Ditemukan 6 dokumen yang sesuai dengan query :: Simpan CSV
Vira Anggraeni; Pembimbing: Atik Nurwahyuni; Penguji: Pujiyanto, Budi Hidayat, Donni Hendrawan, Dian Pratidina
Abstrak:
Perubahan pola pembiayaan dari fee for service menjadi pola INA- CBGs menjadi peluang sekaligus ancaman bagi rumah sakit. Peluang muncul jika rumah sakit dapat menjalankan program JKN-KIS (Jaminan Kesehatan Nasional-Kartu Indonesia Sehat) secara efektif sehingga klaim bernilai positif, sebaliknya JKN-KIS berubah menjadi ancaman jika pelayanan yang diberikan oleh rumah sakit tidak efektif dan efisien (Mardiah and Rivany, 2017). Oleh karena itu casemix dan casemix index menjadi parameter yang penting. Tujuan dari penelitian ini adalah untuk mengetahui capaian casemix dan casemix index RS serta hubungan karakteristik RS, karakteristik pasien dan kapasitas RS terhadap casemix dan casemix index RS. Penelitian ini menggunakan data klaim yang diajukan RS kepada BPJS Kesehatan, data terkait kapasitas RS didapatkan dari RS. Analisis dilakukan secara univariat, bivariat dan multivariat dengan menggunakan regresi linier berganda. Hasil penelitian terdapat hubungan signifikan pada variabel kelas RS D terhadap RS kelas RS B, variabel BOR RS, jumlah tempat tidur intensif, jumlah kasus dengan alat canggih di rawat inap, proporsi kelas rawat 3, proporsi severity level 3 dan proporsi BP dengan casemix rawat inap. Terdapat hubungan signifikan pada variabel kelas RS, jenis RS ,kepemilikan RS , BOR RS, jumlah tempat tidur intensif, proporsi kelas 3, proporsi severity level 3, proporsi BP dan proporsi perempuan dengan casemix index rawat inap. Terdapat hubungan signifikan pada variabel kelas RS D terhadap kelas RS B ,kepemilikan RS, variabel proporsi perempuan, jumlah kasus dengan alat canggih di rawat jalan,proporsi lansia dan proporsi BP terhadap casemix rawat jalan. Terdapat hubungan signifikan pada variabel kepemilikan RS, proporsi perempuan, proporsi BP, jumlah kasus dengan alat canggih di rawat jalan dan jumlah ruang operasi dengan casemix index rawat jalan
The change in financing patterns from fee for service to the INA-CBGs pattern is both an opportunity and a threat for hospitals. Opportunities arise if hospitals can run the JKN-KIS (National Health Insurance-Healthy Indonesia Card) program effectively so that claims are positive, otherwise JKN-KIS turns into a threat if the services provided by the hospital are not effective and efficient (Mardiah and Rivany, 2017). Therefore casemix and casemix index are important parameters. The aim of this research is to determine the hospital casemix and casemix index achievements as well as the relationship between hospital characteristics, patient characteristics and hospital capacity on hospital casemix and casemix index. This research uses claim data submitted by hospitals to BPJS Health, data related to hospital capacity is obtained from the hospital. Analysis was carried out univariate, bivariate and multivariate using multiple linear regression. The results of the research showed a significant relationship between the hospital class D variable and the hospital class B variable, the hospital BOR variable, the number of intensive beds, the number of cases with advanced equipment in inpatient care, the proportion of treatment class 3, the proportion of severity level 3 and the proportion of BP with inpatient casemix. There is a significant relationship between the variables of hospital class, type of hospital, hospital ownership, hospital BOR, number of intensive beds, proportion of class 3, proportion of severity level 3, proportion of BP and proportion of women with inpatient casemix index. There is a significant relationship between the variable hospital class D and hospital class B, hospital ownership, the variable proportion of women, the number of cases with advanced equipment in outpatient care, the proportion of elderly people and the proportion of BP to outpatient casemix. There is a significant relationship between the variables of hospital ownership, proportion of women, proportion of BP, number of cases with advanced equipment in the outpatient setting and number of operating rooms with the outpatient casemix index.
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The change in financing patterns from fee for service to the INA-CBGs pattern is both an opportunity and a threat for hospitals. Opportunities arise if hospitals can run the JKN-KIS (National Health Insurance-Healthy Indonesia Card) program effectively so that claims are positive, otherwise JKN-KIS turns into a threat if the services provided by the hospital are not effective and efficient (Mardiah and Rivany, 2017). Therefore casemix and casemix index are important parameters. The aim of this research is to determine the hospital casemix and casemix index achievements as well as the relationship between hospital characteristics, patient characteristics and hospital capacity on hospital casemix and casemix index. This research uses claim data submitted by hospitals to BPJS Health, data related to hospital capacity is obtained from the hospital. Analysis was carried out univariate, bivariate and multivariate using multiple linear regression. The results of the research showed a significant relationship between the hospital class D variable and the hospital class B variable, the hospital BOR variable, the number of intensive beds, the number of cases with advanced equipment in inpatient care, the proportion of treatment class 3, the proportion of severity level 3 and the proportion of BP with inpatient casemix. There is a significant relationship between the variables of hospital class, type of hospital, hospital ownership, hospital BOR, number of intensive beds, proportion of class 3, proportion of severity level 3, proportion of BP and proportion of women with inpatient casemix index. There is a significant relationship between the variable hospital class D and hospital class B, hospital ownership, the variable proportion of women, the number of cases with advanced equipment in outpatient care, the proportion of elderly people and the proportion of BP to outpatient casemix. There is a significant relationship between the variables of hospital ownership, proportion of women, proportion of BP, number of cases with advanced equipment in the outpatient setting and number of operating rooms with the outpatient casemix index.
T-7006
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Yofen Dhamigus; Pembimbing: Atik Nurwahyuni; Penguji: Pujiyanto, Taufik Santoso, Melanie Husna
Abstrak:
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Penelitian ini mengkaji analisis capaian casemix dan casemix index rawat inap di Rumah Sakit Kelas B Grup Primaya Hospital. Data dikumpulkan dari lima rumah sakit (PH1-PH5) dalam kelompok Primaya Hospital. Penelitian mengevaluasi sumber daya manusia, anggaran, material, metode, dan proses terkait capaian casemix dan casemix index. Hasil penelitian menunjukkan bahwa implementasi clinical pathways (PPK-CP) di PH1, PH2, PH3, dan PH5 efektif dalam meningkatkan standar klinis dan efisiensi operasional. Kelengkapan rekam medis di PH1 tertinggi (93.3%) dibandingkan dengan PH lainnya. Meskipun demikian, tingkat klaim tertunda masih menjadi tantangan, terutama di PH4. Ketepatan koding di PH5 terbaik dengan hanya 14.6% data klaim yang tertunda. Verifikasi klaim di PH1 mencapai 98.2%, menunjukkan kualitas pengajuan klaim yang baik. Hasil penelitian ini memberikan wawasan tentang hubungan antara input, proses, dan output dalam manajemen capaian casemix dan casemix index di rumah sakit tersebut. Implikasi dari temuan ini berpotensi untuk merumuskan strategi korporasi yang efektif dalam meningkatkan kualitas layanan dan efisiensi operasional di rumah sakit kelompok Primaya Hospital.
This research examines the analysis of casemix achievement and casemix index inpatient care at Primaya Hospital Class B. Data were collected from five hospitals (PH1-PH5) within the Primaya Hospital group. The study evaluates human resources, budgets, materials, methods, and processes related to casemix achievement and casemix index. The results show that the implementation of clinical pathways (PPK-CP) in PH1, PH2, PH3, and PH5 is effective in improving clinical standards and operational efficiency. The completeness of medical records in PH1 is the highest (93.3%) compared to other hospitals. However, the level of delayed claims remains a challenge, especially in PH4. Coding accuracy in PH5 is the best with only 14.6% of delayed claim data. Claim verification in PH1 reaches 98.2%, indicating good quality of claim submission. The findings provide insights into the relationship between inputs, processes, and outputs in managing casemix achievement and casemix index at these hospitals. The implications of these findings have the potential to formulate effective corporate strategies to improve service quality and operational efficiency in Primaya Hospital group.
B-2483
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Ida Bagus Yudistira Nugraha Yustama; Pembimbing: Atik Nurwahyuni; Penguji: Masyitoh, Prastuti Soewondo, Kalsum Komaryani, Ni Putu Ayu Prima Dewi
Abstrak:
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Pemanfaatan ketiga indikator (casemix, CMI, dan HBR) secara berkala untuk mempertahankan mutu sembari menjaga efisiensi pelayanan RS di era JKN. Penelitian ini bertujuan untuk menganalisis dan strategi peningkatan capaian indikator casemix, casemix index dan hospital baserate RSU Bali Royal tahun 2019 - 2024.
Penelitian dilakukan di RSU Bali Royal selama bulan Mei - Juni 2025, menggunakan data primer wawancara mendalam dan focus group discussion dan sekunder yang didapatkan dari rekapitulasi elektronik klaim (e-klaim) Kemenkes, laporan keuangan, dan laporan rumah sakit. Penelitian ini menggunakan studi observasional pendekatan kualitatif untuk menganalisis capaian indikator Casemix, CMI dan HBR rawat inap dan rawat jalan.
Hasil penelitian menunjukkan bahwa terdapat unsur struktur (sumber daya manusia, material, mesin, anggaran, dan metode) dan unsur proses (manajemen pasien, manajemen koding, dan manajemen klaim) membuahkan unsur output (indikator casemix, casemix index, dan hospital baserate) Dinamika penambahan unsur struktur berdampak pada proses pelayanan pasien, efisiensi koding hingga 50%, dan keberhasilan klaim. Casemix rawat jalan tahun 2019 – 2024 diperoleh 11.393; 16.037; 32.763; 59.520; 111.193; dan 129.423. Casemix rawat inap kelas 1 tahun 2019 – 2024 diperoleh 907; 1.321; 2.657; 3.165; 3.829; dan 4.014. Casemix rawat inap kelas 2 tahun 2019-2024 diperoleh 818; 1.013; 1.800; 2.511; 3.052; dan 3.309. Casemix rawat inap keas 3 tahun 2019 – 2024 diperoleh 205; 539; 1.557; 2.023; 2.646; dan 3.038. Nilai CMI rawat jalan tahun 2019 – 2024 diperoleh 0,98; 1,11;1,16; 1,21; 1,35;dan 1,24. CMI rawat inap kelas 1 tahun 2019 – 2024 diperoleh 1,32; 1,60; 1,84; 1,57; 1,45; dan 1,37. CMI rawat inap kelas 2 tahun 2019 – 2024 diperoleh 1,17; 1,36; 1,58; 1,41; 1,33; dam 1,33. CMI rawat inap kelas 3 tahun 2019 – 2024 diperoleh 1,46; 1,82; 1,67; 1,54; 1,53; dan 1,45. HBR rawat jalan tahun 2019 – 2024 diperoleh 354.393; 333.231; 257.536; 243.675; 226.650; dan 238.494. HBR rawat inap kelas 1 tahun 2019 – 2024 diperoleh 5.257.416; 6.028.120; 5.477.120; 5.970.918; 6.542.667; dan 7.082.825. HBR rawat inap kelas 2 tahun 2019 – 2024 diperoleh 4.449.693; 5.628.665; 4.817.066; 4.993.043; 5.156.750; dan 5.563.012. HBR rawat inap kelas 3 tahun 2019 – 2024 diperoleh 3.616.138; 4.594.204; 3.746.071; 4.325.317; 4.584.260; dan 4.789.356. Nilai casemix dan casemix index mengalami peningkatan setiap tahunnya dengan capaian CMI di atas standar rumah sakit swasta kelas C regional 2. HBR rawat jalan pada tahun 2021-2024 dibawah HBR nasional, namun HBR rawat inap kelas 1, 2, dan 3 selalu berada di atas HBR nasional. Strategi yang dapat ditempuh untuk peningkatan casemix, casemix index, dan penurunan HBR adalah optimalisasi unsur struktur dengan perbaikan sumber daya manusia dan pengkajian metode, efisiensi mesin, material, dan anggaran, dan evaluasi pada unsur proses (manajemen pasien, koding, dan klaim).
The periodic utilization of three key indicators—casemix, Casemix Index (CMI), and Hospital Base Rate (HBR)—is crucial for maintaining service quality while ensuring operational efficiency in hospitals, particularly within Indonesia's National Health Insurance (JKN) system. This study aimed to analyze factors influencing, and develop strategies for enhancing the performance of, casemix indicators, the Casemix Index, and the Hospital Base Rate at Bali Royal General Hospital over the period 2019–2024. The research was conducted at Bali Royal General Hospital from May to June 2025. Primary data were collected through in-depth interviews and focus group discussions, while secondary data were obtained from the Ministry of Health's electronic claim (e-claim) database, hospital financial reports, and institutional records. This study employed an observational design with a qualitative approach to analyze the performance of casemix indicators, CMI, and HBR for both inpatient and outpatient services. The findings revealed that structural elements (i.e., human resources, materials, machinery, budget, and methods) and process elements (i.e., patient management, coding management, and claims management) collectively determine output elements, identified as casemix indicators, the Casemix Index, and the Hospital Base Rate. Strategic enhancements to these structural elements were found to positively impact patient service processes, improve coding efficiency by up to 50%, and increase claim success rates. Results for the 2019–2024 period were as follows: Outpatient casemix counts were 11,393; 16,037; 32,763; 59,520; 111,193; and 129,423 for the years 2019 to 2024, respectively. Inpatient casemix counts for the years 2019 to 2024 were, respectively: Class 1: 907; 1,321; 2,657; 3,165; 3,829; and 4,014. Class 2: 818; 1,013; 1,800; 2,511; 3,052; and 3,309. Class 3: 205; 539; 1,557; 2,023; 2,646; and 3,038. Casemix Index (CMI) values for the years 2019 to 2024 were, respectively: Outpatient CMI: 0.98, 1.11, 1.16, 1.21, 1.35, and 1.24. Inpatient CMI: Class 1: 1.32, 1.60, 1.84, 1.57, 1.45, and 1.37. Class 2: 1.17, 1.36, 1.58, 1.41, 1.33, and 1.33. Class 3: 1.46, 1.82, 1.67, 1.54, 1.53, and 1.45. Hospital Base Rate (HBR) values for the years 2019 to 2024 were, respectively (currency unit not specified in the original text): Outpatient HBR: 354,393; 333,231; 257,536; 243,675; 226,650; and 238,494. Inpatient HBR: Class 1: 5,257,416; 6,028,120; 5,477,120; 5,970,918; 6,542,667; and 7,082,825. Class 2: 4,449,693; 5,628,665; 4,817,066; 4,993,043; 5,156,750; and 5,563,012. Class 3: 3,616,138; 4,594,204; 3,746,071; 4,325,317; 4,584,260; and 4,789,356. Overall, casemix counts and the Casemix Index exhibited an upward trend annually, with CMI performance exceeding the established standard for Class C private hospitals in Regional Area 2. While the outpatient HBR from 2021 to 2024 fell below the national HBR, the inpatient HBR for Classes 1, 2, and 3 consistently surpassed the national benchmark. Recommended strategies to enhance casemix performance, improve the Casemix Index, and reduce the Hospital Base Rate center on optimizing structural elements. This includes improving human resource competencies, refining methodologies, and increasing the efficiency of machinery, materials, and budget allocation. Furthermore, a rigorous evaluation of process elements—such as patient management, clinical coding accuracy, and claims management procedures—is deemed essential.
T-7325
Depok : FKM UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Devi Trias Tuti; Pembimbing: Atik Nurwahyuni; Penguji: Pujiyanto, Adin Nulkhasanah, Riris Dian Hardiani
Abstrak:
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Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit di bawah sistem pembayaran INA-CBGs. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INACBGs dan global budget yang mulai diujicobakan. Penelitian ini bertujuan untuk menganalisis capaian indikator casemix, casemix index dan hospital baserate RSPON Mahar Mardjono tahun 2018 - 2022. Penelitian dilakukan di RSPON Mahar Mardjono selama bulan Maret - Juni 2024, menggunakan data sekunder yang didapatkan dari rekapitulasi elektronik klaim (e-klaim) Kemenkes dan laporan rumah sakit. Penelitian ini menggunakan studi cross sectional menggunakan pendekatan analitik untuk menghitung capaian indikator Casemix, CMI dan HBR rawat inap dan rawat jalan. Analisis multivariat dengan regresi linier digunakan untuk melihat variabel independen yang berkaitan dengan variabel dependen indikator casemix dan CMI. Hasil penelitian menunjukkan bahwa jumlah kasus, jumlah kasus dengan prosedur canggih, dan proporsi produktif berpengaruh signifikan terhadap casemix rawat jalan. Jumlah Kasus, Jumlah Kasus dengan Prosedur Canggih, dan Proporsi SL3 berpengaruh signifikan terhadap Casemix Rawat Inap. Jumlah Kasus, Jumlah Kasus dengan Prosedur Canggih, dan Proporsi Produktif berpengaruh signifikan terhadap CMI Rawat Jalan. Jumlah Kasus, Jumlah Kasus dengan Prosedur Canggih, Proporsi SL2, Proporsi SL3, dan Proporsi Meninggal berpengaruh signifikan terhadap CMI Rawat Inap. Casemix rawat jalan tertinggi pada bulan November 2022 yakni 7956, sedangkan casemix terendah terjadi pada bulan Mei 2020 sebesar 1929. Capaian rata-rata casemix rawat jalan tertinggi pada tahun 2022 yaitu 6.738,01. Casemix rawat inap tertinggi pada bulan Desember 2022 sebesar 2392 dan terendah pada Mei 2020 sebesar 1006. Capaian rata-rata casemix rawat inap tertinggi pada tahun 2022 yaitu 1980,98 CMI rawat jalan tertinggi pada bulan Maret 2021 sebesar 1,0821 dan terendah pada April 2018 sebesar 0,9461. Capaian rata-rata CMI rawat jalan tertinggi pada tahun 2021 yaitu 1,044. CMI rawat inap tertinggi terdapat pada bulan Februari 2018 sebesar 3,65 dan terendah pada Desember 2020 sebesar 2,18. Capaian rata-rata CMI rawat inap tertinggi pada tahun 2018 yaitu 3,009. HBR Rawat Jalan tertinggi pada tahun 2020 sebesar Rp548.434, dan terendah dicapai pada tahun 2018 sebesar Rp481.862. HBR Rawat Inap tertinggi pada tahun 2018 sebesar Rp12.852.109, dan terendah dicapai pada tahun 2021 sebesar Rp11.031.593. HBR Rawat Jalan dan rawat inap RSPON tahun 2018-2022 lebih tinggi dari HBR Nasional Kelas A Regional I yang berarti RSPON mengalami defisit dengan tarif INA-CBGs yang berlaku.
Casemix, casemix index and hospital baserate are important indicators for assessing hospital performance under the INA-CBGs payment system. These indicators determine the INA-CBGs tariff rates, serve as performance assessment tools for hospitals partnered with BPJS Kesehatan, and contribute to the payment claim structure of the mixed-method INACBGs and global budget being piloted. This research aims to analyze the achievements of casemix, casemix index, and hospital baserate indicators at RSPON Mahar Mardjono from 2018 to 2022. The research was conducted from March to June 2024 by researchers at RSPON Mahar Mardjono. Analysis of the achievement of casemix, casemix index and hospital baserate using secondary data obtained from data recapitulation on electronic claims (e-claims) of the Ministry of Health and hospital reports. This cross-sectional study employed an analytical approach to calculate the achievement of casemix, casemix index, and hospital baserate for both inpatient and outpatient care. Multivariate analysis with linear regression was used to examine independent variables associated with the dependent variables of casemix and casemix index. The results indicate that variables such as number of cases, number of cases with advanced procedures, and productive proportion significantly influence outpatient casemix. Similarly, the number of cases, cases with advanced procedures, and SL3 proportion significantly affect inpatient casemix. For outpatient casemix index, the variables influencing significantly are number of cases, cases with advanced procedures, and productive proportion. For inpatient casemix index, significant variables include number of cases, cases with advanced procedures, SL2 proportion, SL3 proportion, and mortality proportion. The highest outpatient casemix was in November 2022, at 7956, while the lowest occurred in May 2020 at 1929. The highest average outpatient casemix achievement in 2022 was 6,738.01. The highest inpatient casemix was in December 2022, at 2392, and the lowest was in May 2020 at 1006. The highest average inpatient casemix achievement in 2022 was 1980.98. The highest outpatient casemix index was in March 2021 at 1.0821, and the lowest was in April 2018 at 0.9461. The highest average outpatient casemix index achievement in 2021 was 1.044. The highest inpatient casemix index was in February 2018 at 3.65, and the lowest was in December 2020 at 2.18. The highest average inpatient casemix index achievement in 2018 was 3.009. The highest Hospital Baserate for outpatient care was IDR548.434 in 2020, and the lowest was IDR481.862 in 2018. The highest Hospital Baserate for inpatient care was IDR12.852.109 in 2018, and the lowest Rp11.031.593 in 2021. The Hospital Baserate for inpatient and outpatient care at RSPON from 2018 to 2022 was higher than the National HBR Class A Regional I, indicating that RSPON RSPON incurred a deficit with INA CBG's tariffs.
T-7010
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Kartika Malahayati; Pembimbing: Jaslis Ilyas; Penguji: Atik Nurwahyuni, Vetty Yulianty Permanasari, Muhamad Nur Ihwan,
Purwa Kurnia Sucahya
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Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit di bawah sistem pembayaran INA-CBGs. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INA-CBGs dan global budget yang mulai diujicobakan. Penelitian ini dilakukan dengan tujuan untuk menganalisis capaian dan determinan indikator casemix, casemix index dan hospital baserate RSPG Cisarua Bogor selama tahun 2017 – 2022. Penelitian akan dilakukan selama bulan Mei – Juni 2023 oleh peneliti langsung di RSPG Cisarua Bogor. Analisis capaian indikator casemix, casemix index dan hospital baserate rumah sakit menggunakan data sekunder yang didapatkan dari rekapitulasi data pada elektronik klaim (e-klaim) Kementerian Kesehatan. Determinan yang berpengaruh terhadap ketiga indikator yang dihitung dalam penelitian ini akan dianalisis secara crossectional melalui pendekatan analitik kuantitatif dari data sekunder berupa e-klaim dan laporan rumah sakit. Uji statistik berupa uji korelasi dan regresi linier sederhana digunakan untuk melihat determinan yang berkaitan dengan indikator casemix, casemix index dan hospital baserate. Hasil penelitian menunjukkan tren casemix rawat jalan dan rawat inap tahunan RSPG mengalami penurunan dari 2017 hingga 2021 seiring dengan penurunan jumlah kasus. Penurunan pada tahun 2020 dan 2021 diakibatkan adanya penurunan jumlah kasus yang signifikan selama pandemi Covid-19. Nilai casemix di tahun 2022 kembali naik seiring membaiknya kondisi pandemi di Indonesia. Capaian casemix index rawat jalan dan rawat inap RSPG Cisarua lebih rendah bila dibandingkan dengan rata-rata capaian casemix index RS Pemerintah Kelas A di regional I. Terjadi kenaikan casemix index saat pandemi Covid-19 dikarenakan masyarakat berobat dalam keadaan lebih parah di saat pandemi. Hospital baserate rawat jalan RSPG tahun 2017 dan 2021 masih berada di bawah tarif nasional, sedangkan tahun 2018, 2019, 2020, dan 2022 hospital baserate lebih tinggi dibandingkan tarif nasional. Hospital baserate rawat inap RSPG secara konasisten lebih tinggi dibandingkan tarif nasional. Artinya biaya yang dikeluarkan rumah sakit lebih tinggi dibandingkan tarif yang dibayarkan oleh BPJS dalam menangani kasus dengan nilai cost weight=1. Terdapat 5 variabel yang bernilai signifikan dengan p<0,05 terhadap casemix rawat jalan, yakni jumlah kasus, jumlah klinik rawat jalan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Variabel yang berkorelasi secara statistik terhadap casemix rawat inap adalah jumlah kasus, severity level II dan III, lama hari perawatan, jumlah dokter spesialis, proporsi beban pegawai, dan proporsi beban penyusutan. Jumlah klinik rawat jalan dan proporsi beban pegawai memiliki hubungan dengan capaian casemix index rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, serta jumlah dokter spesialis yang praktek di rumah sakit secara statistik berpengaruh terhadap capaian casemix index rawat inap. Hospital baserate di rumah sakit dihitung dengan membagi total biaya dengan casemix. Jumlah klinik rawat jalan, jumlah dokter spesialis, dan proporsi beban pegawai memiliki hubungan (p<0,05) terhadap hospital baserate rawat jalan. Jumlah kasus, severity level I dan III, lama hari perawatan, dan proporsi beban pegawai merupakan determinan yang teridentifikasi terhadap hospital baserate rawat inap.
Casemix, casemix index and hospital baserate are important indicators to evaluate hospital performance under the INA-CBGs payment system. These indicators are the basis for the INA-CBGs tariff rates, the instrument for assessing the performance of BPJS Kesehatan partner hospitals and the constructing instrument of mixed method global budget claim payments for INA-CBGs which has begun to be trialled. This research was conducted to analyze the achievements and determinants of casemix, casemix index and hospital baserate RSPG Cisarua Bogor from 2017 to 2022. The research conducted on May - June 2023 at RSPG Cisarua Bogor. Analysis of the achievement indicators for casemix, casemix index and hospital base rate uses secondary data obtained from Ministry of Health's electronic claims (e-claims). The determinants that affect the indicators will be analyzed cross-sectionally through a quantitative analytical approach from secondary data form e-claims and hospital reports. Correlation and simple linear regression were used to see whether the determinants related to the casemix, casemix index and hospital baserate indicators. The results showed that the casemix trend for outpatient and inpatient at RSPG had decreased from 2017 to 2021 along with the number of visits. The decline in 2020 and 2021 was due to a significant decrease in the number of visits during the Covid-19 pandemic. The casemix in 2022 increased as the pandemic conditions improved in Indonesia. The casemix index for outpatient and inpatient care at RSPG Cisarua were lower than the average casemix index for Class A Government Hospitals in regional I. RSPG outpatient hospital baserate in 2017 and 2021 is still below the national rate, while the other years are higher. RSPG's hospital base rate of inpatient care is consistently higher than the national rate. This means that the costs incurred by the hospital are higher than the rates paid by BPJS in handling cases with cost weight = 1. There are 5 variables that have significant value with p
B-2348
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Tomy Oeky Prasiska; Pembimbing: Pujiyanto; Penguji: Mardiati Nadjib, Atik Nurwahyuni, Sholihul Absor, Benjamin Saut
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Casemix, casemix index dan hospital baserate merupakan indikator penting untuk melihat kinerja rumah sakit dengan pembayaran DRG. Indikator tersebut merupakan penyusun besaran tarif INA-CBGs, instrumen penilaian kinerja rumah sakit mitra BPJS Kesehatan dan instrumen penyusun pembayaran klaim mixed method INA-CBGs dan global budget yang mulai diujicobakan. Cakupan pelayanan rawat inap dan rawat jalan rumah sakit Muhammadiyah Jawa Timur didominasi pasien JKN, rumah sakit harus mempunyai keunggulan kompetitif dan dapat berkembang di era JKN. Penelitian bertujuan menganalisis capaian casemix, casemix index dan hospital baserate Rumah Sakit Muhammadiyah Jawa Timur tahun 2017-2020. Studi observasional dengan pengamatan selama empat tahun dilakukan pada 27 rumah sakit. Penelitian menggunakan data sekunder yang didapatkan dari elektronik klaim (E-klaim) Kementerian Kesehatan. Hasil penelitian menunjukkan klasifikasi rumah sakit, jenis rumah sakit, kelas perawatan, dan lama hari rawat inap mempengaruhi capaian casemix, casemix index dan hospital baserate. Casemix, casemix index dan hospital baserate rumah sakit kelas B lebih besar dibandingkan rumah sakit kelas C dan kelas D, capaian indikator rumah sakit umum kelas C lebih besar dibandingkan rumah sakit khusus kelas C. Capaian indikator antar rumah sakit pada kelas yang sama dapat berbeda signifikan tergantung variasi dan derajat keparahan kasus. Rumah sakit yang menangani kasus derajat berat mempunyai nilai casemix, casemix index dan hospital baserate lebih besar. Hasil uji statistik menunjukkan lama rawat inap berpengaruh signifikan terhadap kenaikan hospital baserate rawat inap, semakin lama hari perawatan maka peluang peningkatan hospital baserate semakin besar (p<0,05). Rumah sakit yang menangani kasus hemodialisis dan operasi katarak mempunyai casemix, casemix index dan hospital baserate rawat jalan lebih besar. Pandemi COVID-19 pada tahun 2020 berdampak pada capaian casemix, casemix index dan hospital baserate rumah sakit. Sebanyak 19 rumah sakit (70,4%) mengalami penurunan capaian casemix rawat inap dan 20 rumah sakit (74,1%) mengalami penurunan casemix rawat jalan. Sebanyak 21 rumah sakit (77,4%) mengalami peningkatan hospital baserate rawat inap dan 23 rumah sakit (85,2%) mengalami peningkatan hospital baserate rawat jalan pada tahun 2020. Kesimpulan: capaian indikator casemix, casemix index dan hospital baserate dipengaruhi oleh klasifikasi, jenis rumah sakit, jumlah kasus, variasi dan derajat keparahan kasus serta lama rawat inap. Pandemi COVID-19 berdampak pada penurunan nilai casemix dan peningkatan hospital baserate rawat inap dan rawat jalan. Rumah sakit harus meningkatkan cakupan pelayanan, mengendalikan biaya pelayanan dan menjamin kualitas pengkodean diagnosis dan prosedur secara optimal. Rumah sakit harus memonitor capaian casemix, casemix index dan hospital baserate rawat inap dan rawat jalan secara berkala dan membandingkan dengan rumah sakit lain yang mempunyai kelas dan kapasitas yang sama
Casemix, casemix index and hospital baserate are important indicators to see the hospital performance with DRG payments. These indicators are the compilers of the INA-CBGs tariff rate, the performance assessment instrument for Healthcare and Social Security Agency partner hospitals and the instrument for compiling claims for the mixed method INA-CBGs and global budget which are being piloted. The coverage of inpatient and outpatient services at Muhammadiyah Hospitals in East Java is dominated by the National Health Insurance patients, therefore the hospitals must have a competitive advantages and be able to develop well in the JKN era. This study aims to analyze the achievement of casemix, casemix index and hospital baserate at Muhammadiyah Hospitals in East Java in year 2017-2020. An observational study within four years of observation was conducted in 27 hospitals. The study used secondary data obtained from the Ministry of Health's electronic claims (E-claims). The results showed that hospital classification, type of hospital, treatment class, and length of stay affected the achievement of casemix, casemix index and hospital base-rate. The casemix, casemix index and hospital base-rate of class B hospitals are higher than those of class C and class D hospitals, the indicator achievement of class C general hospitals is greater than those of special class C hospitals. The achievement of indicators between similar class hospitals can differ significantly. depending on the variety and severity level. Hospitals that handle severe cases have higher casemix, casemix index and hospital baserate values. The results of statistical tests showed that the length of stay had a significant effect on the increase of inpatient hospital baserate, the longer the days of stay, the greater the chance of increasing the hospital baserate (p <0.05). Hospitals that handle cases of hemodialysis and cataract surgery have a higher casemix, casemix index and outpatient hospital base-rate. The COVID-19 pandemic in 2020 had an impact on the achievement of casemix, casemix index and hospital base-rates. A total of 19 hospitals (70.4%) experienced a decrease in inpatient casemix achievement and 20 hospitals (74.1%) experienced a decrease in outpatient casemix. A total of 21 hospitals (77.4%) experienced an increase in inpatient hospital baserate and 23 hospitals (85.2%) experienced an outpatient hospital baserate increase in 2020. Conclusion: the achievement of the casemix, casemix index and hospital baserate indicators are influenced by classification, type of hospital, number of cases, variation and severity level and length of stay. The COVID-19 pandemic has resulted a decrease in casemix values and an increase in inpatient and outpatient hospital baserates. Hospitals must increase healthcare coverage, control costs and ensure optimal quality of diagnostic coding and procedures. Hospitals must monitor the achievement of casemix, casemix index and hospital baserates of inpatient and outpatient regularly and compare to other hospitals of the same class and capacity. Keyword : casemix, casemix index, hospital baserate, the National Health Insurance, outpatient, inpatient
B-2255
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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