Faculty of Public Health Journal Universitas Indonesia
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Penghitungan Biaya Satuan pada Instalasi Rawat Jalan di Rumah Sakit X Jambi menggunakan Metode Step Down
Get PDFAbstrak Tanggung jawab Rumah sakit adalah memberikan pelayanan yang berkualitas dan terjangkau bagi masyarakat, sehingga penentuan tarif dengan perhitungan biaya aktual sangat diperlukan sebagai dasar pengambilan keputusan yang lebih presisi. Penelitian ini bertujuan untuk menghitung biaya satuan dan analisis perbandingan biaya antar unit di instalasi rawat jalan menggunakan metode step down. Penelitian ini merupakan bagian dari partial economic evalution yaitu hanya memotret deskripsi biaya dari suatu objek (cost object) tanpa membandingkan luaran layanan dari unit yang di analisis. Tahapan analisis data meliputi identifikasi sumber dari pusat biaya dengan menentukan final cost, intermediate cost dan indirect cost, tahap kedua yaitu mengidentifikasi dan menghitung biaya investasi, biaya operasional dan biaya pemeliharaan. Hasil penelitian menujukkan biaya satuan tertinggi terdapat di poli gigi dan mulut sebesar Rp 621.100,99 /kunjungan sedangkan biaya satuan terendah di poli penyakit dalam yaitu sebesar Rp 214.307,51/kunjungan. Diharapkan hasil penelitian ini dapat menjadi pertimbangan dalam perubahan ataupun penyesuaian tarif layanan dan menjadikan bahan evaluasi pada poli rawat jalan agar lebih efisien dalam pengelolaanya. Abstract Hospital has a responsibility to provide quality and affordable health care to the community. Therefore, determining tariffs by calculating the actual cost is very important, especially for internal stakeholders in undergoing cost analysis, performance evaluation and decision making, including tariff negotiation with external stakeholders. This research objective is to calculate unit costs and comparatively analyzing costs between units in an outpatient installation using the step-down method. This research used a partial economic evaluation which only portrays the description of cost object without comparing the output from the analyzed unit. The stages of data analysis include identifying the resource of cost center by firstly determining the final cost, intermediate cost and indirect cost, the second stage is identifying and calculating investment cost, operational cost, and maintenance costs, the third stage is determining the allocation basis, and the fourth stage is calculating the total cost. The highest unit cost occurs in dental poly at Rp.621.100,99/visit, while the lowest unit cost is in internal medicine which is Rp.241.307,51/visit. It is hoped that the results of this study can be taken into consideration in the changes made by service rates and making evaluation materials on outpatient care so that they are more efficient in their management
AN ANALYSIS ON THE IMPLEMENTATION OF THE HUMAN RESOUCES IN THE HEALTH FIELD PLANNING POLICY IN DEPOK, 2017
Get PDFAbstract. According to the Minister of Health Regulation no. 33/2015 (Permenkes 33) on Guidelines for Composing the Human Resources in the Health Field (HRH) Planning, planning for HRH must be done from the bottom up. In 2016, Depok City has implemented the regulation, but the results were not applicable. This qualitative study analyzes the process of creating the planning document at Depok City in 2017 through in-depth interviews and documentary research. We discovered that the 2017 HRH planning document in Depok City did not completely follow all the steps stated in Permenkes 33. Ineffective communication caused lack of commitment and support from the stakeholders, which in turn, caused the lack of support from the bureaucratic structure, such as standard operational procedures, regulation, and allocation of resources, whether it was manpower, funding, or facilities. Therefore, we recommend that the socialization or advocation process to the stakeholders to be increased.Abstrak. Menurut Peraturan Menteri Kesehatan nomor 33 Tahun 2015 tentang Pedoman Penyusunan Perencanaan Kebutuhan Sumber Daya Manusia dalam bidang Kesehatan (SDMK), perencanaan SDMK harus dilakukan secara berjenjang dari bawah ke atas. Di tahun 2016, kota Depok telah melaksanakan permenkes tersebut, akan tetapi hasilnya belum dapat dijadikan pertimbangan dalam manajemen kepegawaian. Penelitian ini merupakan penelitian kualitatif yang bertujuan untuk melakukan analisis terhadap pelaksanaan penyusunan dokumen perencanaan kebutuhan SDMK kota Depok tahun 2017 dengan teknik pengumpulan data berupa wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa penyusunan dokumen perencanaan kebutuhan SDMK kota Depok tahun 2017 belum sesuai dengan tahapan yang terdapat dalam Permenkes 33 tahun 2015. Permasalahan disebabkan oleh komunikasi yang tidak efektif, yang menyebabkan tidak adanya komitmen dan dukungan dari pemangku kepentingan, sehingga tidak terdapat dukungan dari struktur birokrasi yang berupa SOP dan peraturan, dan alokasi sumber daya, baik manusia, dana, maupun fasilitas. Untuk itu, sebaiknya proses sosialisasi atau advokasi ke para pemangku kepentingan ditingkatkan
Variasi Biaya Sectio Caesaria di Rumah Sakit Indonesia
Get PDFABSTRAK Penetapan harga/variasi biaya merupakan salah satu langkah strategis yang harus ditempuh karena mengacu kepada biaya yang dikeluarkan, baik biaya marjinal maupun biaya total, termasuk biaya tidak langsung (overhead cost). Operasi sectio caesaria (SC) adalah salah satu tindakan yang paling umum dilakukan di ruang operasi yang juga membutuhkan perencanaan biaya layanan yang matang, sehingga dengan penetapan harga yang sesuai rumah sakit dapat beraktifitas tanpa mengurangi mutu layanan. Tulisan ini bertujuan melihat beda biaya SC di Indonesia berdasarkan kelas/tingkatan rumah sakit serta kepemilikan rumah sakit, apakah rumah sakit tersebut milik pemerintah atau private/swasta serta kelas atau kamar perawatan. Tujuan lain dari tulisan ini adalah melihat beda proporsi biaya yang terjadi di komponen biaya SC. Metode yang digunakan dalam tulisan ini adalah perbandingan data atau study literatur dari 20 rumah sakit yang ada diperpustakaan UI, dan untuk bisa membandingkan data-data tersebut dan menghindari selisih inflasi maka perlu dilakukan penyekarangan data yang diambil atau dipresent valuekan (PV). Kasus SC yang dipilih adalah kasus SC biasa tanpa emergensi dan penyulit. Terdapat interval/variasi yang cukup lebar biaya pelayanan dan proporsi komponen biaya (Jasa pelayanan, akomodasi, pemeriksaan medis dan obat, ATK serta BHP) baik rumah sakit pemerintah maupun swasta diberbagai tipe rumah sakit. Peran manajemen rumah sakit menentukan tarif/harga pelayanan merupakan salah satu kunci keberhasilan dalam strategi pemasaran rumah sakit, diperkuat dari penelitian dari banyak negara lain. Rumah sakit yang proporsi komponen biaya pelayanannya tidak sesuai dengan aturan yang ada agar segera melakukan revisi agar tidak terjadi gangguan pelayanan di rumah sakit, apalagi sejak UHC dicanangkan pemerintah. Marketing, Sectio Caesaria, Variasi Kelas Rumah Sakit, Proporsi Biaya. ABSTRACT Pricing / variation of costs is one of the strategic steps that must be taken because it refers to costs incurred, both marginal and total costs, including indirect costs (overhead costs). Cesarean section (SC) surgery is one of the most common actions performed in the operating room which also requires careful planning of service costs, so that the appropriate price setting for the hospital can do activities without reducing service quality. This paper aims to look at the different costs of SC in Indonesia based on the class / level of the hospital and hospital ownership, whether the hospital is owned by the government or private / private as well as classes or treatment rooms. Another purpose of this paper is to look at the different proportions of costs that occur in the SC cost component. The method used in this paper is a comparison of data or literature studies from 20 hospitals in the UI library, and to be able to compare these data and avoid the difference in inflation, it is necessary to do the data collection or presentation of valuation (PV). The case of SC chosen was a normal case of SC without emergency and complication. There are intervals / variations that are quite wide service costs and the proportion of cost components (services, accommodation, medical and drug examinations, stationery and BHP) in both public and private hospitals in various types of hospitals. The role of hospital management in determining service rates / prices is one of the keys to success in hospital marketing strategies, reinforced from research from many other countries. Hospitals whose proportion of service cost components are not in accordance with existing regulations so that they immediately revise so that there is no disruption in hospital services, especially since the UHC was declared by the government. Marketing, Sectio Caesaria, Hospital Class Variation, Cost Proportion.
Larvicidal Effect of Mixture of Beauveria bassiana Crude Metabolite and Chitinase Enzyme against Aedes aegypti Larvae
Get PDFAedes aegypti is a major vector of dengue, a deadly disease causing deaths of millions of people in developing countries, both in urban and rural populations. Aedes aegypti control with chemical insecticide is widely used, and affects on a widespread insecticide resistance. Mosquito biological control was needed to replace the use of chemical insecticide. This study aimed to evaluate larvicidal effect of mixture of Beauveria bassiana crude metabolite and chitinase enzyme against Aedes aegypti larvae. An experimental study using completely Randomized Design was conducted in March-April 2016 at Banjarnegara Research and Development Unit for Zoonosis Control. Biolarvacide formula was made of mixture with 2 : 1 ratio between Beauveria bassiana crude metabolite and chitinase isolated from chitinolytic bacteria, which was propagated by the Agency’s Bacteriology Laboratory. In experimental method, 120 Aedes aegyptilarvae (3rd instar) were exposed with four concentrations of biolarvacide formula (4%, 8%, 16%, and 32%) in 3 replicates. Results showed that exposure of biolarvacide formula caused the third instar larval mortality which started on the first day of exposure. Probit analysis showed LC50 value was obtained at concentration of 53.2 ppm. This shows that larvacide formula of Beauveria bassiana and chitinase enzyme compounds are effective to be used as larvacides against Aedes aegypti larvae
Analisis Formularium RSUD Cimacan Tahun 2017
Get PDFABSTRAK Rumah sakit harus memberikan pelayanan kesehatan menyeluruh, terpadu dan berkesinambungan yang dalam penyelenggaraannya rumah sakit tidak terlepas dari pelayanan farmasi. Kebutuhan akan penyediaan dan pemakaian obat-obatan yang berkualitas dan rasional diatur dalam sistem formularium dimana obat-obatan yang dipakai terdapat dalam buku formularium. Tujuan penelitian ini adalah untuk menganalisa formularium RSUD Cimacan dilihat dari penyusunan, pemeliharaan dan evaluasi obat formularium. Evaluasi obat formularium dengan melakukan analisis ABC pemakaian, investasi, indeks kritis dan VEN sehingga didapatkan hasil berupa usulan revisi formularium RSUD Cimacan. Penelitian ini menggunakan pendekatan kualitatif. Hasilnya adalah proses penyusunan formularium RSUD Cimacan belum optimal, prosedur pemeliharaan formularium sudah ada namun belum lengkap, pengadaan dan peresepan belum sesuai formularium. Ditemukan 495.690 pemakaian obat non formularium dan 201 jenis obat non formularium yang disediakan di instalasi farmasi. Ada 322 jenis obat formularium yang dipakai (43%), ada 21 jenis obat dengan nilai investasi RP. 3.001.658.694. Hanya 31 jenis obat yang sangat kritis dan 39 jenis obat yang Vital terhadap pelayanan pasien. ABSTRACT Hospitals must provide comprehensive, integrated and sustainable health services which in the organization of the hospital is inseparable from pharmaceutical services. The need for the provision and use of qualified and rational medicines is regulated in the formulary system where the drugs used are contained in the formulary book. The purpose of this study was to analyze the formulary of RSUD Cimacan seen from the preparation, maintenance and evaluation of formulary drugs. Evaluation of formulary drugs by performing ABC analysis of use, investment, critical index and VEN to obtain the result of proposed revision formulary of RSUD Cimacan. This research uses qualitative approach. The result is the process of formulary of RSUD Cimacan not optimal, procedure of maintenance of formulary already exist but not yet complete, procurement and prescription not according to formulary. 495,690 non-formulary drug use and 201 kinds of non-formulary drugs were provided in pharmaceutical installations. There are 322 kinds of formulary drugs used (43%), there are 21 types of drugs with an investment value of RP. 3.001.658.694. Only 31 types of drugs are very critical and 39 types of drugs are Vital to patient care.
Analisis Biaya Satuan dan Kualitas Hidup Penderita Gagal Ginjal Kronik yang Menggunakan Tindakan Hemodialisis di Rumah Sakit Tebet Tahun 2015
Get PDFABSTRAK Penelitian ini bertujuan untuk mengetahui gambaran biaya satuan dan kualitas hidup penderita gagal ginjal kronik yang menggunakan tindakan hemodialisis di Rumah Sakit Tebet tahun 2015. Biaya dihitung berdasarkan perspektif rumah sakit, kemudian dilakukan penyusunan alat ukur kualitas hidup penderita gagal ginjal kronik (Dialysis Health Related Quality of Life) dan clinical pathway tindakan hemodialisis di Rumah Sakit Tebet. Alat ukur kualitas hidup berisikan 13 atribut untuk mengukur utility dan time preference (pertambahan tahun hidup) penderita gagal ginjal kronik yang menggunakan tindakan hemodialisis. Tigabelas atribut tersebut terdiri dari rasa kecap terhadap makanan, gangguan tidur, berjalan, kelelahan, cemas, emosi, nyeri, mandiri, kegiatan sehari- hari (bekerja, belanja, belajar, jalan-jalan, dll), komunikasi, bergaul, terisolasi, beban orang lain. Quality adjusted life years (QALY’s) didapatkan dari perkalian utility dengan time preference. Nilai QALY’s yang didapatkan yaitu 3.35 artinya penderita gagal ginjal kronik yang menggunakan hemodialisis mendapatkan 3 tahun hidup berkualitas, di mana nilai rata-rata utility 0,62 (0 = mati, 1 = sehat), dan nilai rata-rata time preference atau pertambahan hidup yang diperoleh penderita gagal ginjal kronik yang menggunakan hemodialisis yaitu 5 tahun. Biaya yang dikeluarkan rumah sakit untuk satu kali pelayanan hemodialisis dengan single use yaitu Rp 1.315.644,- Dengan asumsi frekuensi hemodialisis rutin 2 kali dalam satu minggu maka biaya yang dikeluarkan oleh rumah sakit yaitu Rp 41.324.355,-. Biaya tersebut mencakup skrinning indikasi dialysis, tindakan dialysis (single use), pemeriksaan lanjutan/ regular, dan virus marker. Penerapan clinical pathway diperlukan sebagai alat kendali mutu dan kendali biaya dalam pemberian pelayanan kesehatan. ABSTRACT The research aims to describe unit cost of hemodialysis and quality of life of Chronic Kidney Disease patients who use hemodialysis as a therapy at Tebet Hospital in 2015. Unit cost is calculated based on hospital perspective. Developing questioner of quality of life of Chronic Kidney Disease (CKD) patients (Dialysis Health Related Quality of Life) and clinical pathway of hemodialysis. Dialysis Health Related Quality of Life has 13 dimensions (sense of taste, sleep disorders, mobility, fatigue, anxiety, emotional, pain, self-care, daily activities (working, shopping, study, travelling, etc), communication, social interaction, being isolated, the burdens of others), measuring utility and time preference of patients who use hemodialysis as a therapy. QALY’s score is 3,35 which means patient of CKD gets 3 years of quality life. While using hemodialysis, utility score is 0,6, 0 means death and 1 means healthy life, and time preference score is 5,1 years, which means patient of CKD gets 5 more years when they use hemodialysis as a therapy. Unit cost of single use of hemodialysis is Rp 1.315.644,- Unit cost of hemodialysis for 6 months with 2 times a week of hemodialysis is Rp 41.324.355,-. Costs include screening of dialysis indication, single use dialysis, regular medical check up, and virus marker. The implication of clinical pathway is needed for quality and cost control.
Analisis Tatakelola Sasaran Keselamatan Pasien Pada Alur Pelayanan Penyakit Sepsis Di Rumah Sakit Tebet 2015Analisis Tatakelola Sasaran Keselamatan Pasien Pada Alur Pelayanan Penyakit Sepsis Di Rumah Sakit Tebet 2015
No full textABSTRAK Dalam konteks pengobatan modern, kompleksitas sistem perumahsakitan dianggap sebagai faktor utama penyebab insiden kesalahan medis. Dengan paradigma ”pelayanan berfokus pasien”, hak pasien mendapatkan pelayanan kesehatan yang aman telah menjadi indikator dalam Standar Akreditasi Rumah Sakit versi 2012 (SARS 2012) di Indonesia, melalui penerapan 6 Sasaran Keselamatan Pasien (SKP). Adapun salah-satu jenis penyakit dengan mortalitas dan morbiditas yang tinggi adalah Sepsis. Pengunaan modifikasi klinis Internasional Classification of Desease (ICD) berbasis revisi ke-9, telah menimbulkan kerancuan terminologi dan meningkatkan mortalitas sepsis. Secara global, mortalitas sepsis mencapai 8 juta/tahun, dengan pertumbuhan di negara berkembang berkisar 8 – 13% per-tahun. Untuk memastikan efektifitas Keselamatan Pasien pada alur pelayanan penyakit sepsis, dilakukan penelitian terhadap imlementasi Tatakelola 6 Sasaran Keselatanan Pasien. Melalui kerangka studi kasus, dengan pendekatan kualitatif diskriptik-analitik, dilaksanakan penelitian di Rumah Sakit Tebet Jakarta pada bulan April-Mei 2015. Hasil penelitian menunjukkan, efektifitas Tatakelola 6 SKP mencapai 96,283%, dengan tingkat kesalahan dibawah 5%. Penelitian ini berhasil membuktikan implementasi Tatakelola 6 SKP pada alur pelayanan penyakit sepsis. Disimpulkan bahwa Tatakelola 6 Sasaran Keselamatan Pasien sangat efektif mengurangi resiko KP. ABSTRACT In the context of modern medicine, complexity hospital’s management is regarded as the primary cause of medical error (ME). The new healthcare paradigm of “Patient-Focused Care”, patient’s right to receive safe healthcare treatment is considered as main indicator in Standar Akreditasi Rumah Sakit of 2012 (SARS 2012) in Indonesia, through the implementation of 6 Patient Safety (KP) standards. In the category of emergency medical treatment, Sepsis is considered as a disease with high mortality and morbidity rate. The use of The International Classification of Diseases, based on Ninth Revision (ICD-9), have caused terminological confusion and contribute to the increase of sepsis mortality rate. Globally, sepsis’ mortality rate reaches 8 million/year or 24.000/day, with growth rate of 8-13% per-year. To ensure the effectiveness of KP standard implementation in sepsis medical treatment, a research on the implementation of 6 Targets of KP in RS Tebet is conducted. Using case study, qualitative and descriptive analysis, this research is performed in the course of April-May 2015. The research shows that effectiveness 6 Targets of KP implementation reaches 96,283%, with 5% margin of error. This research proves that implementation of 6 Targets of KP in healthcare treatment procedure for sepsis cases can reduce the risk of ME
Perceived Stigma in People Affected by Leprosy in Leprosy Village of Sinatala, Tangerang District, Banten Province, Indonesia
No full textLeprosy is a disease of neglected tropical diseases (NTDs) which becomes a global problem and causes the perceived stigma in people affected by leprosy. This study aimed to determine most dominant factors affecting perceived stigma in people affected by leprosy in leprosy village of Sitanala, Tangerang District, Banten Province, Indonesia. The data used was secondary data taken from cross-sectional survey of a thesis which determined factors related to perceived stigma of leprosy in leprosy village of Sitanala, Tangerang, Indonesia. Samples were selected by purposive sampling. The results of the study showed that factors related to perceived stigma were level of education, perception of knowledge about leprosy, level of disability, and cultural values. There was modification effect between the level of disability and perception of knowledge about leprosy, OR1=4.82 (95% CI 1.26-18,34) and OR2=1.18 (95% CI 0.2-6.98). The dominant factor is level of education with PAR% = 38.8%
Analysis of Policy Implementation for The Improvement Capability of Internal Government Supervisory Apparatus (APIP) at Inspectorate General of Ministry of Health
Get PDFThe capability of the Internal Government Supervisory Apparatus (APIP) is the ability to carry out supervisory tasks consisting of three interrelated elements: capacity, authority, and competence. The objective of this research is to give policy recommendations for enhanced APIP capability in the Inspectorate General of the Ministry of Health. This research is a descriptive study with qualitative analysis method with in-depth interview and literature study. Results of this research indicate that there are some obstacles: the socialization done only to some employees of Itjen; no Special Team on the process of improving APIP capability; the time and task division is unclear; has no special budget yet; there has not been a derivative rule from the Internal Audit Charter (IAC); no reward and punishment system; no documentation of supervision working papers; the policy has not been internalized. This research concludes that the implementation of the policy has not been reached optimally based on PERKA BPKP Number PER-1633/K/JF/2011. Communication is the most influential factor in the implementation of APIP enhancement policy. The recommendation from this research are consistently socialize to employees within the Inspectorate General, make Standard Operating Procedures (SOP), allocate budget activities in 2018, create memorandum of understanding with other agencies, and self-assessment and program evaluation absolutely must do continuously
Perlukah Keselamatan Pasien Menjadi Indikator Kinerja RS BLU?
Get PDFABSTRAK Pemerintah dalam hal ini Kementerian Kesehatan melalui peraturannya mengamanahkan pentingnya keselamatan pasien. Hal ini dapat dilihat dari disebutkannnya keselamatan pasien dalam empat pasal di Undang-Undang Nomor 44 Tahun 2009 tentang Rumah Sakit dan secara khusus dalam Peraturan Menteri Kesehatan. Pentingnya isu kesela-matan pasien di rumah sakit tidak berbanding lurus dengan indikator kinerja Rumah Sakit BLU yang tertulis dalam Peraturan Direktur Jenderal Perbendaharaan Nomor 34 Tahun 2014 Tentang Pedoman Penilaian Kinerja Badan Layanan Umum Bidang Layanan Kesehatan. Dalam Perdirjen ini, dapat dilihat bahwa penilaian kinerja RS BLU terdiri dari aspek keuangan dan aspek pelayanan. Keselamatan pasien dapat dilihat pada aspek pelayanan lebih khu-susnya dapat dilihat pada kelompok indikator mutu klinik yang memiliki skor maksimal 12 dari 100. Mutu klinik di ukur dengan lima indikator yang empat di antaranya adalah angka kematian. Jika merujuk kepada besarnya penekanan terhadap keselamatan pasien dan definisi keselamatan pasien, maka pertanyaannya adalah apakah indi-kator berupa angka kematian cukup merepresentasikan pentingnya keselamatan pasien dirumah sakit? Penulisan ini bertujuan untuk memberikan gambaran peranan keselamatan pasien dalam tatanan indikator kinerja Rumah Sakit BLU. Penulisan ini menggunakan metode literatur review. Hasil dari telaah ini menunjukkan bahwa upaya kesela-matan pasien belum sepenuhnya menjadi tolak ukur kinerja Rumah Sakit BLU. ABSTRACT The government which is the Ministry of Health through its regulations mandates the importance of patient safety. This can be seen from the mention of patient safety in the four articles in Undang-Undang Number 44 Year 2009 about Hospital and specifically in the Minister of Health Regulation. The importance of patient safety issues in hos-pitals is not directly proportional to the performance indicators of the BLU Hospital written inPeraturan Direktur Jenderal Pembendaharaan Number 34 Year 2014 about the Guidelines for Performance Appraisal of Public Ser-vice Bodies for Health Services. In this regulation, it can be seen that the performance assessment of BLU Hospital consists of financial aspect and service aspect. Patient safety can be seen in service aspect more specially can be seen in group of clinical quality indicator which have maximum score 12 from 100. Clinic quality is measured with five indicator which four of them is death rate. If it refers to the magnitude of the emphasis on patient safety and the definition of patient safety, then the question is whether the indicator of mortality adequately represents the im-portance of patient safety in the hospital? This article aimed to provide an overview of the role of patient safety in the performance indicators of hospital performance BLU. This study was conducted by using the literature review method. The results of this study indicate that the patient's safety efforts have not fully become the benchmark of BLU Hospital performance.