Kesehatan Nasional (JKN) in , to increase the healthy quality standard of .. STANDAR PELAYANAN MEDIS DAN FORMULARIUM JAMKESMAS PADA. Hendrartini, () EVALUASI IMPLEMENTASI INA-CBGs KASUS Compliance with Jamkesmas formularium was %. 8/24/ AM Curriculum vitae Nama: Prof. dr. Ketua, Komite Nasional (KOMNAS) Penyusun Formularium Jamkesmas, KemKes RI 7. Ketua Tim.
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An interview guide and checklist were used as instrument for observation and interview. UHC, or sometimes called universal coverage, is defined by the World Health Organization as ensuring that all people obtain the health services they need of sufficient quality to be effective, without suffering financial hardship when paying for them [ 1 ]. This management principle underlies the whole management of funds derived from contributions of participants and the results of development.
Sample are coder and Independent verificator. With a retrospective payment, a provider will treat a patient and submit an itemized bill formullarium an insurance company detailing the services rendered.
Hospital payment systems based on diagnosis- related groups: The system is used to help a hospital manager controlling the physician’s behaviour. INA-CBGs Payment System, Bahteramas Public Hospital of Southeast Sulawesi Province The results showed that the Bahtermas Public Hospital of Southeast Sulawesi Province in the implementation in has begun the significantly change to be better and optimal, including adequate human resources with good skills in every duty, medical records has begun equipped to the appropriate time, the target, and regulations which set forth by hospital management, facilities also available according to the needs in the INA-CBG system, and hospital revenue that increased in quantity compared to previous years.
Incomplete medical records reached Similar to the case mix group, this system is applied as an insurance payment system. There are two methods of payment used for hospital that is retrospective and prospective payment method. Evaluation of the application of the system JKN raised three main issues, namely grade 3 treatment rooms are often full, there are limits of service for each type of health insurance, and one ways of controlling patient JKN with INA CBGs system is the administration of drugs adapted to the National Formulary Fornas for participants JKN.
There was hospital policy that enforced control over cost and quality, as indicated from the availability of Integrated Management Team of Community Health Service Insurance, obligation to prescribe according to Jamkesmas formularium, standard operational procedures of DM and medical records. Causes of negative difference are mostly lack of understanding of doctors, incomplete medical records, and lack of effort to control quality and cost.
Evaluasi Ketersediaan Obat Terhadap Formularium
In this type of organization, public hospitals can be managed as a business organization with flexibility in financial management based on productivity and effectiveness [ 8 ]. Filtering process There were The prospective payment There are two methods of payment used for hospital that is retrospective and prospective payment method. In this system, there is only one insurer institution, BPJS Kesehatan, a social security agency established by the government to provide health insurance for Indonesian people.
The European Journal of Health Economics, vol. The method of determining cost using the INA-CBG’s system implemented by the hospital and the payer government represented by BPJS no longer specify the charges based on the details of the services provided but based on several important data, namely:. Social Security Agency is not allowed to make a profit. The results showed that it had a positive impact on the financial aspects, namely the income hospitals can already covered all needs and operational expenditure with income derived from the implementation of the INA-CBGs, including from purchasing the drug has begun to be resolved, the food inpatients, maintenance is already entered.
Other factors like supporting examination completeness of medical records can also affect the rate difference. This condition also happens at A. Studying the limited diseases within each disease group and the key factors influencing medical expenses of these diseases, as well the simplification of DRGs standard-setting standardized clinical pathways and accurate costing, will greatly increase implementing DRGs in developing countries.
Most of journals that are used as references say that there is a significant difference of INA-CBGs rates in each hospital. This provides a basis for describing the types of patients or other health care provider treatments its case mix.
The goal is for all Indonesia’s population is protected in the insurance system, so that they can meet the basic needs of public health. In this sytem health providers partially take the financial risk whenever they are inefficiency in budget utilization.
Each public hospital management must have a strategy and innovation to improve the quality of service so they can compete with other hospitals and financial performance can be improved in this JKN era. Because of diversity of comorbid types experienced by patients with diabetes mellitus, the cost of needed drugs tend to give greater impact on total costs of treatment.
The study was descriptive with holistic single case study design. The method of determining cost using the INA-CBG’s system formularikm by the hospital and the payer government represented by BPJS no longer specify the charges based on the details of the services provided but based on several important data, namely: Diagnosis Related Groups DRGs are one of the most striking prospective payment systems around the world in recent years, since jamkesmsa of universal health coverage, which booming in the formularuum, uses a system of claims based on DRG systems [ 11 ].
Indonesia started the national health insurance jamkedmas on 1 January INA-CBGs rate is package rates that include all the components of hospital resources used in the service of both medical and non-medical, the rates will not be affected by the days of treatment.
22.214.171.124 Evaluasi Ketersediaan Obat Terhadap Formularium….
A Diagnosis-Related Group DRG is a statistical system of classifying any inpatient stay into groups for payment purpose. However, the manager of the hospital should be able to address these challenges by conducting innovation using information system and technology, increasing hospital facilities to meet public demand, enhancing of hospital physical development, adding new types of services and confirming that the medical record is complete, timely and accurate.
A case mix group CMG is used for inpatient classification system to group patients with similar characteristics together. According to JKN socialization handbook in the national social security system, the National Health Insurance is managed by the principle: