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This study analyzes age, gender, diagnosis, lenght of stay, and diagnosis of disease ofparticipants on the level of utilization and claim cost in Health care program in Bapel JPKM PTX di RS P. This is describe about descriptic analytical study use cross sectional design. Theresults of this study suggest Skripsi ini membahas analisis umur, jenis kelamin, wilyah tempattinggal dan diagnosis penyakit terhadap tingkat utilisasi dan biaya klaim Program JaminanPemeliharaan Kesehatan Bapel JPKM PT X di RS P. Penelitian ini adalah penelitian deskriptikanalitik dengan desain cross sectional atau potong lintang. Hasil penthat it is need to considerother factors besides age, gender, diagnosis and status of participants. Same factors needs to beconcerned are leght of stay and type of health care.Key word :Utilization.
Program JFK Jamsostek tidak bersifat wajib bagi pcrusahaan yang telah mclaksanakan sendiri pelayanan kesehatannya secara lebih baik. Saat ini belum ada pcngembangan penilaian kinerja Program JPK di Kanwil III yang dilaksanakan secara komprehensifdengan pendekatan teori balanced scorecard. Studi ini bertujuan mcngetahui gambaran kineda dari perspektif keuangan, perspektif pclanggan, perspeklif bisnis internal dan perspektif pertumbuhan dan pembelajaran. Penelitian deskriptif analitik dengan metode penelitian kuantitatif dan kualitatif. Data yang digunakan terdiri dari data primer seperti kuesioner kepuasan pelanggan dan karyawan serta wawancara mendalam, serta data sckunder yang berasal dari lapcran. Pclaksanaan di Kanwil III Bulan Februari - Mei 2009. Uji validitas dilakukan di Kanwil IV. Keempat perspektif diasumsikan mempunyai bobot yang sama pentingnya dan pengaruhnya terhadap performa JPK Kanwil III. Hasil penilaian untuk perspektifpertumbuhan dan pembelajaran ideal, perspcktif proscs bisnis internal tidak ideal, perspektif pelanggan ideal . dan perspcktif kcuangan ideal. Secara keseluruhan penilaian kinerja Program JFK Kanwil III termasuk kritcria ideal. Peneliti mengusulkan kepada manajemen agar penetapan target dilakukan dengan Icbih menantang mengacu pada parameter SMART : spesyic. measurable. achievable, relevant dan time constrained.
Healthcare program called as JPK is an optional program for company who have better quality healthcare program compare to JPK program. Till nowadays, there isn’t comprehensive performance management system developed to monitor the perfonnance of JPK program at region III. The purpose ofthe study is to find out the pcrfonnance of' JPK PT. Jamsostck (Persero) region Ill from several persPCctive, which are financial. customer, intemal process and learn & growth. This study categorized as analytic descriptive using quantitative and qualitative method. The data used consist of primary and secondary data. Primary data comes from customer and employee satisfaction research previously conducted and in-depth interview. Data collected during February-May 2009. Four perspectives assumed have same weight in tenn of its degree of importance and its effect to JPK pcrfom1ance. The result of the study shows that three of perspective (learn and growth, customer, financial) are ideal condition while one perspective (intemal process) isn’t ideal condition. Overall, performance of .IPK region Ill categorized as ideal criteria. Researcher recommend management to set the target using five criteria's, which are SMART, stand for S-Specific, M-Measurable, A-Achievable, R-Relevant, T-Time Constrained.
Penelitian ini bertujuan untuk menilai besarnya biaya akibat stroke pada penderita stroke yang mengalami kejadian stroke pertama kalinya pada periode 1 Januari – 31 Maret 2011 di Rumah Sakit Umum Pusat Fatmawati Jakarta. Penelitian ini merupakan penelitian dengan desain studi cost of illness crosssectional retrospektif, menggunakan pendekatan insiden kasus dan metode estimasi biaya dengan pendekatan ”bottom up”. Sampel populasi penderita stroke diambil berdasarkan purposive sampling sebanyak 100 responden. Untuk melihat faktor-faktor yang mempengaruhi biaya stroke digunakan uji Kai Kuadrat dan untuk melihat derajat hubungan menggunakan Odds Rasio dengan CI 95%. Berdasarkan hasil penelitian ditemukan bahwa estimasi rata-rata biaya akibat stroke per pasien pada tahun pertama adalah Rp18.872.561, dari total biaya ini rata-rata besar biaya langsung adalah Rp. 15.110.241 dan rata-rata biaya tidak langsung adalah Rp 3.762.360. Faktor-faktor yang mempengaruhi biaya akibat stroke antara lain Lama Hari Rawat, Status Neurologis saat masuk pertama kali ke rumah sakit, kondisi pasien saat keluar RS serta perbedaan kelas perawatan, tingkat pendidikan, status pekerjaan, tingkat pendapatan serta mekanisme pembayar. Hasil penelitian ini menyarankan kepada Kementerian Kesehatan dan Rumah Sakit untuk menata ulang perhitungan tarif dari semua penjamin baik Askes, Jamkesda, Jamkesmas dan TM DKI supaya banyak provider yang mau ikut serta dalam mekanisme pembiayaan ini. Kata kunci : Stroke, biaya, RSUP Fatmawati.
This study aimed to estimate the cost of stroke among stroke patients who experienced the first stroke acute in the period of 1 January to 31 March 2011 at the Fatmawati Public Hospital Jakarta. This research is design by cost of illness study of cross-sectional retrospective, using incident cases and the approach to cost estimation methods with a "bottom up". Sample population of stroke patients will be taken based on purposive sampling as much as 100 respondents. Factors that influence the cost of stroke in tests using the Kai Squares test and to see the degree of relationship using the Odds Ratio with 95% CI. The results showed that the estimated average cost per patient of a stroke in the first year is Rp18.872.561, the average of direct cost is Rp. 15.110.241 of total cost and the average of indirect cost is Rp 3.762.360. Factors that affect the cost of a stroke include the Length Of Stay (LOS), Neurological status at first time admission to the hospital, condition when patient’s discharge and treatment of class differences. In the present study also found that the cost of a stroke is indirectly affected by education level, employment status, income and method payment. These results suggest to the Ministry of Health and Hospitals to conduct the rate calculation of all method payment so many providers are willing to participate in this financing mechanism. Key words: Stroke, cost, Fatmawati Public Hospital Jakarta.
This study aims to analyze the experiences of participants and officers in the medical care verification process within the Occupational Injury Insurance Program (JKK) managed by PT ASABRI (Persero). This program is designed to provide social protection for Indonesian National Armed Forces (TNI) soldiers, National Police members, and Civil Servants (ASN) within the Ministry of Defense and the Police. A qualitative approach with a case study design was used. Data were collected through in-depth interviews with three JKK participants and three ASABRI officers directly involved in the verification process, along with a review of supporting documents. The findings reveal that the verification process includes several stages: document checking, medical data validation, and compliance evaluation with standard operating procedures (SOPs). Participants reported that the verification process is often complicated and bureaucratic, especially regarding documentation requirements and the lack of clear information. From the officers’ perspective, the main challenges include low participant literacy, lack of socialization, and limited human resources in handling complex claims. Perceptions of service quality, assessed through the SERVQUAL dimensions (tangibles, reliability, responsiveness, assurance, empathy), influence participant satisfaction levels. This study concludes that enhancing the effectiveness of the medical care verification process is essential for ensuring participant satisfaction. Recommendations include simplifying administrative procedures, improving staff training, and optimizing information systems to support the claims process. These findings are expected to serve as input for evaluating and improving policy in ASABRI’s JKK services.
ABSTRAK This thesis discusses the demand pattern of outpatient care in those commercial health insurance in Indonesia by using outpatient claims data at 2.566.850 million. Using quantitative esearch method with cross sectional design. The results showed that outpatient demand on the commercial health insurance participants related to the characteristics of participants, the diagnosis of disease, characteristic of health insurance benefits, and types of health care facilities. The dominant predictor affecting the demand are tuberculosis and the benefits of unlimited ceiling. As a suggestion for a national social health insurance policy, outpatient premium is amounting to Rp 3,112 per person per month and outpatient premium for commercial health insurance is amounting to Rp 115,665. Keywords: Demand, health insurance
ABSTRAK
Pembiayaan kesehatan terus mengalami peningkatan. Beberapa faktor menyebabkan terjadinya peningkatan tersebut. Dampak negatif dari meningkatnya pembiayaan kesehatan adalah menekan kemampuan pemberi dana atau perusahaan untuk menyediakan biaya pelayanan kesehatan bagi karyawan dan keluarga karyawannya. Penelitian ini bertujuan untuk melihat bagaimana hubungan karakteristik peserta dengan angka kunjungan dan biaya penyakit katastropik pada peserta ASO PT. GAMI tahun 2011 ? 2012. Penelitian dilakukan dengan pendekatan kuantitatif dengan disain penelitian cross sectional.
Dari hasil penelitian disimpulkan bahwa karakteristik peserta yang paling berhubungan dengan angka kunjungan dan biaya penyakit katastropik adalah usia. Klasifikasi benefit as charge dengan limit tahunan mempunyai hubungan yang signifikan dengan biaya penyakit katastropik. Penelitian selanjutnya, bisa lebih menggali variabel periode kepesertaan.
ABSTRACT
Health financing continues to increase. Several factors led to this increase. The negative impact of rising health care financing is pressing lenders or companies ability to provide health care costs for employees and employee families. This study aims to look at how the characteristics of the participants relationship with the number of visits and the cost of catastrophic illness on ASO participants PT. GAMI years 2011-2012. Research is a quantitative approach with a crosssectional study design.
The final conclusion is that the characteristics of the participants are most related to the number of visits and the cost of catastrophic illness is the age. Benefit classification as a charge to annual limit has a significant connection with catastrophic illness costs. For further research could further explore variable period of membership.