ANALISIS TARIF PELAYANAN POLI PENYAKIT DALAM DI RUMAH SAKIT UMUM DAERAH DALAM ERA JAMINAN KESEHATAN NASIONAL

ANALYSIS OF INTERNAL DISEASES POLY SERVICE TARIFF DURING THE ERA OF THE NATIONAL HEALTH INSURANCE IN A DISTRICT HOSPITAL

Abstract

Background: The Hospital as an advanced health facility has an essential role in implementing the National Health Insurance (JKN).
Reimbursement mechanism of health services using INA-CBGs package tariff, which the objectives for controlling healthcare costs
and improving service standards. However, this has not been implemented well. Therefore INA-CBGs has a disadvantage potential
to Hospital.
Objective: To determine the difference between Hospital tariff and INA-CBGs for JKN patients.
Methods: This study was descriptive with a qualitative approach and case study design. Review documents and in-depth interviews
with Hospital structural and functional management were used for data collection. Data analyzed used descriptive analysis for secondary
data and qualitative analysis to explore hospital policies and strategies to the tariff difference to deepen this study result. The
research was conducted from April to June 2018.
Results: Healthcare cost of JKN patients in Internal Disease Poly has negative difference during January–June 2017 with an average
of 20,3%. The main factor causing the difference was pharmaceutical 63%. This tariff difference occurred due to several factors
such as related with the most morbidity diseases: 61,7% chronic diseases, policies implemented for capacity building of human resources
in JKN patient services, improvement of a referral program for stable patients, cross-subsidizing of other income and government,
specific strategies in JKN services that listed in the strategic plan. Furthermore, for service output was planned to reach hospital
accreditation and conduct excellent heart disease service.
Conclusion: Healthcare cost in Internal Disease Poly had deficit due to hefty deviation tariff between hospital tariff and INA-CBGs.
However, potential losses could be anticipated with policies and strategies that support cost control and improve service standards.