Kesehatan Nasional (JKN) in , to increase the healthy quality standard of .. STANDAR PELAYANAN MEDIS DAN FORMULARIUM JAMKESMAS PADA. Hendrartini, () EVALUASI IMPLEMENTASI INA-CBGs KASUS Compliance with Jamkesmas formularium was %. 8/24/ AM Curriculum vitae Nama: Prof. dr. Ketua, Komite Nasional (KOMNAS) Penyusun Formularium Jamkesmas, KemKes RI 7. Ketua Tim.
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Indonesia started the national health insurance system on 1 January In this system, there is only one insurer institution, BPJS Kesehatan, a social security agency established by the government to provide health insurance for Indonesian people. The aim of this review is to describe the application of the INA-CBGs system and its effect on financial performance of the public hospital and helping them in identifying and anticipating problems in implementation of the INA-CBGs system.
From the 15 selection research journals, we found that the implementation of the INA-CBGs system with the prospective payment system can provide a positive impact on the financial performance in public hospital, when the hospital could reduce inefficient cost of treatment.
Furthermore, public hospitals achieve a surplus since they receive a donation from the government for salary expenses and investment-related expenses.
Public hospital management in Indonesia should consider the competence of their accounting and financial managers so they can manage their hospitals properly. Each public hospital management must have a strategy and innovation to improve the quality of service so they can compete with other hospitals and financial performance can be improved in this JKN era.
UHC, or sometimes called universal coverage, is defined by the World Health Organization as ensuring that all people obtain the health services they need of sufficient quality to be effective, without suffering financial hardship when paying for them [ 1 ]. According to the report of the Sustainable Development Solutions Network SDSNbyevery country should be well positioned to ensure universal health coverage for all citizens at every stage of life, with particular emphasis on the provision of comprehensive and affordable primary health services delivered through a well-resourced health system [ 2 ].
While middle-income countries, including Thailand and many in Latin America, have paved the way, countries such as China, India, Indonesia, and Vietnam are quickly gaining steam — politically and technically — to achieve universal health coverage [ 3 ]. The Universal Health Coverage embodies three related objectives, the first is equity in access to health services, the second is good quality of health services and last but least, financial-risk protection.
Universal Coverage is firmly based on the WHO constitution of declaring health as a fundamental human right. Health is a basic right of every individual and all citizens are entitled to health services including the poor. The passing of laws Undang — Undang No.
Indonesia has reformed its national health insurance scheme. The new national health insurance scheme started on January 1st, Based on Undang – Undang No. The government hopes eventually the entire Indonesia citizen can become a participant of social security system. Hospitals will receive payments based on INA CBGs rate which is the average amount spent by the group for a diagnosis.
The amount of the bill for the diagnosis had been organized and endorsed by the Minister of Health Regulation No. The application system adopts a more refined DRGs, which is a type of prospective payment, system of payments to health service facility, either a hospital or a doctor in the amount set before a service is provided without regard to the action jamiesmas or the duration of treatment.
It is expected the hospital should be able to manage costs effectively in every provision of health care to patients. From some research journals that are used as reference, the implementation of the Jamkesma CBGs system with the prospective payment can provide a positive impact on the financial performance at public hospital, when the hospital could reduce the cost of treatment is not effective.
The results showed that it had a positive impact on the financial aspects, namely the income hospitals can already covered all needs and operational expenditure with income derived from the implementation of the INA-CBGs, including from purchasing the drug has begun to be resolved, the food inpatients, maintenance is already entered. Based on some of the issues that use for this systematic review, the aim of this article is to describe the implementation of the INA CBGs system and its effect on ajmkesmas hospitals’ financial performance.
It is expected jamkesms help public hospitals in identifying and rormularium problems in the INA CBGs system implementation. There are two steps of searching strategies in this review. If those hand-searched articles were suitable, they were included for review. Searching process is done within time frame 1 s t January — 16 t h Novemberwith English and Indonesian language restriction. The first restriction is filtered by year, period of —and by choosing jamkessmas journal articles, dissertation or thesis because most of Indonesian researchers are in the form of the latter.
After that articles were screened by title and next 51 articles were screened by abstract. Fifteen 15 articles deemed relevant were then searched for full-text and assessed for its eligibility. Final 9 articles were included for qualitative synthesis.
The selection process could be seen in Figure 1. The goal is for all Indonesia’s population is protected in the insurance system, so that they can meet the basic needs of public health. According to JKN socialization handbook in the national social security system, the National Health Insurance is managed by the principle:. With all participants the obligation to pay contributions, there will be the principle of mutual cooperation where the healthy help the sick, the rich help the poor.
Social Security Agency is not allowed to make a profit. The funds collected from the public is a trust fund, so that the development should be utilized for the benefit of participants. This management principle underlies the whole management of funds derived from contributions of participants and the results of development. This principle ensures that even the participants settle in a new place or a new job, as long as the territory of the Republic of Indonesia will still be able to use their rights as participants JKN.
All people become participants so that they can be protected. Application remains adjusted to the economic capacity of the people and government as well as the feasibility of the implementation of the program. Funds collected from participants’ contributions are funds deposited by administering body to be managed as well for the sake of the interests of the participants. Evaluation of JKN in public hospitals can be seen from the aspect of membership, aspects of health care services and tariffs, several problems are found in this transition period, including the discovery of restriction of services to any type of health insurance, third ward who often have queuing and type of drugs given only contained in the National Formulary only.
However the internal policies set by the hospital management that still refer to the principles of mutual aid of JKN, is a solution that remain underserved patient without causing any damages to the hospital’s financial and avoid up coding and fraud [ 9 ]. There are two methods of payment used for hospital that is retrospective and prospective payment method.
Retrospective payment recompenses healthcare providers based on their actual charges. With a retrospective payment, a provider will treat a patient and submit an itemized bill to an insurance company detailing the services rendered. The primary benefit of retrospective payment is that they may allow patients to receive more attentive because there is no limitation of approved treatment plans for providers, they can adjust their services to meet patients’ needs individually [ 7 ].
On the other hand, prospective payment works by assigning a fixed payment rate to specific treatments. While these rates might change over time because of factors such as inflation, they are not adjusted to accommodate patients individually. Under prospective payment, a healthcare provider will always receive the same payment for providing the same specific type of treatment. The previous researches obtained that Prospective Payment System intends to motivate providers to deliver patient’s health care effectively and efficiently.
This approach assumes that the degree of care required case intensity is a function of the patient’s diagnosis and the payment to the provider should be based on the intensity of care [ 8 ]. As it was shown in article —Does prospective payment increase hospital in efficiency? Evidence from the Swiss hospital, the effectiveness of prospective payment in reducing hospital cost inefficiency are found, particularly with payment per patient case.
Prospective payment is more effective in terms of cost reduction than the retrospective alternative [ 7 ]. One of the prospective payment approach is the case-mix group system. A case mix group CMG is used for inpatient classification system to group patients with similar characteristics together. This provides a basis for describing the types of patients or other health care provider treatments its case mix.
The development of case-mix system is diagnosis-related group system. Thomson from Yale School of Public Health. The system is used to help a hospital manager controlling the physician’s behaviour. A Diagnosis-Related Group DRG is a statistical system of classifying any inpatient stay into groups for payment purpose.
formularium – [XLS Document]
The DRG classification system divides formulatium diagnoses into more than 20 major body systems and subdivides them into almost groups for the purpose of Medicare reimbursement. Although DRG-based payment systems are now mainly understood as fodmularium reimbursement mechanism, the original purpose was to enable performance comparisons across hospitals [ 10 ]. DRG classification system is grouped according to principal diagnosis, type of treatment, age, surgery, and discharge status [ 11 ]. Diagnosis Related Groups DRGs are one of the most striking prospective payment systems around the world in recent years, since implementation of universal health coverage, which booming in the world, uses a system of claims based on DRG systems [ 11 ].
This system allows hospital managers to determine more accurately the type of resources to treat a particular group and to predict the formularikm of the treatment. Similar to the case mix group, fomrularium system is applied as an insurance payment system. In this system, patients are classified based on the groups of diagnosis, then that groups are coded by using a DRG software. Next, the diagnosis codes are translated into the payment that must be compensated by insurers.
In this system, hospitals were paid a 22013 fee for treating patients in a single INA-DRG category, jammesmas of the actual cost of care for the individual. INA-CBGs rate is package rates that include all the components of hospital resources used in the service of both medical and non-medical, the rates will not fomrularium affected by the days of treatment.
The method of determining cost using the INA-CBG’s system implemented by the hospital and the payer government represented by BPJS no longer specify the charges based on the details of the services provided but based on several important data, namely:. Hospital must provide good quality health care to make sure the goals of universal health coverage could be achieved efficiently and effectively.
In order to be able to give good quality services, hospitals need to be financially healthy. Financing capability represent a vital element of competitive advantage [ 12 ].
Evaluasi Ketersediaan Obat Terhadap Formularium
The hospitals’ revenue is collected from services given to their patients. To jamkemsas their patients, hospitals spent money for materials, human resources and equipment. In order to be able to survive and make some development, hospitals need to cover all costs they spend. Some surplus is also expected to improve the services. A Surplus is the differences between revenues and costs in a same accounting period.
A surplus is one way to figure out a hospital financial performance [ 8 ]. Public hospital is an institution under the supervision of local governments engaged in the public sector by giving health services.
Health services provided by hospitals common areas are social and economic with more priority health care for the community. Public hospital as one government agency should be able to provide accountable both financially and non-financially local government and the community as service users. In this type of organization, public hospitals can be managed as a business organization with flexibility in financial management based on productivity and effectiveness [ 8 ].
The key points of accrual accounting include the following:. Cash flow is a separate issue for consideration. Most of journals that are used as references say that there is a significant difference of INA-CBGs rates in each hospital. In both outpatient cases and inpatient cases, the claims under the JKN are higher than under the hospitals’ rate. Sardjito Yogyakartashows that the average value of hospital charges for treatment patients with the severity level I are much lower compared with rates of INA package CBG’s.
Because of diversity of comorbid types experienced by patients with diabetes mellitus, the cost of needed drugs tend to give greater impact on total costs of treatment. One way to overcome the difference in costs is making a clinical-pathway which contain detailed essential steps to handle the patients, it consists of protocol therapy and the standard care ranging from admission to hospital discharge [ 13 ].
This new payment system can increase hospital efficiency so it will improve the financial performance as written in —Does prospective payment increase hospital in efficiency? Evidence from the Swiss hospital sector journal.