Jurnal Manajemen Pelayanan Kesehatan
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ANALISIS BIAYA JAMINAN KESEHATAN MASYARAKAT DAN ASURANSI KESEHATAN PADA PASIEN STROKE NON-HEMORAGIK DI RUMAH SAKIT UMUM DAERAH KABUPATEN SLEMAN
Full text linkBackground: Non-hemorrhagic stroke causes many deaths.Its treatment requires long-term care, resulting in very highcost. Controlinging costs and quality are very important in maintainingsustainability, however, in reality there are cost sharingby patients and hospitals outside the insurance coverage.Aim: This study aims to identify the difference in cost thatmust be shared to the patient and the hospital for inpatientnon-hemorrhagic stroke of the Jamkesmas and Askes patientsin Sleman Hospital.Method: This study used a cross ssectional design. Datawere retrieved retrospectively with a primary diagnosis ofnon-hemorrhagic stroke hospitalizations for patients admittedto the hospital during the period of January 2011 to May 2012.Data were analyzed using univariate, bivariate correlation,and multivariate.Result: The average cost of inpatient care non-hemorrhagicstroke Jamkesmas patients was Rp3.541.021,00 +Rp2.609.488,00 and for Askes patients Rp4.678.509,00 +3.257.816,00. The average cost sharing in Askes patients isRp.1.851.536,00 + 1.968.757,00 and Jamkesmas isRp405.976,00 +Rp2.303.903,00. Percentage the greatest costcomponent in Askes patients is drugs (47%) and accomodation(44%), while in Jamkesmas is drug (52%) and accommodation(36%). Components of the cost sharing in Askes patients wasdrug (87%). The difference in the cost of hospital rates wasgreater than INA-CBGs respectively Rp3.541.021,00 +Rp2.609.488,00 and Rp3.135.045,00 + Rp727.710,00.Conclusion: The proportion of costs covered by the insuranceand shared by patient/hospital is 87:13 for Jamkesmaspatient, 55:45 for Askes patients (January 2011-May 2011),and 59:41 for the Askes patients (June 2011-May 2012). Theproportion of cost sharing of inpatient care non-hemorrhagicstroke by Askes patients outside the program is greater thanthe proportion of costs sharing by the hospital on Jamkesmasprogram.Keywords: cost sharing, Askes costs, Jamkesmas costs,non-hemorrhagic stroke patien
UPAYA MANAJEMEN RUMAH SAKIT DALAM MENDUKUNG KOLABORASI ANTARA DOKTER UMUM DAN SPESIALIS DI INSTALASI GAWAT DARURAT
Full text linkBackground: General practitioners play a major role in runningthe service in the emergency department. As members ofthe team, general practitioners often disagree with specialistdoctors. Problems in communication and coordination oftenhave an impact on the poor service. They even have legalconsequences for the hospital.Objective: This study identified problems of collaboration betweengeneral practitioners and specialists in the managementof patients in the emergency unit, factors that impede thecollaborative process and evaluated efforts of hospital managementin supporting the collaborative process.Methods: This descriptive and exploratory study obtaineddata from in-depth interviews, official documents and routing,as well as participant observation and field observations.Results: General practitioners and specialists have a poorworking relationship that can be coined the legal consequencesin the management of patients in the emergency unit. Individualfactors such as a lack of confidence in the competence ofspecialist physicians, social closeness, the arrogance of specialiststo general practitioners, incomplete standards of carein the emergency unit, and physician adherence to hospitalpolicies and regulations are all obstacles in implementing cooperationteamwork in the emergency unit. The hospital management,on the other hand, takes a losing position in thepresence of doctors. Hospital management failed to prioritizethe development and the implementation of hospital bylawsthat control poor professional coordination and communication.The hospital management still has problems in contractsystem with the doctor, the procedures in the recruitment process,debriefing doctor, and the standard of care in the emergencyunit. This situation becomes more complicated with theexistence of blaming culture, no informal meetings betweendoctors, tacit practices in the supervision and guidance of themedical staff, as well as management’s lack of assertivenessoffenses committed by doctors on hospital policies and regulations.Conclusion: This study shows that general practitioners andmedical specialists fail to understand the legal consequencesof poor cooperation in emergency services. If a hospital managerdevelop and enforce the hospital bylaws relevant to situationalproblems in emergency care, reluctance and barrierscollaboration between physicians, personal issues, and professionalbias in medical practice would no longer a source ofpoor team performance. Hospital managers should enforcetheir hospital bylaws to control personal and professional arrogance.Keywords: Collaboration between GP and specialists, hospitalmanagement, emergency unit
ANALISIS BIAYA RAWAT JALAN HEMODIALISIS DAN PERITONEAL DIALISIS MANDIRI BERKESINAMBUNGAN PADA PESERTA ASKES DI PT ASKES (PERSERO) DIVISI REGIONAL VI
Full text linkBackground: End Stage Renal Diseases (ESRD) becomes aserious healthcare problem because of the increasingprevalence of RRT andhealthcare costs. ESRD patients needRenal Replacement Therapy (RRT). There are two types ofRRT: Hemodialysis (HD) and Continuous Ambulatory PeritonealDialysis (CAPD). Several previous studies showed that CAPDhas more advantage than HD, but it was stilldebated.Thebackground of the country and the healthcare cost systeminfluenced the treatment results CAPD and HD.Aims: The aim of the study wasto comparebetween HD costsand CAPD cost covered by PT Askes (Persero) or known asthe insurance medical cost and out of pocket cost from thepatients.Methods: This study was an observational comparative studywith descriptive analytical design. The data of insurance costwas obtained from Askes database, whereas the patient costwas taken by questionnaires. The subjects were 59 patientsundergoing HD and 50 patients undergoing CAPD in the centerof HD provided by PT Askes (Persero) Regional Division VI.Random sampling was conducted with consecutive samplingsystem.Results: The medianof HD insurance medical cost was Rp5.949.234,00/person/month, while CAPD was Rp5.023.792,00/person/month. There were also medical and non-medicalcostspaid by the patients. these median were Rp287.208,00/person/month for HD patients and Rp323.000,00/person/monthfor CAPD patients.30,5% of HD patients and 22% of CAPDpatients got their income decreased, whereasthe patient familythat got decreased their income were 10% of HD patient familyand 6% of CAPD patient family. The median of the incomereduction among HD patients and HD patient family wasRp2.250.000,00/person/month, whereas CAPD patients andCAPD patient family was Rp2.125.000,00/person/month.Conclusion: The HD insurance medical expenseswere higherthan that of CAPD. Compared to CAPD, thepatientexpenses(medical and non-medical) werelower in HD. Theincome deduction among HD patients and HD patient familywas bigger than the one in CAPD patient andCAPD patientfamily.Keywords: hemodialysis, continuous ambulatory perytonealdialysis, healthcare costs, cost-minimization analyses
PENINGKATAN KUALITAS PELAYANAN TUBERKULOSIS DI RUMAH SAKIT DI INDONESIA: PEKERJAAN YANG BELUM SELESAI
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AUDIT OF ELECTRICAL ENERGY IN AIR CONDITIONING AND LIGHTING EFFORTS ON ENERGY EFFICIENCY IN SURAKARTA ISLAMIC HOSPITAL
No full textBackground: The hospital has a high level of dependency on energy requirements in carrying out operational activities. The tendency of increasing energy costs and the entry into force of the National Health Insurance Program since January 1st, 2014, bringing the consequences of the need for reforms in terms of efficiency. Implementation of energy efficiency are still many obstacles encountered due to costly and has not performed an energy audit. Energy audit is one way to determine whether the intensity level of energy consumption in the category of wasteful or inefficient. By using energy more efficiently can reduce operating costs so that hospitals become more productive and competitive.In this study, energy conservation is focused on the use of air conditioning and lights because it is still possible to do control the use, not to use energy-saving technologies, not including the category of vital equipment.Objective: To evaluate the use of air conditioning energy and lights in Surakarta Islamic Hospital.Methods: This study used a descriptive case study research design using problem solving. The instrument of this research is in-depth interview guide and observation guide.Results and Discussion: The need for operational electrical energy supplied from PLN as the primary source. There is one panel, the power factor is less than standard. Energy Consumption Intensity values in Surakarta Islamic Hospital is 12.3 kWh/m²/month, Standard Operating Procedures and policies governing energy management is not complete and has not been completely understood, the communication between the parts has not been going well, the pattern of air conditioning treatments is less done well, schedule treatment has been carried out but with limited human resources and incomplete document control card. Logistics division can work optimally.Conclusions and Recommendations: Energy Consumption Intensity is 12.3 kWh/m²/month, relatively efficient, can be optimized by replacing to Inverter AC and replacing the lamps into LED lights. Energy efficiency targets will be implemented if supported by policies and Standard Operating Procedures, the availability of human resources, trained staff, prevention efforts with preventive maintenance. Keywords: Hospital, Energy Consumption Intensity, Inverter AC, LED, energy efficiency
FAKTOR-FAKTOR YANG MEMPENGARUHI RUJUKAN BALIK PASIEN PENDERITA DIABETES MELLITUS TIPE 2 PESERTA ASURANSI KESEHATAN SOSIAL DARI RUMAH SAKIT KE DOKTER KELUARGA
Full text linkBackground: Increased number of Askes insurance memberswith type 2 diabetes mellitus (DM) may have an impact of costof health care. Since 2010, PT Askes (Persero) implementedthe Chronic Disease Management Programme (Prolanis),especially for type 2 DM disease. However, back referral frominternal medicine specialist to primary care physician was notwell implemented.Aim: This study aims to identify perceptions of internal medicinespecialist and patients affecting implementation of back referralfor patients with type 2 DM from the hospital to primary carephysician.Method: A qualitative study was employed, using in-depthinterviews, observation and focus group discussions. In-depthinterviews were conducted with eight internal medicinespesialists in three hospitals in Kudus district and two primarycare physicians. Focus group discussions were conductedwith four groups of patients with type 2 DM, and observationwas made to describe the working environment at the hospital.Result: This study found that implementation of back referralswere influenced by physicians’ workload at the hospital,perceived competence of primary care physician, lack ofcommunication and coordination between the specialists andprimary care physicians, as well as patient demands towardspecialist doctor. Patients felt that access to a specialist doctorwas limited due to referrals made by the primary physicians.Conclusion: Both the internal medicine specialists and patientsfactors affect poor implementation of back referrals, despitetheir perceived understanding of the importance.Keywords: back referral, Askes insurance members, type 2diabetes mellitus, qualitative stud
EFEKTIVITAS PELAYANAN SELAMA PENERAPAN CLINICAL PATHWAY SKIZOFRENIA RAWAT INAP DI RSUP DR. SARDJITO YOGYAKARTA
Full text linkBackground Clinical pathway is a requirement for quality andcost control, especially on cases potentially exhausting onavailable resources. Schizophrenia is a mental disorder with apotency to exhaust available resources, therefore requiresevaluation for its service effectiveness.Method and Aims This study was a quasi experimentalstudy with qualitative approach. The aims of this study wereto assess the effectiveness of clinical pathway applicationand patient service during three months application of clinicalpathway for schizophrenia in the inpatient service in SardjitoHospital, Yogyakarta. The data for this study was obtainedfrom both primary and secondary sources.Result: Our results showed that the preparation phase forthe clinical pathway was appropriate with guideline providefor clinical pathway development in Sardjito Hospital.Nevertheless the application was still ineffective. T hecompleteness of the clinical pathway forms was only 33.11%.This was because the information about the clinical pathwayapplication was not properly disseminated to the informant.The design of the forms was difficult to read due to its smallfonts. The planning concepts for the inpatient service forschizophrenia according to the clinical pathway had not wellapplied. The verification and validation of the service providedby the residents in training by home psychiatrist were notconsisted and were not well documented.Conclusion: To solve this, dissemination of the clinical pathwaywith personal approach is required. The design of the clinicalpathway needs also to be improved. Commitment of eachmembers of the multidisciplinary team needs to be improved sothat the application of the planning concept and patient servicefor schizophrenia can fulfill the clinical pathway and theminimum service requirement.Keywords: effectiveness, clinical pathway, schizophreni
BIAYA SATUAN POLIKLINIK IBU DAN ANAK SEBAGAI USULAN PENETAPAN SUBSIDI DI RUMAH SAKIT IBU DAN ANAK
Full text linkBackground: Funding is a very important aspect to improvequality of services and sustainability. The calculation per unitof service at the hospital is required to determine the amountof subsidy from the government.Aim: To calculate of unit cost and operating cost subsidiesand to explore stakeholder opinions toward the calculation inmaternal and child hospital, Government of Aceh.Method: The study used a descriptive case study design.Data processing referred to the calculation of unit cost byusing Activity Based Costing (ABC) through two steps of directtracing and driver tracing.Results: The average cost of direct cost is Rp13.616,00. andthe driver cost is Rp2.421,00 and the unit cost is Rp20.046,00.The highest unit cost is Rp38.343,00 for implant removalservice. The total subsidy required by this hospital in 2012amounted to Rp1.019.946.211,00.Conclusion: Costs produced per unit of service are greaterthan tariff. Stakeholders strongly support the calculation ofunit costs and will use the information for proposing subsidyto the Government of Aceh.Keywords: unit cost, activity based costing, subsidie
PENGARUH INTERVENSI DISKUSI KELOMPOK KECIL DISERTAI UMPAN BALIK TERHADAP PERENCANAAN KEBUTUHAN OBAT DI RUMAH SAKIT UMUM DAERAH TIDAR KOTA MAGELANG
Full text linkBackground: In order to increase health service to people toobtain healing and restore health, very influencing factor issufficient drug need planning, either for its type and amount.Problem faced in Magelang Tidar Hospital is excessive drugand low appropriate drug requirement plan (<100%). Thisresearch to increase appropriate drug need planning inMagelang Tidar Hospital in 2013.Method: This research used quasi experiment research designwith pretest-posttest design. It used indicator of drug needplanning as output before and after FGD intervention.Results: 1) Average drug suitability with formulary for regularin before and after FGD intervention are 82.2% and 84.1%, forASKES in before and after intervention are 95.1% and 97.5%,and for Jamkesmas in before and after FGD intervention are64.7% and 81.8%. 2) Average drug appropriateness withDOEN 2011 for regular in before and after FGD interventionare 65.6% and 72.8%, for ASKES in before and af terintervention are 66.6% and 69.1% and for Jamkesmas beforeand after FGD intervention are 68.7% and 71.1%. 3) Drug fundallocation has reached 100% of available fund. (4) Percentageof drug item amount in planning and real drug item in usage forregular drug before and after FGD intervention are 124.6%and 241.7%, for ASKES in before and after intervention are185.5% and 265.2%, and for Jamkesmas in before and afterFGD intervention are 220.5% and 399.8%. (5) Percentage ofplanning appropriateness for regular drug before and afterFGD intervention are 40.1% and 10.4%, for ASKES in beforeand after intervention are 13.5% and 4.9%, and for Jamkesmasin before and after FGD intervention are 13.8% and 4.5%.Conclusion: FGD intervention with feedback can increasesome appropriateness indicator of drug need planning inMagelang Tidar Hospital such as drug suitability with formularyindicator and drug suitability to DOEN indicator. Fund allocationindicted that required fund have accorded to available fund.Percentage of drug item amount in planning and in real usageis increase and percentage of planning appropriateness isdecreased due to excessive drug budget.Keywords: FGD intervention, drug need planning, MagelangTidar Hospita