RESPON RUMAH SAKIT SWASTA SOSIAL KEAGAMAAN TERHADAP ASURANSI SOSIAL: STUDI PENANGANAN KASUS MATERNAL DI RUMAH SAKIT NUR HIDAYAH BANTUL, YOGYAKARTA

RESPONSES OF PRIVATE SOCIAL RELIGIOUS HOSPITAL TOWARD SOCIAL HEALTH INSURANCE SCHEMES: A CASE STUDY OF MATERNAL MANAGEMENT IN NUR HIDAYAH HOSPITAL BANTUL, YOGYAKARTA

Abstract

Background: The difference between the hospital real cost and
the tariff of INA-CBGs has negative impact on hospital causes
financial losses, especially private hospital. The potential for this
loss is likely to encourage hospitals to establish a strategy to
minimize losses. There are some distortions induced by the
prospective payment system i.e. up-coding, cream skimming,
readmission, and unbundling. Objective: The aim of this study was to determine Nur Hidayah
hospital behaviour in response to INA-CBGs practice in
maternal management. Methods: This study was a quantitative research uses a case
study approach. Secondary data from medical records, social
insurance claim documents, records or reports regarding
maternal care and the regulation of social insurance services in
the period of January-June 2014 were use as the data sources
of this study. Results: There was no evidence to support the practice of upcoding,
cream skimming, readmission and unbundling in
maternal care at Nur Hidayah Hospital. Nur Hidayah Hospital
implemented efficiency strategies and anti-fraud & abuse to
deal with social insurance schemes. Conclusion: The INA CBGs-based payment resulted in
increased efficiency of the maternal care in Nur Hidayah
Hospital.