Hospital Baserate Klaim Persalinan JKN-KIS Rumah Sakit

Abstract

Abstrak

Total klaim kasus persalinan JKN-KIS tahun 2019 sebesar Rp 23,6 triliun, meliputi sectio caesaria sebesar Rp.18,7 triliun dan persalinan vaginal sebesar Rp. 4,8 triliun. Hospital baserate menggambarkan informasi keuntungan atau kerugian rumah sakit dengan pembayaran INA CBGs. Penelitian bertujuan menganalisis hospital baserate klaim persalinan Rumah Sakit Muhammadiyah Aisyiyah (RSMA) Jawa Timur. Studi longitudinal retrospektif klaim persalinan tahun 2017-2020 dilakukan pada 24 rumah sakit. Hasil penelitian menunjukkan hospital baserate persalinan RSMA Jawa Timur lebih tinggi dibandingkan tarif yang berlaku, kecuali RSMA C9 dan RSMA D12, sehingga dipastikan RSMA C9 dan RSMA D12 mendapatkan keuntungan klaim persalinan. Hasil uji korelasi rank Spearman menunjukkan tidak ada hubungan antara klasifikasi rumah sakit dengan lama perawatan persalinan vaginal (p:0.06) dan persalinan sectio caesaria (p:0,825), tidak ada hubungan antara klasifikasi rumah sakit dan lama perawatan terhadap surplus/defisit klaim persalinan vaginal (p:0.243) dan persalinan sectio caesaria (p:0.086). RSMA Jawa Timur belum efesien mengelola kasus persalinan dan harus memonitor hospital baserate secara berkala. Hospital baserate menjadi indikator pengambilan keputusan strategis peningkatan mutu dan efesiensi rumah sakit.

Abstract

The total claims for JKN-KIS deliveries in 2019 was Rp. 23.6 trillion, including sectio caesarea Rp. 18.7 trillion and vaginal delivery Rp. 4.8 trillion. Hospital baserate provides information on profits or losses of hospitals with this payment. This study aims to analyze the hospital baserate of delivery claims at Muhammadiyah Aisyiyah Hospital (RSMA) East Java. Longitudinal retrospective study was conducted 2017-2024 claim in 24 hospitals. The results showed the hospital baserate for deliveries was higher than the tariff, except for RSMA C9 and D12, means they get benefits from claims. The results of the Spearman rank correlation test showed that there was no relationship between hospital classification and the length of care for vaginal delivery (p: 0.06) and cesarean delivery (p: 0.825), between hospital classification and length of stay with surplus/deficit vaginal delivery (p:0.243) and cesarean section (p:0.086). The East Java's RSMA hasn't been efficiently managed JKN-KIS delivery claims and must monitor the hospital baserate regularly.  Hospital baserate is instrument for strategic decision-making to improve quality and efficiency.

Keywords: hospital baserate, JKN-KIS, delivery