Diare merupakan penyakit yang sering dijumpai dan menyebabkan 4% dari seluruh kematian di dunia. Kasus diare akut pada anak merupakan salah satu penyakit yang termasuk high risk, high volume dan high cost. Menurut data tahun 2018 total kasus diare akut sebanyak 938 kasus dan termasuk urutan pertama dari 10 besar kasus rawat inap di RSU Bhakti Yudha. Implementasi clinical pathway berhubungan erat dengan upaya mengendalikan mutu dan biaya pelayanan kesehatan yang terjangkau serta dapat diperkirakan. Pengendalian biaya dapat terealisasi jika proses dalam pelayanan kesehatan secara menyeluruh dapat direncanakan dan distandarisasi sejak awal.Clinical pathway jika dilakukan dengan baik dan benar dapat mengurangi biaya pelayanan kesehatan, mengurangi lama hari rawat inap, meningkatkan hasil klinis pasien. Adanya ketidaksesuaian penerapan clinical pathway dapat berpengaruh pada jumlah tagihan/ billing pasien. Penelitian ini bertujuan mengetahui kesesuaian penerapan clinical pathway diare akut ringan - sedang pasien rawat inap anak di RSU Bhakti Yudha. Disain penelitian mix method yang bersifat deskriptif kuantitatif dan studi kasus kualitatif. Hasil penelitian didapatkan Kepatuhan dokter masih kurang dalam pemberian tatalaksana medis. Masih ditemukan ketidaksesuaian antara clinical pathway dengan pelayanan yang diberikan. Ketidaksesuaian tersebut diantaranya adanya variasi dalam pemberian terapi obat-obatan, pemeriksaan penunjang, dan tindakan keperawatan. Variasi tersebut dilakukan karena kondisi pasien berbeda-beda kebutuhan penanganan. Gap terbesar pada penggunaan obat yaitu 145 % dimana pada billing tagihaan riil lebih besar dibanding tagihan sesuai clinical pathway dikarenakan penggunaan obat yang tidak sesuai clinical pathway. Banyaknya varian yang tidak sesuai clinical pathway akan mempengaruhi besaran tagihan rumah sakit

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Diarrhea is a disease that is often found and causes 4% of all deaths in the world. Cases of acute diarrhea in children is a disease that includes high risk, high volume, and high cost. According to 2018 data, there were 938 cases of acute diarrhea and were in first place in the top 10 causes of hospitalization at Bhakti Yudha General Hospital. The implementation of clinical pathways is closely related to efforts to control the quality and cost of affordable and predictable health services. Cost control can be realized if the process of overall health services can be planned and standardized from the start. Clinical pathways if done properly and correctly can reduce the cost of health services, reduce the length of stay, and improve patient clinical outcomes. The existence of a mismatch in the application of clinical pathways can affect the number of billing patients. This study aims to determine the appropriateness of the application of clinical pathways of mild acute diarrhea - moderate inpatient children in Bhakti Yudha General Hospital. The mixed-method research design is quantitative descriptive and qualitative case studies. The results showed that doctor compliance was still lacking in the provision of medical management. There are still discrepancies between clinical pathways and services provided. These discrepancies include variations in drug therapy, supporting examinations, and nursing actions. This variation was made because the patient's condition needed different treatments. The biggest gap in the use of drugs is 145% wherein  real billing is greater than the bill according to the clinical pathway due to the use of drugs that are not following the clinical pathway. The number of variants that do not fit the clinical pathway will affect the amount of the hospital bill.

Latar Belakang. Demam Berdarah Dengue (DBD) merupakan masalah kesehatan di Indonesia yang juga membebani kondisi RSU Bhakti Yudha karena merupakan kasus penyakit tertinggi yang memiliki nilai defisit negatif tertinggi (-112%) untuk kasus rawat inap JKN (Jaminan Kesehatan Nasional) non tindakan tahun 2021. Perhitungan Cost of Treatment (COT) DBD diperlukan sebagai evaluasi biaya pelayanan agar tercipta kendali mutu dan biaya. Tujuan Penelitian ini agar diketahui cost of treatment rawat inap DBD pada pasien JKN di RSU Bhakti Yudha tahun 2021. Metode Penelitian yaitu dengan pendeketan kuantitatif untuk memperoleh informasi cost of treatment DBD. Perhitungan cost of treatment didasari oleh perhitungan unit cost pada unit produksi pelayanan DBD yaitu IGD, Laboratorium, Radiologi, dan Rawat Inap dengan metode Activity Based Costing. Sampel penelitian yaitu 109 pasien yang dipilih sesuai kriteria inklusi dan perhitungan metode Slovin. Perhitungan biaya dilakukan melalui wawancara serta studi dokumentasi dari data rekam medis, laporan keuangan, dan data terkait lainnya. Hasil penelitian diperoleh karakteristik pasien JKN dengan diagnosis DBD mayoritas kelompok umur 10-14 tahun, jenis kelamin perempuan, ruang perawatan kelas 1, dan rata-rata LOS 3,5 hari. Variasi aktivitas DBD cukup tinggi. Unit cost untuk setiap tindakan/aktivitas di unit produksi telah didapatkan untuk menghitung COT DBD. COT DBD untuk kelas 1, kelas 2, dan kelas 3 secara berurutan yaitu Rp1.910.461, Rp1.639.751, dan Rp1.906.122. Kesimpulan. Telah diperoleh COT DBD untuk pasien DBD dimana hasil COT DBD masih menunjukkan selisih negatif kelas 3 dengan tarif INA-CBG. Perlu adanya upaya efisiensi yang dilakukan dengan cara menurunkan biaya tidak langsung dengan meningkatkan utilisasi pelayanan. Upaya efisiensi yang dapat dilakukan khusus untuk pelayanan DBD adalah pembuatan Clinical Pathway dan audit kepatuhannya agar tercipta kendali mutu dan kendali biaya.

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Background. Dengue Hemorrhagic Fever (DHF) is a health problem in Indonesia which also a burden to Bhakti Yudha General Hospital due to its highest case with the highest negative deficit value (-112%) for non-operative JKN (National Health Insurance) inpatient cases in 2021. The Cost of Treatment (COT) of DHF is needed as an evaluation of service costs in order to create quality and cost control. Purpose. This study aimed to identify the cost of treatment of DHF JKN inpatients at Bhakti Yudha General Hospital in 2021. Research method. A quantitative approach to obtain information on the costs of DHF treatment. The calculation of the cost of treatment was based on the calculation of the unit cost in production units for DHF services, namely the Emergency Room, Laboratory, Radiology, and Inpatient Care using the Activity Based Costing method. The research sample was 109 patients selected according to the inclusion criteria and the calculation of the Slovin method. Cost calculations were carried out through interviews and documentation studies from medical record data, financial reports, and other related data. Result. The results show that the significant characteristics of JKN patients with DHF were age group of 10-14, female sex, class 1 treatment room, and an average LOS of 3.5 days. The variation of DHF activity was quite high. The unit costs for each activity in the production unit were obtained to calculate the COT of DHF. COT of DHF for class 1, class 2, and class 3 respectively were Rp1,910,461, Rp1,639,751, and Rp1,906,122. Conclusion. The results of DHF COT show a negative difference with INA-CBG rates for class 3. Management should carry out efficiency efforts by reducing indirect costs by increasing service utilization. Efficiency efforts that can be made specifically for DHF services are the creation of a Clinical Pathway and compliance audit to create quality control and cost control.