Faculty of Public Health Journal Universitas Indonesia
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Kinerja Rumah Sakit Swasta dengan Pembayaran INA-CBGs di Era Jaminan Kesehatan Nasional: Casemix, Casemix Index, Hospital Base Rate
Get PDFAbstrak Pembayaran ke rumah sakit yang sebelumnya fee for service, pada era JKN diselenggarakan melalui pola DRG atau INA-CBGs. Rumah sakit swasta harus memonitor kinerjanya menggunakan indikator yang lazim digunakan dalam sistem pembayaran DRG yaitu casemix, casemix index dan Hospital base rate. Kajian ini bertujuan untuk menganalisis kinerja rumah sakit swasta meliputi casemix, casemix index dan hospital base rate. Studi cross sectional ini dilakukan dengan sampel 7 RS yang dipilih secara purposif mewakili RS swasta kelas B, C, dan D yang tersebar di 6 provinsi. Casemix dan CMI RS sangat dipengaruhi oleh kapasitas RS sehingga RS kelas B memiliki casemix dan CMI lebih tinggi dari RS kelas C dan D. Terdapat fenomena CMI di RS kelas C lebih kecil dari kelas D yang kemungkinan disebabkan oleh akurasi koding. Kelengkapan dan ketepatan pengkodean diagnosis dan prosedur sangat berdampak pada besaran casemix dan CMI RS. Hampir semua RS memiliki HBR di atas HBR Nasional kecuali RSC3. Dapat dipastikan RSC3 mendapatkan profit dari implementasi INA-CBGs. Rumah sakit sebaiknya memonitor casemix, CMI dan HBR secara berkala. Kementerian Kesehatan diharapkan mempublikasikan cost weight dan HBR Nasional INA-CBGs serta besaran rata-rata casemix dan CMI menurut kelas RS agar dapat digunakan sebagai benchmark oleh RS. Abstract Private hospitals must monitor their performance using indicators commonly used in DRG payment systems: casemix, casemix index and hospital base rate. This study aims to analyze the performance of private hospitals including casemix, casemix index and hospital base rate. This cross sectional study was conducted with a sample of 7 hospitals selected purposively representing private hospital type B, C, and D in 6 provinces. Casemix and CMI RS are strongly influenced by the hospital capacity, which the hospitals class B have higher casemix and CMI than class C and D hospitals. There is a phenomenon, CMI in class C hospitals smaller than class D which is probably caused by coding accuracy. The completeness and accuracy of diagnosis and procedures coding predominating affect the casemix and CMI. Almost all hospitals have HBR which are higher than National HBR except RSC3. It definitely will trigger profit from the implementation of INA-CBGs. Hospitals should monitor casemix, CMI and HBR regularly. The Ministry of Health is expected to publish the Cost Weight and National HBR as well as the average of casemix and CMI according to class of hospital, for a benchmark by hospitals
Analysis Of Risk for Class Shifting And Determinants of BPJS Kesehatan Membership Using Generalized Ordered Logit-Unconstrained Partial Proportional Odds Model
Get PDFAbstract The main source of funding of BPJS Kesehatan comes from the different premium class in which the participant registered. The medical benefits among classes are equivalent, except inpatient facilities. But when the improvement health degree is not linear with the incurred costs, problem would arise. This study aims to analyze class shifting and determinants of BPJS Kesehatan mem- bership. Around 1.53 percent of participants access higher classes, while 5.62 percent access lower classes. Class III participants with inpatient status severity level 2 and 3, reaching 41% and 43%, respectively. In addition, 60% of non-PBI participants are Class II premium participants; most of them are male, productive age, and workers. This research using Generalized Ordered Log- it-Unconstrained Partial Proportional Odds Model concludes that participants who are married tend to choose higher premium class. Whereas productive age participants and a worker is in the lower premium class. The recommendation is the evaluation of membership based on class premium contributions considering potential participants (productive age and workers) who tend should be conducted in a lower class. Although mutual assistance is the principle of National Health Insurance, specific mechanisms should be established to examine the relation of age and health status to each participant regarding the difference in the registered class, besides their economic factors. Abstrak Pendanaan utama BPJS Kesehatan adalah iuran peserta yang besarnya tergantung dari kelas premi yang didaftarkan peser- ta. Manfaat medis setiap kelas adalah setara kecuali fasilitas ruang inap. Di sisi lain, hal ini dapat menimbulkan permasalahan ketika derajat kesehatan tidak linier dengan biaya yang seharusnya dikeluarkan. Penelitian ini bertujuan untuk melihat per- bedaan antara kelas premi saat peserta mengakses pelayanan kesehatan dengan kelas premi yang didaftarkan. Ditemukan 1,53 persen peserta mengakses kelas lebih tinggi dibanding kelas yang terdaftar, dan 5,62 persen peserta yang mengakses kelas lebih rendah dibanding kelas yang terdaftar. Berdasarkan tingkat keparahan saat menjalani rawat inap, diketahui bah- wa peserta kelas III dengan status rawat inap tingkat keparahan 3 (berat) dan 2 (sedang) masing-masing mencapai 41% dan 43%. Selain itu hampir 60 persen peserta yang membayar iuran sesuai dengan ketentuan yang ditetapkan (non PBI) adalah peserta iuran premi Kelas II yang sebagian besar merupakan peserta laki-laki, berusia produktif, dan berstatus sebagai pekerja. Hasil analisis dengan metode Generalized Ordered Logit-Unconstrained Partial Proportional Odds Model disimpulkan bahwa peserta berstatus kawin cenderung berada pada kelas premi yang lebih tinggi. Sedangkan peserta usia produktif serta peserta dengan status pekerja cenderung berada pada kelas premi yang lebih rendah. Rekomendasi yang diberikan adalah evaluasi kepesertaan berdasarkan iuran premi kelas dapat dilakukan kembali mengingat peserta potensial (usia produktif dan berstatus sebagai pekerja) cenderung berada pada kelas yang lebih rendah. Selain itu meskipun asas gotong royong menjadi prinsip pelaksanaan Program JKN, namun sebaiknya dapat dibuat mekanisme tertentu agar dapat dicermati terkait dengan faktor usia dan derajad kesehatan peserta terhadap perbedaan kelas premi peserta yang didaftarkan tanpa mengabaikan kemampuan ekonomi yang bersangkutan
Analisis Penerapan Prinsip Keselamatan Pasien Dalam Pemberian Obat Terhadap Terjadinya Medication Error di Rawat Inap Rumah Sakit X Tahun 2018
Get PDFABSTRAK Kesalahan medikasi adalah kejadian pemberian obat yang dapat menimbulkan cedera kepada pasien yang seharusnya dapat dicegah selama dalam kontrol tenaga kesehatan, dan pasien itu sendiri. Dari 10 fakta WHO mengenai patient safety pada negara berkembang tahun 2017 disebutkan bahwa 1 dari 10 pasien yang dirawat di rumah sakit berisiko terhadap terjadinya medical error dan kesalahan obat yang merugikan. Dari data insiden keselamatan pasien di rumah sakit X tahun 2015 - 2016 tercatat ada 30 kasus insiden keselamatan pasien yang 12 kasus diantaranya adalah kasus kesalahan pemberian obat di rawat inap. Hal ini tidak sesuai dengan standar yang diatur oleh Kemenkes RI tahun 2008 yang menyatakan bahwa insiden di rumah sakit seharusnya zero accident. Desain penelitian yang dipilih adalah penelitian kualitatif yang bertujuan untuk menganalisa faktor faktor apakah yang mempengaruhi penerapan prinsip keselamatan pasien dalam proses pemberian obat oleh perawat di rawat inap rumah sakit X. Dari hasil penelitian didapatkan bahwa faktor yang mempengaruhi penerapan prinsip keselamatan pasien dalam pemberian obat antara lain kurangnya supervisi dari pimpinan, kurangnya jumlah SDM perawat, tingginya turnover perawat, tidak tersedianya SPO pemberian obat dengan prinsip 7 benar, sosialisasi yang tidak dilakukan secara kontinyu dan tidak adanya program diklat atau pelatihan di rumah sakit X. ABSTRACT Medication error is the incident of a drug provision that can inflicting injury to the patient with should be able to prevent as long as in control of a trained health professional, and of patients itself. From the 10 fact from World Health Organization on patient safety for the developing country in 2017 mentioned that 1 of 10 patients treated at hospital runs the risk against an onset of medical error and drug mistakes that may cause adverse effect. From the data of patient safety incident in hospital X performed from 2015 until 2016 there were 30 cases of patient safety incidents there were 12 cases of them was the case of error in administering medicine in inpatient unit. It is not conforming to standard of which are regulated by the Ministry of Health of Indonesia in 2008 which states that the incident at the hospital supposed to be zero accident. A design of this research is the qualitative study that aimed to analyze factors affecting patient safety in the process of administering medication by nurses in the X hospital for inpatient unit. The result shows that factors affecting the application of patient safety in administering medication are the lack of supervision of leaders, the lack of human resources, nursing turnover, absence of standard procedure of 7 right principle in administering medication, absence of training program for nurses, and also the lack of socialization
Obesity Indicators and C-Reactive Protein in Indonesian Adults (More than Equal to 40 Years Old): The Indonesian Family Life Survey 5
Get PDFC-reactive protein (CRP) is the best clinical marker for systemic inflammation. Obesity is associated with increased CRP levels. Systemic inflammation is present before morbidity occurs. Research reveals that the identification of obesity indicators and CRP levels is limited among Indonesians. The present study investigated the associations between obesity indicators (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]) and CRP levels among Indonesian adults. This cross-sectional study based on Indonesian Family Life Survey-5 2014–2015 was conducted among 3,386 adults (≥ 40 years) living in 13 provinces in Indonesia during the study period. All data were collected in 2014. Multiple logistic regression was used to estimate the odds ratio (ORs) and 95% confidence interval (95% CIs) for hs-CRP levels on obesity indicators by using underweight (BMI) and normal (WC, WHR, and WHtR) as references. Our multivariable logistic regression analysis indicated that respondents with increased WHR (OR: 1.278, 95% CI: 1.005–1.625, p-value < 0.001) were more likely to have high-risk hs-CRP levels than those with normal WHR. Compared with respondents with normal WHtR, those with increased WHtR were found associated with high-risk hs-CRP levels (OR: 1.980, 95% CI: 1.544–2.541, p-value < 0.001). Therefore, WHR and WHtR can predict central obesity, which is associated with hs-CRP levels
Relationship between Spirituality and Acceptance of Illness Level in Bipolar Patients
Get PDFBipolar disorder is a chronic mental condition that affects patients’ quality of life. The management process is affected by acceptance of illness. The ability to accept the illness is related to the spirituality level which is something that is held strongly by Indonesian people. There has been very little research related to the relationship between spirituality with bipolar disorder. This study aimed to analyze relationship between spirituality levels with acceptance of illness in patients with bipolar disorder. This study is a correlational study using questionnaire from bipolar disorder patients contacted through Harmony in Diversity online community as a sample. Samples were taken in total sampling according to inclusion and exclusion criteria. The numbers of samples were 30 samples. Calculation of the correlation between acceptance of illness in patients with bipolar disorder with vertical spirituality (RWB) (p = 0.050) (r = 0.306), horizontal spirituality (EWB) (p = 0.001) (r = 0.556), and general spirituality (SWB) (p = 0.007) (r = 0.444). There is a significant positive correlation between acceptance of illness in patients with bipolar disorder and general spirituality with a more significant horizontal dimension compared to vertical dimension
Information System Policy of Web-based Patient Safety Incident Reporting Information System at RSJ Prof Dr. Soerojo Magelang
Get PDFAbstract. To provide security to their patients, healthcare providers use a system for patient safety which includes risk reporting and analysis of incidents, identification and management of risks, and the ability to learn about events that have occurred. According to the 2017 patient safety data at Prof. Dr. Soerojo Psychiatric Hospital, 7% of patient safety incidents at the hospital required a Root Cause Analysis. To aid the process, an online information system is necessary. This research was qualitative research that used the waterfall method for the information syntax. This involved planning, analysis, design, implementation, and system. From there, the data was then evaluated based on its accessibility, completeness, accuracy, and speed. The qualitative data was gathered through questionnaires, in-depth interviews, and unstructured interviews with selected informants. 26 informants were involved in this research, this included the reporters, the Patient Safety (KPRS) Team, and the hospital management board. Results of the would then produce recommendations on how to handle the problems found. Based on the data gathered, we discovered that after the application of the information system, the hospital experienced a 53.8% increase in patient safety
COVID-19 Pandemic and Law No. 6 Year 2018 regarding Health Quarantine
Get PDFAbstract. By late March, to anticipate the spreading of COVID-19 pandemic, the President of the Republic of Indonesia has issued several regulations. The Author has examined that the main laws that were used as the based for the issuance of those regulations are Law No.6 Year 2018 regarding Health Quarantine (the Health Quarantine Law). Therefore in order to handle COVID-19 pandemic, an understanding of the Law become a must. The aim of this research is to elaborate and explain the Health Quarantine Law to reduce the COVID-19 pandemic. This research is normative legal research. The research used secondary data, which consisted of primary legal sources and secondary legal sources. Data were collected through the "google scholar machine". Data obtained were analyzed using a qualitative approach. Findings and analysis proved that besides those newly issued regulations there were several measures and acts that should be taken to handle the COVID-19 pandemic in Indonesia. The Author suggests that the Central Government shall take the necessary steps as soon as possible
Pengembangan Sistem Informasi Monitoring Dokumen Rekam Medis Rawat Inap di RSUP Fatmawati Tahun 2020
Get PDFInformasi yang tidak efektif disebabkan oleh adanya keterlambatan pengembalian dan ketidaklengkapan pengisian data rekam medis. Kepmenkes Nomor 129 Tahun 2008 tentang Standar Pelayanan Minimal Rumah Sakit menetapkan waktu pengembalian dokumen rekam medis yaitu 1x24 jam dan kelengkapan dokumen rekam medis harus 100%. Di RSUP Fatmawati Jakarta terdapat peningkatan prosentase keterlambatan pengembalian dan ketidaklengkapan dokumen rekam medis rawat inap. Penelitian ini bertujuan untuk mengetahui dan mengidentifikasi alur, kebutuhan sistem informasi yang akan dikembangkan, serta merancang sistem informasi monitoring dokumen rekam medis rawat inap di RSUP Fatmawati. Penelitian ini menggunakan metode kualitatif dan dilakukan secara bertahap sesuai tahapan SDLC, serta menggunakan pendekatan metode prototype. Adanya masalah-masalah pada sistem informasi rumah sakit saat ini yang membuat petugas masih harus melaksanakan pekerjaannya secara manual. Sistem informasi monitoring dokumen rekam medis rawat inap dirancang melalui penyusunan alur sistem, perancangan basis data, tampilan antarmuka (userinterface), SPO, dan manualbook. Sistem informasi yang baru dapat mengatasi permasalahan yang terjadi, mempercepat dan mempermudah pekerjaan petugas, serta menghasilkan laporan yang bermutu. Sehingga capaian SPM rumah sakit dan indikator mutu IRMIK meningkat. Sebaiknya ada dukungan penyediaan sarana dan prasarana dari rumah sakit untuk pengembangan sistem informasi monitoring dokumen rekam medis rawat inap, perlu adanya sosialisasi SPO dan manualbook, proses uji coba sistem kepada user, serta sebaiknya dilakukan upaya perawatan basis data secara berkala
The Relationship between Antenatal Care with Childbirth Complication in Indonesian’s Mothers (Data Analysis of The Indonesia Demographic and Health Survey 2012)
Get PDFLabor complications often lead to maternal death. A good antenatal care can reduce maternal and infant mortality. The purpose of this study was to analyze the relationship between antenatal care and labor complication among Indonesian’s mothers. Data of the Indonesia Demographic and Health Survey (IDHS) 2012 from 33 Provinces were used in this study. Samples consisted of 11.803 women aged 15-49 years who delivered baby at sometimes during the last 5 years before survey. A cross-sectional design was used. Variables in the study consisted of dependent variable (labor complication), main independent variable (antenatal care) and potential confounder variables including maternal age in the last labor, mother’s education, number of parity, preceding birth interval, birth attendance, place of delivery, a history of pregnancy complications, history of previous labor complication and multiple pregnancies. A logistic regression was used for analyzing data. Results of this study showed that the prevalence of labor complications was 49.2% and the prevalence of poor antenatal cares (do not use a standard criteria recommended by Indonesian Health Ministry) was 91.2%. After controlling for all potential confounder variables, this study showed that, mothers with a poor antenatal care had a 1.3 times higher risk of labor complications than mothers with a good antenatal care (POR 1.3, 95% CI: 1.1 - 1.4)
ACCUPRESSURE PROGRAM AT THE HEALTH CENTERS IN SOUTH JAKARTA IN 2018
Get PDFAbstract. Traditional Health Services is a treatment or therapy using methods and medication that is based on the experience and skills of our ancestors that can be accounted for and is in accordance with the norms prevailing in the community. One example is acupressure, ehich is a healing method that uses pressure on certain points of the body or acupuncture points. This type of service has been regulated in various laws on traditional health. However, not all Health Centers provide this service. In South Jakarta City, there are only two Health Centers that provide acupressure services. This is a qualitative research, and aims to analyze the policies and implementation of the implementation of acupressure services in the Health Centers and its obstacles. The data was collected through in-depth interviews and document review. In this study we found that the quality and quantity of health workers trained in acupressure and their comprehension of the program was inadequate. In addition, the room for acupressure is only found in health centers that have provided this service. Communication is still a problem, because there is no regulation socialization regarding the regulation of acupressure services for policy implementers. However, 60% of patients were satisfied with the services provided. Abstrak. Pelayanan Kesehatan Tradisional adalah pengobatan/atau perawatan dengan cara dan obat yang berdasarkan pada pengalaman dan keterampilan turun temurun secara empiris, dapat dipertanggungjawabkan dan diterapkan sesuai dengan norma yang berlaku di masyarakat. Salah satu diantaranya adalah akupresur. Akupresur merupakan suatu cara penyembuhan dengan teknik penekanan titik-titik tertentu pada tubuh (titik-titik akupunktur) yang menggunakan jari-jari tangan ataupun alat bantu seperti batang kayu. Pelayanan jenis ini sudah dituangkan dalam berbagai undang-undang tentang kesehatan tradisional. Namun, tidak semua puskesmas menyelenggarakan layanan ini. Di Kota Jakarta Selatan, hanya terdapat dua Puskesmas yang menyelenggarakan pelayanan akupresur. Penelitian ini adalah penelitian kualitatif, dan bertujuan untuk menganalisis kebijakan dan implementasi pelaksanaan pelayanan akupresur di Puskesmas serta hambatannya. Metode pengumpulan data melalui wawacara mendalam dan telaah dokumen. Dalam penelitian ini ditemukan bahwa kualitas dan kuantitas tenaga kesehatan yang terlatih akupresur dan mengerti tentang program masih belum mencukupi. Selain itu, ruangan untuk akupresur hanya terdapat pada puskesmas yang sudah menyediakan pelayanan ini. Komunikasipun masih menjadi masalah, karena belum ada sosialisasi regulasi tentang pengaturan pelayanan akupresur bagi pelaksana kebijakan