Inpatient Readmission Insidence of National Health Insurance Patients at Partner Hospitals of BPJS-Health in Sukabumi 2015

Atmiroseva Atmiroseva; Atik Nurwahyuni

doi:10.7454/ihpa.v2i2.1909

Inpatient Readmission Insidence of National Health Insurance Patients at Partner Hospitals of BPJS-Health in Sukabumi 2015

Atmiroseva Atmiroseva, Atik Nurwahyuni

Abstract

The INA-CBG payment system in the JKN program allegedly increasing the incidence of readmission. This study aims to map the incidence of readmission in JKN participants admitted to thirteen partner hospitals of BPJS-Health in Sukabumi. The research design is a descriptive study with the unit of analysis is patient. The study used secondary data from inpatient claims in thirteen partner hospitals BPJS-Health Sukabumi which has been verified during 2015. The study found that the number of readmission is 8.81% with the most readmission incidence occurs in the equal CMG category and at the least in the equal severity level category. The cost of inpatient readmission services is more expensive 104-113% of the initial care cost. Moreover, about 15-16% cases of severity level readmission is increasing and 12-13% of its severity level is decreased. Less than 3% cases of readmission ended not good because they died, were referred, or had to come home forcibly.

Keywords

Adherence level; Prolanis’ participant; type 2 diabetes; determinants.

Full Text:

PDF

References

CNN Indonesia, 2015, www.cnnindonesia.com/nasional/20150505201700-20-51412/laporan-keuangan-bpjs-kesehatan-wajar-tanpa-pengecualian/; diakses pada 31 Mei 2016.

Donze, Jacques; Aujesky, Drahomir; Williams, Deborah; Schnipper, Jeffrey L. (2013). Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. Dalam https://www.ncbi.nlm.nih.gov/pubmed/23529115, diakses pada 24 April 2017.

Hidayat B, Pujiyanto, Nurwahyuni A, dan Hidayat T. Caveat INA CBG - Readmisi, Bloody Discharge dan uppier Induced Demand : Analisis Data Klaim INA CBG Periode Januari 2014 s.d Juli 2015.

Hines, Anika L.; Barret, Marguerite L.; Jiang, H. Joanna; and Steiner, Claudia A. (2014). Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011. Dalam https://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.jsp, diakses pada 19 April 2017.

Kristensen, Søren Rud; Bech, Mickael; Quentin, Wilm. (2015). A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States. Dalam http://googleweblight.com/?lite_url=http://www.sciencedirect.com/science/article/pii/S0168851014003431&ei=1QhWN59l&lc=id-ID&s=1&m=676&ts=1449719603&sig=ALL1Aj4o2vIj7qvbzETKFqQHDWIpoYM-5w, diakses pada 5 Mei 2017.

Or, Zeynep and Häkkinen, Unto (2011). DRGs and quality: For better or worse? In R. Busse, A. Geissler, W. Quentin, & M. Wiley (Eds.), Diagnosis-Related Groups in Europe : Moving towards transparency, efficiency and quality in hospitals (pp. 115-129). Maidenhead, Berkshire, England: Open University Press.

OSLA (2014). Pushed Out of Hospital, Abandoned at Home: After Twenty Years of Budget Cuts, Ontario’s Health System is Failing Patients. Dalam https://www.osla.on.ca/uploads/Pushed%20Out%20of%20Hospital%20FINAL_February%202014.pdf, diakses pada 25 April 2017.

UnitedHealthcare, (2017). Hospital Readmissions. Dalam https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Hospital_Readmissions.pdf, diakses pada 12 Juli 2017.

DOI: http://dx.doi.org/10.7454/ihpa.v2i2.1909