Kinerja Rumah Sakit Swasta dengan Pembayaran INA-CBGs di Era Jaminan Kesehatan Nasional: Casemix, Casemix Index, Hospital Base Rate

Abstract

Abstrak Pembayaran ke rumah sakit yang sebelumnya fee for service, pada era JKN diselenggarakan melalui pola DRG atau INA-CBGs. Rumah sakit swasta harus memonitor kinerjanya menggunakan indikator yang lazim digunakan dalam sistem pembayaran DRG yaitu casemix, casemix index dan Hospital base rate. Kajian ini bertujuan untuk menganalisis kinerja rumah sakit swasta meliputi casemix, casemix index dan hospital base rate. Studi cross sectional ini dilakukan dengan sampel 7 RS yang dipilih secara purposif mewakili RS swasta kelas B, C, dan D yang tersebar di 6 provinsi. Casemix dan CMI RS sangat dipengaruhi oleh kapasitas RS sehingga RS kelas B memiliki casemix dan CMI lebih tinggi dari RS kelas C dan D. Terdapat fenomena CMI di RS kelas C lebih kecil dari kelas D yang kemungkinan disebabkan oleh akurasi koding. Kelengkapan dan ketepatan pengkodean diagnosis dan prosedur sangat berdampak pada besaran casemix dan CMI RS. Hampir semua RS memiliki HBR di atas HBR Nasional kecuali RSC3. Dapat dipastikan RSC3 mendapatkan profit dari implementasi INA-CBGs. Rumah sakit sebaiknya memonitor casemix, CMI dan HBR secara berkala. Kementerian Kesehatan diharapkan mempublikasikan cost weight dan HBR Nasional INA-CBGs serta besaran rata-rata casemix dan CMI menurut kelas RS agar dapat digunakan sebagai benchmark oleh RS. Abstract Private hospitals must monitor their performance using indicators commonly used in DRG payment systems: casemix, casemix index and hospital base rate. This study aims to analyze the performance of private hospitals including casemix, casemix index and hospital base rate. This cross sectional study was conducted with a sample of 7 hospitals selected purposively representing private hospital type B, C, and D in 6 provinces. Casemix and CMI RS are strongly influenced by the hospital capacity, which the hospitals class B have higher casemix and CMI than class C and D hospitals. There is a phenomenon, CMI in class C hospitals smaller than class D which is probably caused by coding accuracy. The completeness and accuracy of diagnosis and procedures coding predominating affect the casemix and CMI. Almost all hospitals have HBR which are higher than National HBR except RSC3. It definitely will trigger profit from the implementation of INA-CBGs. Hospitals should monitor casemix, CMI and HBR regularly. The Ministry of Health is expected to publish the Cost Weight and National HBR as well as the average of casemix and CMI according to class of hospital, for a benchmark by hospitals.