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ABSTRAK Nama : Firda Tania Program Studi: Kajian Administrasi Rumah Sakit Judul : Cost and Outcome Analysis Tindakan Hemodialisis Pada Pasien Gagal Ginjal Kronik (GGK) di Rumah Sakit Kelas B dan C Tahun 2016 Latar belakang: GGK merupakan kondisi yang semakin meningkat kejadiannya, menghabiskan banyak biaya dan mengakibatkan hilangnya produktivitas. Sejak 2014, BPJS menanggung sebagian besar biaya hemodialisis (HD) di Indonesia dengan besaran tarif yang berbeda sesuai kelas Rumah Sakit (RS). Pertanyaan penelitian ini ialah apakah tarif BPJS yang dibayarkan lebih tinggi pada kelas RS lebih tinggi menghasilkan hasil yang lebih baik atau malah mencerminkan inefisiensi. Selain itu, perlu diketahui pula apakah terdapat perbedaan biaya yang sebenarnya dikeluarkan RS dengan kelas berbeda untuk menyelenggarakan HD. Metode: Studi evaluasi ekonomi ini dilakukan di dua RS dengan kelas berbeda: kelas B (RS B) dan kelas C (RS C). Responden dipilih dari pasien GGK yang menjalani HD di kedua RS selama Februari-April 2016. Analisis biaya menurut perspektif pasien dengan metode kuantitatif, sedangkan perspektif RS dengan metode kualitatif. Analisis hasil dilakukan penilaian kualitas hidup (instrumen EQ-5D), IDWL dan Hb. Perbedaan rerata nilai hasil diuji dengan Student’s t-test. Hasil: Pada penelitian, total responden sebanyak 100 orang (RS B 76 orang & RS C 24 orang). Menurut perspektif pasien, biaya langsung medis HD selama sebulan di RS B Rp5.215.331 dan di RS C Rp7.781.744. Biaya langsung non medis HD selama sebulan di RS B Rp566.260 dan di RS C Rp334.500. Biaya tidak langsung HD selama sebulan di RS B Rp165.530 dan di RS C Rp45.830. Rerata total biaya HD selama sebulan di RS B Rp6.149.285 dan di RS C Rp8.162.077. Menurut perspektif RS, tidak terdapat perbedaan biaya yang sebenarnya dikeluarkan oleh RS dengan kelas berbeda untuk menyelenggarakan HD. Pada hasil didapatkan bahwa rerata Hb pada RS B (M=10,26) berbeda secara signifikan dengan RS C (M=8,21), t(98)= 8,244, p= 0,000. Rerata IDWL pada RS B (M= 0,0403) tidak berbeda secara signifikan dengan RS C (M= 0,0438), t(98)= -1,326, p= 0, 188. Rerata EQ Indeks pada RS B (M= 0,7178) tidak berbeda secara signifikan dengan RS C (M= 0,7208), t(98)= -0,075 p= 0,94. Rerata EQVAS pada RS B (M= 64,74) tidak berbeda secara signifikan dengan RS C (M= 64,79), t(98)= -0,018 p= 0,986. Kesimpulan: Pada penilaian efektivitas HD tanpa melibatkan tambahan sumber daya, tidak terdapat perbedaan hasil secara signifikan diantara kedua kelas RS. Fakta bahwa pengeluaran yang lebih besar dari BPJS tidak mengakibatkan hasil kesehatan yang lebih baik biasanya diinterpretasikan sebagai bukti adanya inefisiensi. Biaya RS dengan kelas berbeda untuk menyelenggarakan HD pun tidak berbeda karena secara persyaratan sama. Perbedaan biaya medis langsung dari billing RS berkaitan dengan status kepemilikan RS dan perbedaan rerata Hb berkaitan dengan perbedaan akses terhadap koreksi anemia yang ada di kedua RS. Kata Kunci: Cost and Outcome Analysis, Hemodialisis, Kelas RS, Tarif BPJS
ABSTRACT Name : Firda Tania Study Program: Hospital Administration Title : Cost and Outcome Analysis of Hemodialysis on Chronic Kidney Disease (CKD) Patients at Class B and C Hospital in 2016 Background: Chronic kidney disease (CKD) is an increasing condition, which consumes a lot of cost and causes productivity lost. Since 2014, BPJS has covered most of hemodialysis (HD) in Indonesia with different tariff according to hospital’s classification. The research question is whether higher tariff paid to higher hospital class produced better outcome or otherwise reflecting inefficiency. The other question is whether hospital’s real cost to effectuate HD unit was different according to hospital’s class. Methods: This economic evaluation study was conducted in two hospitals with different classification; class B (B Hospital) and class C (C Hospital). Respondents were chosen from CKD patients undergoing hemodialysis in both hospital during Februari to April 2016. Costs from patient’s perspective were analyzed using quantitative method, while hospital’s perspective were analyzed using qualitative method. As outcomes, HRQOL assessed using EQ-5D instrument, mean IDWL & Hb. Differences in outcomes tested using T-test. Results: In this study, total respondents participated were 100 patients; 76 from B hospital and 24 from C hospital. According to patient’s perspective, HD direct medical cost monthly average was IDR 5.215.331 in B hospital and IDR 7.781.744 in C hospital, direct non medical cost monthly average was IDR 566.260 in B hospital and IDR 334.500 in C hospital and indirect cost monthly average was IDR 165.530 in B hospital and IDR 45.830 in C hospital, so total HD cost monthly average was IDR 6.149.285 in B hospital and IDR 8.162.077. According to hospital’s perspective, there were no difference in hospital’s real cost to effectuate HD unit. Outcome results found that mean Hb in B hospital (10,26) were significantly different from mean Hb in C hospital (8,21), t(98)= 8,244, p=0,000. While mean IDWL in B (0,0403) were not significantly different with mean IDWL in C (0,0438), t(98)= -1,326, p=0,188. Mean EQ Indeks score (0,7178) and EQ VAS score (64,74) in B hospital were not significantly different with mean EQ Indeks score (0,7208) and EQ VAS (64,79) in C hospital, t(98)=0,075, p=0,94 and t(98)=-0,018, p=0,986 respectively. Conclusion: This findings showed that in hemodialysis effectivity assessment which did not include the use of additional resources from standard (PMK No. 812/2010), there were no significant difference in outcome in two different class of hospitals. Higher CBGs tariff for higher class of hospital had not produced better health outcome, which usually interpreted as an evidence of inefficiency. Hospital’s real cost to effectuate HD unit were not different since the requirements were the same (PMK 812/2010). Difference in direct medical cost from hospital billing related to hospital’s ownership status and difference of mean Hb related to different access to anemia correction in both hospital. Keywords: Cost & Outcome Analysis, Hemodialysis, Hospital Class, BPJS tariff
Standard precautions are one of the principles of infection prevention and control efforts with the aim of preventing disease transmission in the environment around health care facilities. This study aims to determine the factors associated with the standard vigilance behavior of Tanjung Priok Class I Port Health Office officers in 2023 based on the theory of the Health Belief Model. This study used a cross sectional study design. A sample of 140 officers was taken by simple random sampling. Data collection by means of respondents filling out the questionnaire themselves. Univariate, bivariate (Chi Square), and multivariate (multiple logistic regression) analyzes were performed in this study. The results showed that Tanjung Priok Class I Port Health Office Officers had good standard precautionary behavior. The individual perception factor associated with standard vigilance behavior is self-efficacy. The modifying factor associated with standard vigilance behavior is training. Self-efficacy is the most dominant factor associated with standard vigilance behavior of officers, officers who have low self-efficacy are 4.07 times more likely to have less standard vigilance behavior than officers with high self-efficacy (OR= 4.07 95% CI 1.788 - 9.286). For this reason, the Ministry of Health and the Tanjung Priok Class I Port Health Office can work together to make efforts to increase the self-efficacy of officers through the implementation of intensive and comprehensive training programs for officers so that the implementation of standard precautionary behaviors can be maximized. Keywords: Standard precautions, behavior, officers, Class I Tanjung Priok Port Health Office.
Penelitian ini untuk memperoleh gambaran faktor-faktor dan hubungannya dengan TB U yaitu usia, jenis kelamin, berat badan lahir, riwayat sakit, frekuensi konsumsi sumber energi, frekuensi konsumsi sumber protein, frekuensi konsumsi sayur, pekerjaan ayah, pekerjaan ibu, pendidikan ayah, pendidikan ibu dan pengeluaran per kapita. Disain penelitian adalah cross sectional, pendekatan kuantitatif dan pengambilan sampel secara probability proporsional to size (PPS) dengan metode cluster survey, uji regresi logistik. Variabel yang berhubungan adalah usia, riwayat sakit, frekuensi sumber energi, frekuensi sumber protein dan frekuensi konsumsi sayur. Hasil penelitian didapatkan bahwa prevalensi stunting adalah 22,5%. Hasil penelitian dapat ditarik kesimpulan bahwa prevalensi anak pendek merupakan masalah karena masih diatas batas non public health problem yang ditentukan WHO. Diperlukan adanya kerjasama yang baik antara Dinas Kesehatan dengan lintas sektor terkait dalam rangka penurunan prevalensi stunting pada anak sekolah. Kata kunci : Stunting pada anak kelas 1 SD/MI
This study to obtain a picture of the factors and their relationship height with age ie. age, gender, birth weight, history of illness, frequency of consumption of energy sources, the frequency of consumption of protein sources, the frequency of consumption of vegetables, father’s work, work’s mother, father education, mother’s education and per capita outcome. Research design was cross sectional, quantitative approach and the sampling probability proportional to size (PPS) cluster survey method, logistic regression test.Variables related to the age, history of illness, frequency energy source, frequency source of protein and vegetable consumption frequency. The study found that the prevalence of stunting was 22.5%. The results can be concluded that the prevalence of stunting children is a problem because it is still above the limit of non-public health problem defined by WHO. It is necessary to good cooperation between the Health Department with traffic-related sectors in order to decrease the prevalence of stunting in school children. ix Universitas Indonesia Key words : Stunting children of Class 1 Elementary School