar klaim diselesaikan dalam waktu 6–14 hari (39,1%) dan 0–5 hari (37,5%). Terdapat dua variabel yang memiliki hubungan signifikan secara statistik terhadap durasi klaim, yaitu asal daerah dan kelengkapan dokumen. Peserta dari luar Pulau Jawa cenderung mengalami durasi klaim lebih lama, sedangkan klaim dengan dokumen lengkap memiliki peluang yang jauh lebih besar untuk diselesaikan dalam waktu singkat. Empat variabel lainnya—sebab dirawat, jenis rumah sakit, nominal klaim, dan riwayat pengajuan sebelumnya—tidak menunjukkan hubungan signifikan namun memiliki kecenderungan praktis yang relevan.
The duration of claim settlement is an important indicator in assessing the efficiency of insurance services, particularly for hospital daily cash benefit products. Delays in the claim process may reduce customer satisfaction and trust in insurance companies. This study aims to analyze the factors associated with the duration of claim settlement for hospital daily cash benefits at PT. X based on 2023–2024 data. A cross-sectional design with a quantitative approach was used, utilizing secondary data from 320 claims. The analysis was conducted using univariate and bivariate methods with ordinal logistic regression. The results showed that most claims were settled within 6–14 days (39.1%) and 0–5 days (37.5%). Two variables showed statistically significant relationships with claim duration: region of origin and completeness of documents. Participants from outside Java Island tended to experience longer claim durations, while claims submitted with complete documents had a significantly higher likelihood of being processed more quickly. The other four variables—reason for hospitalization, hospital type, claim amount, and claim history—were not statistically significant but showed relevant practical trends.
The duration of claim settlement is an important indicator in assessing the efficiency of insurance services, particularly for hospital daily cash benefit products. Delays in the claim process may reduce customer satisfaction and trust in insurance companies. This study aims to analyze the factors associated with the duration of claim settlement for hospital daily cash benefits at PT. X based on 2023–2024 data. A cross-sectional design with a quantitative approach was used, utilizing secondary data from 320 claims. The analysis was conducted using univariate and bivariate methods with ordinal logistic regression. The results showed that most claims were settled within 6–14 days (39.1%) and 0–5 days (37.5%). Two variables showed statistically significant relationships with claim duration: region of origin and completeness of documents. Participants from outside Java Island tended to experience longer claim durations, while claims submitted with complete documents had a significantly higher likelihood of being processed more quickly. The other four variables—reason for hospitalization, hospital type, claim amount, and claim history—were not statistically significant but showed relevant practical trends.
S-12000
Depok : FKM-UI, 2025
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Monica Tara Chrishanti; Pembimbing: Pujiyanto; Penguji: Sabarinah, Mardiati Nadjib
Abstrak:
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Penyakit kardiovaskular merupakan penyebab utama kematian di Indonesia dan menimbulkan beban pembiayaan yang besar dalam Program Jaminan Kesehatan Nasional (JKN). Meskipun pelayanan Rawat Inap Tingkat Lanjut (RITL) menyerap proporsi pembiayaan JKN yang tinggi, hasil penelitian menunjukkan hanya sebagian kecil peserta JKN dengan penyakit kardiovaskular di Provinsi DKI Jakarta yang memanfaatkan RITL. Penelitian ini bertujuan mengetahui gambaran dan hubungan karakteristik peserta JKN dengan utilisasi RITL kasus penyakit kardiovaskular di Provinsi DKI Jakarta tahun 2023. Penelitian menggunakan pendekatan kuantitatif dengan desain cross-sectional dan sumber data berupa Data Sampel BPJS Kesehatan Tahun 2024. Sampel penelitian terdiri atas 915 peserta sebelum pembobotan yang setelah dilakukan pembobotan merepresentasikan 142.621 peserta JKN yang memperoleh pelayanan di Fasilitas Kesehatan Rujukan Tingkat Lanjut di Provinsi DKI Jakarta dengan diagnosis primer penyakit kardiovaskular kode ICD-10 I05–I09, I11, I20–I25, dan I30–I50. Data dianalisis secara univariat dan bivariat menggunakan uji Chi-Square dan regresi logistik sederhana. Hasil penelitian menunjukkan bahwa sebesar 9,0% peserta memanfaatkan RITL, sedangkan 91,0% tidak memanfaatkan RITL. Median lama rawat peserta RITL adalah empat hari. Usia, jenis kelamin, status perkawinan, hak kelas rawat, segmentasi kepesertaan, dan hubungan keluarga memiliki hubungan yang signifikan dengan utilisasi RITL (p-value <0,05). Proporsi RITL tertinggi ditemukan pada peserta usia 15 – 64 tahun sebesar 9,9%, perempuan sebesar 10,8%, belum menikah sebesar 10,5%, kelas II sebesar 14,9%, PBI APBN sebesar 14,5%, dan kelompok hubungan keluarga sebagai anak sebesar 33,8%. Kelompok tambahan pada variabel hubungan keluarga tidak menunjukkan hubungan yang signifikan dibandingkan peserta utama. Utilisasi RITL yang relatif rendah tidak dapat langsung dimaknai sebagai hambatan akses karena sebagian peserta dimungkinkan memperoleh pengelolaan melalui pelayanan primer dan rawat jalan tingkat lanjut. BPJS Kesehatan, Dinas Kesehatan Provinsi DKI Jakarta, dan fasilitas kesehatan disarankan mempertahankan kesinambungan pengelolaan penyakit kronis serta memanfaatkan data klaim untuk memantau kelompok peserta dengan proporsi RITL relatif tinggi tanpa membatasi akses pelayanan sesuai kebutuhan medis.
Cardiovascular disease is the main cause of death in Indonesia and causes a large financing burden in the Program Jaminan Kesehatan Nasional (JKN). Although the Advanced Inpatient Service (RITL) absorbs a high proportion of JKN financing, research results show that only a small percentage of JKN participants with cardiovascular disease in DKI Jakarta Province take advantage of RITL. This study aims to find out the characteristics and relationship of JKN participants with the RITL utilization of cardiovascular disease cases in DKI Jakarta Province in 2023. Research uses a quantitative approach with cross-sectional design and data sources in the form of BPJS Health Sample Data for 2024. The study sample consisted of 915 participants before the weighting, who after the weighting represented 142,621 participants of JKN who received services at Advanced Reference Health Facilities in DKI Jakarta Province with primary diagnosis of cardiovascular disease code ICD-10 I05–I09, I11, I20–I25, and I30–I50. Data are analyzed univariate and bivariate using Chi-Square tests and simple logistic regression. Research results showed that 9.0% of participants used RITL, while 91.0% did not use RITL. The median length of care for RITL participants is four days. Age, sex, marital status, nursing class rights, participation segmentation, and family relationships have a significant relationship with RITL utilization (p-value <0.05). The highest proportion of RITLs was found in participants aged 15–64 at 9.9%, women at 10.8%, unmarried at 10.5%, class II at 14.9%, PBI APBN at 14.5%, and family relations groups as children at 33.8%. Additional groups on the family relationship variable showed no significant relationship compared to the main participants. The relatively low utilization of RITL cannot be immediately interpreted as an access barrier because some participants may obtain management through advanced primary and outpatient services. BPJS Health, the DKI Jakarta Provincial Health Office, and health facilities are advised to maintain continuous management of chronic diseases and utilize claim data to monitor groups of participants with relatively high proportions of RITL without limiting service access according to medical needs.
S-12434
Depok : FKM-UI, 2026
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Andi Kayla Ardani; Pembimbing: Pujiyanto; Penguji: Vetty Yulianty Permanasari, Laksmi Damaryanti
Abstrak:
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Latar belakang: Penyakit menular, khususnya Tuberkulosis (TB), masih menjadi tantangan besar di Indonesia, dengan prevalensi yang tinggi dan dampak signifikan terhadap sistem kesehatan. Komorbiditas seperti Diabetes Mellitus (DM) dan koinfeksi HIV memperburuk pengobatan TB, memperpanjang durasi terapi, serta meningkatkan beban biaya. Penelitian ini bertujuan untuk menganalisis perbandingan biaya rawat inap pada pasien TB dengan komorbid DM dan koinfeksi HIV di fasilitas kesehatan Indonesia, khususnya yang terdaftar dalam program Jaminan Kesehatan Nasional (JKN). Tujuan: Mengetahui perbandingan biaya rawat inap pada layanan FKRTL peserta JKN penderita TB/DM dan TB/HIV di Indonesia selama satu tahun. Metode: Penelitian ini menggunakan pendekatan kuantitatif dengan studi cross-sectional menggunakan data sampel BPJS Kesehatan tahun 2023. Sampel penelitian ini adalah peserta dengan diagnosis primer TB yang memiliki diagnosis sekunder DM dan HIV pada pelayanan FKRTL. Hasil: Terdapat sebanyak 4.753 peserta RITL JKN tahun 2022. Dari total kunjungan, sebanyak 4.531 merupakan peserta komorbid TB/DM dan 232 peserta koinfeksi TB/HIV. Pada tahun 2022, BPJS Kesehatan membayarkan sebesar Rp28,8 miliar untuk peserta RITL komorbid TB/DM dan Rp3,1 miliar untuk peserta RITL koinfeksi TB/HIV. Kesimpulan: Faktor-faktor yang berhubungan dengan biaya komorbid TB/DM pada kunjungan RITL peserta JKN 2022 adalah umur, hak kelas rawat, segmen kepesertaan, dan rujukan FKTP. Sedangkan, faktor-faktor yang beruhubungan dengan biaya koinfeksi pada kunjungan RITL pada kunjungan peserta JKN 2022 adalah jenis kelamin, umur, hak kelas rawat, dan segmen kepesertaan.
Background: Infectious diseases, particularly Tuberculosis (TB), remain a major challenge in Indonesia, with high prevalence and significant impact on the healthcare system. Comorbidities such as Diabetes Mellitus (DM) and HIV coinfection worsen TB treatment, prolong therapy duration, and increase healthcare costs. This study aims to analyze the comparison of inpatient costs for TB patients with comorbid DM and HIV coinfection in Indonesian healthcare facilities, specifically those enrolled in the National Health Insurance (JKN) program. Objective: To determine the comparison of inpatient costs for JKN FKRTL services for TB/DM and TB/HIV patients in Indonesia over the course of one year. Method: This study employs a quantitative approach with a cross-sectional design using BPJS Health sample data from 2023. The research sample includes participants with a primary TB diagnosis and secondary diagnoses of DM and HIV in FKRTL services. Results: There were 4,753 JKN inpatient participants in 2022. Of these, 4,531 were TB/DM comorbid patients, and 232 were TB/HIV coinfected patients. In 2022, BPJS Health paid Rp28.8 billion for TB/DM comorbid patients and Rp3.1 billion for TB/HIV coinfected patients. Conclusion: Factors related to the cost of TB/DM comorbidity for JKN inpatient visits in 2022 include age, inpatient class entitlement, membership segment, and FKTP referral. Meanwhile, factors related to the cost of coinfection for JKN inpatient visits in 2022 include gender, age, inpatient class entitlement, and membership segment.
S-11835
Depok : FKM UI, 2025
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Anne Aryanti; Pembimbing: Prastuti Soewondo; Penguji: Atik Nurwahyuni, Amila Megraini
Abstrak:
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Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan utilisasi rawat jalan tingkat lanjut peserta JKN pada anak yang merupakan pasien diabetes mellitus di Indonesia berdasarkan Data Sampel BPJS Kesehatan Kontekstual Diabetes Mellitus tahun 2015-2020. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan desain studi observasional yang bersifat cross sectional. Teknik pengambilan sampel menggunakan total sampling dan sampel merupakan seluruh data peserta JKN di Indonesia yang pernah didiagnosis diabetes mellitus di layanan Fasilitas Kesehatan Rujukan Tingkat Lanjut antara tahun 2015-2020. Penelitian ini menggunakan aplikasi olah data Stata. Sampel hasil pembobotan diperoleh sebesar 938 peserta Hasil penelitian diperoleh bahwa utilisasi rawat jalan tingkat lanjut peserta JKN pada anak yang memiliki penyakit diabetes mellitus di Indonesia tahun 2015-2020 sebagian besar diakses oleh peserta dengan jenis kelamin perempuan (80,65%), Jenis FKTP dokter umum (100%), kepemilikan FKRTL swasta (80,64% ), segmentasi kepesertaa PBI APBN (93,05%), hak kelas rawat III (83,53%), wilayah tempat tinggal regional 4 dan 5 (100%), dan memiliki penyakit penyerta (89,58%). Variabel yang memiliki hubungan secara signifikan dengan utilisasi rawat jalan tingkat lanjut adalah jenis FKTP, segmentasi kepesertaan, hak kelas rawat, wilayah tempat tinggal, dan penyakit penyerta. Dari hasil analisis didapatkan nilai Adjusted Odds Ratio (AOR) terbesar yaitu pada peserta yang memiliki penyakit penyerta 18,06 (95% CI: 11,01 – 29,62) yang menunjukkan bahwa peserta dengan penyakit penyerta memiliki peluang sebanyak 18,06 kali untuk melakukan utilisasi pelayanan kesehatan rawat jalan tingkat lanjut dibandingkan peserta yang tidak memiliki penyakit penyerta. Hasil penelitian menyimpulkan bahwa variabel yang paling berpengaruh terhadap pemanfaatan rawat jalan tingkat lanjut diabetes mellitus di Indonesia adalah penyakit penyerta.
This study aims to determine the factors associated with outpatient utilization of JKN participants in children who are diabetes mellitus patients in Indonesia based on the 2015-2020 Diabetes Mellitus Contextual BPJS Health Sample Data. This research is a quantitative study using an observational study design that is cross sectional. The sampling technique uses total sampling and the sample is all data on JKN participants in Indonesia who have been diagnosed with diabetes mellitus at Advanced Referral Health Facilities services between 2015-2020. This study uses the Stata data processing application. The sample of the weighting results was obtained for 938 participants. The results showed that the utilization of advanced outpatient care for JKN participants for children with diabetes mellitus in Indonesia in 2015-2020 was mostly accessed by participants with female sex (80.65%), FKTP types of general practitioners (100%), ownership Private FKRTL (80.64%), APBN PBI membership segmentation (93.05%), right to class III care (83.53%), region of residence regional 4 and 5 (100%), and have comorbidities (89, 58%). Variables that have a significant relationship with the utilization of advanced outpatient care are the type of FKTP, membership segmentation, treatment class entitlement, area of residence, and comorbidities. From the analysis results, the largest Adjusted Odds Ratio (AOR) value was obtained for participants who had comorbidities of 18.06 (95% CI: 11.01 – 29.62) which indicated that participants with comorbidities had 18.06 times the chance of making use of advanced outpatient health services compared to participants who do not have comorbidities. The results of the study concluded that the variables that most influenced the use of advanced diabetes mellitus outpatient care in Indonesia were comorbidities.
S-11390
Depok : FKM-UI, 2023
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Glorianna Hutauruk; Pembimbing: Suprijanto Rijadi, Penguji: Pujiyanto, Jenal M Sambas
S-4655
Depok : FKM UI, 2006
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Meti Suprapti; Pembimbing: Ronnie Rivany
S-2845
Depok : FKM-UI, 2002
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Nurul Muthia Amalia Pratiwi; Pembimbing: Kurnia Sari; Penguji: Vetty Yulianty Permanasari, Prisca Gisella
Abstrak:
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Waktu tunggu merupakan indikator penting dalam menilai mutu pelayanan rawat jalan. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan waktu tunggu pasien di poliklinik anak dan penyakit dalam RS X pada kuartal IV tahun 2024. Penelitian menggunakan desain cross-sectional dengan pendekatan kuantitatif. Data sekunder diperoleh dari laporan bulanan dan dianalisis menggunakan uji chi-square dan regresi logistik berganda. Hasil menunjukkan rata-rata waktu tunggu adalah 34,23 menit, dengan faktor yang berhubungan secara signifikan yaitu keterlambatan dokter, jenis poliklinik, hari kunjungan, dan jumlah pasien. Variabel jenis poliklinik merupakan faktor paling dominan dengan nilai Exp(B) sebesar 2,254, yang berarti pasien di poliklinik penyakit dalam berisiko lebih tinggi mengalami waktu tunggu ≥60 menit. Disimpulkan bahwa penguatan kepatuhan terhadap jadwal praktik dokter serta pengelolaan beban pelayanan diperlukan untuk mengurangi lama durasi waktu tunggu.
Waiting time is a crucial indicator in assessing the quality of outpatient services. This study aims to analyze the factors influencing patient waiting time at the pediatric and internal medicine clinics of Hospital X during the fourth quarter of 2024. A cross-sectional design with a quantitative approach was used. Secondary data were obtained from monthly polyclinic reports and analyzed using chi-square tests and multiple logistic regression. The results showed that the average waiting time was 34.23 minutes. Significant factors associated with longer waiting times included doctor delays, clinic type, visit day, and number of patients per doctor. Among these, clinic type was the most dominant factor, with an odds ratio (Exp(B)) of 2.254, indicating that patients in the internal medicine clinic were more likely to experience delays of 60 minutes or more. It is concluded that strengthening adherence to doctors' practice schedules as well as managing service load is necessary to reduce waiting time duration.
S-11904
Depok : FKM-UI, 2025
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Alya Syaharani Tajuddin; Pembimbing: Kurnia Sari; Penguji: Pujiyanto, Wilda Alvernia Lumban Gaol
Abstrak:
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Kasus katastropik menghabiskan 25% dari total biaya klaim BPJS Kesehatan dengan total biaya sebesar Rp20,0 triliun di tahun 2020, sementara penyakit kanker berada di posisi kedua dengan biaya terbesar Rp3,5 triliun. Penelitian ini menganalisis klaim biaya penyakit kanker peserta JKN yang berkunjung ke FKRTL dan faktor- faktor yang berhubungan. Penelitian menggunakan desain cross-sectional dengan menggunakan data sampel BPJS tahun 2022 yang berisi data kunjungan tahun 2021. Hasil penelitian mendapatkan bahwa proporsi terbesar pasien dengan penyakit kanker di FKRTL adalah kanker payudara (C50). Ditemukan bahwa rata-rata klaim kanker sebesar Rp358.865 per pasien rajal dan Rp11.200.000 pasien ranap. Biaya tinggi ditemui pada karakteristik pasien yang berusia ≥ 61 tahun, berjenis kelamin laki-laki, di regional 3, status telah menikah, dengan hari rawat tinggi, diagnosis C69-C72 (Kanker mata, otak, dan bagian lain dari sistem saraf pusat), severity level 2, di FKRTL milik TNI AL, dan kelas perawatan 1. Tingkat keparahan merupakan prediktor utama tingginya biaya penyakit kanker. Oleh karena itu, skrining dan deteksi dini perlu digencarkan terus untuk mengendalikan biaya penyakit kanker.
Catastrophic cases account for 25% of the total BPJS Kesehatan claim costs, with a total cost of IDR 20.0 trillion in 2020, while cancer ranks second with the highest cost of IDR 3.5 trillion. This study analyzes the cancer disease claim costs of JKN participants who visited FKRTL and the related factors. The study uses a cross-sectional design with BPJS sample data from 2022, which contains visit data from 2021. The results show that the largest proportion of patients with cancer at FKRTL is breast cancer (C50). It was found that the average cancer claim is IDR 358,865 per outpatient and IDR 11,200,000 per inpatient. High costs were found in patients aged ≥ 61 years, male, in region 3, married status, with high hospital stay days, diagnoses C69-C72 (eye, brain, and other parts of the central nervous system cancer), severity level 2, in FKRTL owned by the Indonesian Navy, and in class 1 care. Severity level is the main predictor of high cancer costs. Therefore, continuous screening and early detection are needed to control cancer costs.
S-11778
Depok : FKM UI, 2024
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Evi Rahayu; Pembimbing: Wachyu Sulistiadi; Penguji: Nurwahyuni, Atik; Alviah, Evi
Abstrak:
Skripsi ini menggambarkan ekses klaim provider PT Asuransi X pada polis yang diterbitkan tahun 2012 periode pelayanan Januari 2012 ? Oktober 2013. Penelitian ini adalah penelitian cross sectional dengan desain deskriptif melalui pendekatan kuantitatif. Hasil penelitian dari data-data sekunder perusahaan dapat digambarkan bahwa biaya ekses klaim dipengaruhi oleh beberapa faktor, untuk faktor klasifikasi provider provider gold 50,20% dan 49.80 % dari total biaya ekses untuk provider silver. Faktor jenis kepesertaan ; karyawan 43.98%, pasangan 36.68% dan kepesertaan anak 19.35 % dari total biaya ekses klaim. Faktor berikutnya paket manfaat/pelayanan kesehatan yang terdiri dari rawat inap 51,43%, rawat jalan 29.05%, persalinan 13,19%, rawat gigi 6.24% dan paket manfaat kacamata 0.09% dari total biaya ekses klaim. Dari faktor kesesuaian isi polis terkait limitasi manfaat; rawat inap 52.96%, rawat jalan 23.75%, persalinan 15.02%, rawat gigi 8.16%, sedangkan limitasi manfaat kacamata 0.11% dari total biaya ekses klaim. Dari faktor pengecualian pada polis yang disebabkan karena: pengecualian diagnose 41.38%, pengecualian obat 31.27%, tindakan tidak indikasi 18.48%, pelayanan diluar tanggal efektif polis 7.13%, non medis 1.07% dan peserta yang tidak memiliki paket manfaat 0.66% dari biaya ekses klaim.
This study aims to describe the excess claim at PT Insurance X provider for policy issued in 2012 at January 2012 ? October 2013 Service Period. This study is cross sectional study with descriptive design through a quantitative approach. The result showed taken from Insurance Company secondary data describe that the excess claim cost influence by some factors, for classification of provider factor; gold provider reach 50.20% and 49.80% for silver provider from totally excess claim cost. Type of membership factor; employee 43.98%, couple 36.68% and children membership 19.35% from totally excess claim cost. The next factor of package benefit/health services that consist of inpatient 51.43%, outpatient 29.05%, maternity 13.19%, dental service 6.24% and package benefit of glasses 0.09% from totally excess claim cost. From the factor of compatibility policy content related to limitation of benefit inpatient 52.96%, outpatient 23.75%, maternity 15.05%, dental service 8.16% and package benefit of glasses 0.11% from totally excess claim cost. From the exclusion policy that caused by diagnose exclusion 41.38%, medicine exclusion 31. 27%, not indication treatment 18.48%, services out of effective date policy 7.13%, non medical 1.07% and member that have not benefit package 0.66% from totally excess claim cost.
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This study aims to describe the excess claim at PT Insurance X provider for policy issued in 2012 at January 2012 ? October 2013 Service Period. This study is cross sectional study with descriptive design through a quantitative approach. The result showed taken from Insurance Company secondary data describe that the excess claim cost influence by some factors, for classification of provider factor; gold provider reach 50.20% and 49.80% for silver provider from totally excess claim cost. Type of membership factor; employee 43.98%, couple 36.68% and children membership 19.35% from totally excess claim cost. The next factor of package benefit/health services that consist of inpatient 51.43%, outpatient 29.05%, maternity 13.19%, dental service 6.24% and package benefit of glasses 0.09% from totally excess claim cost. From the factor of compatibility policy content related to limitation of benefit inpatient 52.96%, outpatient 23.75%, maternity 15.05%, dental service 8.16% and package benefit of glasses 0.11% from totally excess claim cost. From the exclusion policy that caused by diagnose exclusion 41.38%, medicine exclusion 31. 27%, not indication treatment 18.48%, services out of effective date policy 7.13%, non medical 1.07% and member that have not benefit package 0.66% from totally excess claim cost.
S-8401
Depok : FKM-UI, 2014
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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