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The result of BPJS customer satisfaction survey in primary clinic in 2014was 80%, which means it achieved Road Map to Jaminan Kesehatan Nasionaltarget. However, there are still many complaints from the BPJS customer asshown in YLKI report and in Kemenpan official website regarding unfulfillmentof their expectation. Therefore, we needs to know the determinants and their levelof expectation.This study aim to determine information about the determinant of memberof BPJS Kesehatan expectation to the service of primary clinic in Depok Cityperiod May 2016. This study is combined qualitative and quantitative study.Design of this study is sequential exploratory, which is started by qualitative studyto explore the phenomena and then followed by quantitave study. Number ofinforman in qualitative study is 12 and number of respondent in quantitative studyis 203.The result of this study is there is no correlation between gender, age, andoccupation with the level of respondent expectation. There is correlation betweenlevel of education, personal needs, word-of-mouth, and past experience with thelevel of respondent expectation. The most dominant factor that influences thelevel of respondent expectation is personal needs, which means the higherrespondent frequency to visit primary clinic to get treatment when sick, the higherlevel of respondent expectation.Keyword: member of BPJS Kesehatan expectation, personal needs, pastexperience, words-of-mouth
ABSTRAK Nama : Noer Triyanto Rusli Program Studi : Kajian Administrasi Rumah Sakit Judul : Analisis Biaya dan Faktor-Faktor Penentu Inefisiensi Layanan Hemodialisis Pada Pasien Gagal Ginjal Kronik Rumah Sakit RK Charitas Palembang Tahun 2016 Diberlakukannya JKN di rumah sakit mengubah sistem pembayaran dari pembayaran secara retrospektif (fee for service) menjadi sistem pembayaran prospektif (INA-CBG’s) Sebagai salah satu fasilitas pelayanan kesehatan, RS RK Charitas mempunyai peranan untuk memberikan pelayanan yang berkualitas namun tetap memperhatikan cost effective pelayanan yang diberikan. Penelitian ini bertujuan untuk menganalisis biaya dan mengidentifikasi faktor-faktor penentu inefisiensi layanan hemodialisis pada pasien gagal ginjal kronik di RS RK Charitas. Jenis penelitian ini bersifat analisis deskriptif dengan menggunakan data primer dan data sekunder. Analisis biaya menggunakan pendekatan Activity Based Costing (ABC) dengan metode “Bottom Up”. Metode ABC untuk mengalokasikan biaya dengan mengidentifikasi pemicu biaya (cost driver) penyebab terjadinya biaya layanan hemodialisis. Beban biaya operasional merupakan beban yang terbesar dalam penyelenggaraan layanan hemodialisis. Analisis faktor-faktor penyebab inefisiensi dilakukan dengan perhitungan Value Stream Mapping (VSM). Komposisi value added (VA) dibanding non value added (NVA) adalah 17.73%:82.27%. Implementasi lean pada layanan hemodialisis dapat mengeliminasi pemborosan. Kata kunci: Analisis biaya, metode ABC, implementasi lean
ABSTRACT Name : Noer Triyanto Rusli Programme : Hospital Administration Title : Analysis of Cost and Determinants of Inefficiency of Hemodialysis Services for Patients with Chronic Renal Failure at RK Charitas Hospital Palembang 2016 Enactment of JKN in hospital changes the payment system from retrospective payment (fee for service) into prospective payment (INA-CBG's). As a healthcare facility, RK Charitas Hospital has a role to provide not only quality but also to consider cost effective of services. This study aimed to analyze costs and identify the determinants of the inefficiency of hemodialysis services in patients with chronic renal failure at RK Charitas Hospital. This is a descriptive analysis research using primary and secondary data. Approach of cost analysis is Activity Based Costing (ABC) with "Bottom Up" method. ABC method is used to allocate costs by identifying cost drivers of hemodialysis services. Operational cost is the biggest expense in the hemodialysis services. Analysis of the inefficiency factors uses the calculation of Value Stream Mapping (VSM). The composition of value added (VA) compared to non-value added (NVA) is 17.73%: 82.27%. Lean implementation on hemodialysis services could eliminate waste. Key words: Cost analysis, ABC method, lean implementation
Tantangan yang dihadapi RSU GMC dalam mengelola biaya pelayanan kesehatan, khususnya pada tindakan operasi pterygium yang memiliki variasi rawat inap dan rawat jalan pada pelayanannya, di tengah sistem pembayaran berbasis INA-CBGs BPJS Kesehatan yang seringkali tidak mencerminkan biaya riil pelayanan. Penelitian ini bertujuan untuk menganalisis biaya satuan dan tingkat pemulihan biaya (Cost Recovery Rate/CRR) pada layanan operasi pterygium di RSU GMC, Pesawaran Lampung tahun 2024. Metode penelitian yang digunakan adalah studi kasus dengan pendekatan kuantitatif melalui analisis biaya menggunakan metode Double Distribution dan Relative Value Unit (RVU), serta pendekatan kualitatif melalui wawancara mendalam dengan informan kunci di rumah sakit. Data yang dikumpulkan meliputi biaya investasi, operasional, dan pemeliharaan untuk seluruh unit terkait selama tahun 2024, baik biaya langsung maupun tidak langsung. Hasil penelitian menunjukkan bahwa total biaya yang dikeluarkan RSU GMC untuk seluruh pelayanan rumah sakit pada tahun 2024 mencapai Rp18,4 miliar, dengan proporsi terbesar dialokasikan untuk biaya operasional (74%), diikuti investasi (25%) dan pemeliharaan (1%). Biaya satuan tindakan operasi pterygium rawat inap bervariasi menurut kelas, mulai dari Rp8.393.130 (VVIP) hingga Rp5.758.508 (kelas 3), sedangkan estimasi jika dilakukan rawat jalan sebesar Rp3.222.238 untuk metode konjungtival graft dan Rp2.680.442 untuk metode bare sclera. Terdapat selisih negatif yang signifikan antara unit cost aktual dan tarif INA CBGs, dengan tingkat pemulihan biaya (CRR) pada rawat inap hanya 80-87% dan rawat jalan 49-58%. Rekomendasi penelitian yaitu evaluasi ulang terhadap perjanjian KSO alat operasi, pengkajian ulang jasa medis, serta optimalisasi utilitas SDM dan ruang operasi. Kesimpulan dari penelitian ini adalah bahwa tarif INA CBGs belum mampu menutupi biaya riil pelayanan operasi pterygium di RSU GMC, baik pada layanan rawat inap maupun rawat jalan, sehingga diperlukan evaluasi biaya rumah sakit dan efisiensi internal agar keberlanjutan dan mutu pelayanan tetap terjaga.
The main challenge faced by RSU GMC in managing healthcare service costs is related to providing pterygium surgery, which includes both inpatient and outpatient care, within the limitations of the INA-CBGs payment system under BPJS Kesehatan that often does not reflect the actual service costs. This study aims to analyze the unit cost and cost recovery rate (CRR) of pterygium surgery services at RSU Gladish Medical Center (GMC) Pesawaran, Lampung, in 2024. The research applies a case study method with a quantitative approach using cost analysis based on the Double Distribution and Relative Value Unit (RVU) methods, supported by a qualitative approach through in-depth interviews with key hospital informants. The data collected include investment, operational, and maintenance costs for all related units in 2024, covering both direct and indirect costs. The results show that the total hospital expenditure in 2024 reached IDR 18.4 billion, with the majority allocated to operational costs (74%), followed by investment (25%) and maintenance (1%). The unit cost of inpatient pterygium surgery varied by class, from IDR 8,393,130 for VVIP to IDR 5,758,508 for Class 3. For outpatient procedures, the estimated cost was IDR 3,222,238 for the conjunctival graft method and IDR 2,680,442 for the bare sclera method. There is a significant negative gap between the actual unit cost and the INA-CBGs tariff. The CRR for inpatient care ranges from 80% to 87%, while for outpatient care it is lower, between 49% and 58%. Based on these findings, it is recommended that the hospital conduct a comprehensive review of the surgical equipment partnership agreement, reassess medical service fees, and optimize the use of human resources and operating room capacity. This study concludes that the INA-CBGs tariff does not sufficiently cover the actual costs of pterygium surgery at RSU GMC, for both inpatient and outpatient services. Therefore, regular cost evaluation and internal efficiency improvements are crucial to maintain the sustainability and quality of healthcare services.
