e-ISSN 2598-3849       print ISSN 2527-8878

Vol 5, No 2 (2020)

Sistem Pembayaran Mixed Method INA-CBGs dan Global Budget di Rumah Sakit: Tahap 1 Uji Coba Mixed Method INA-CBGs-Global Budget di Indonesia

Fachmi Idris, Atik Nurwahyuni, Mundiharno Mundiharno, Benjamin Saut, Citra Jaya, Wan Aisyiah Baros, Ayunda Oktavia, Dedy Revelino, Erzan Dhanalvin, Rasinta Ria Ginting

Abstract


Abstrak

Tidak ada sistem pembayaran pelayanan kesehatan yang sempurna dalam penerapannya termasuk sistem pembayaran DRG (Diagnosis-Related Groups) yang lebih dikenal dengan nama INA-CBGs (Indonesia Case-Based Groups) di Indonesia. Beberapa negara yang mengadopsi DRG telah menerapkan kebijakan pembayaran mixed method DRG-Global Budget dengan variasi implementasinya demi menjaga kesinambungan sistem jaminan kesehatan nasional di negaranya. BPJS Kesehatan menginisiasi studi operasional penerapan sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget mulai tahun 2018. Terdapat tiga tahapan dalam uji coba sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget ini. Tahap pertama adalah Global Budget Tanpa Resiko yang bertujuan untuk menguji metode penghitungan global budget dan mengidentifikasi tantangan yang dihadapi bila kebijakan mixed method INA-CBGs dan Global Budget ini diberlakukan. Studi dilakukan di 5 (lima) kabupaten/kota di 30 rumah sakit (RS). Hasil studi menunjukkan bahwa metodologi penghitungan global budget yang diterapkan cukup akurat untuk memprediksi realisasi klaim di RS. Penghitungan global budget di tingkat kabupaten/kota lebih akurat hasilnya dibandingkan dengan menghitung global budget di tingkat RS karena mengakomodir shifting pasien dari RS yang satu ke RS yang lainnya akibat perubahan kapasitas RS. Perubahan kapasitas RS di tahun berjalan dan adanya pandemi COVID-19 menyebabkan adanya selisih antara penghitungan global budget dan realisasi klaim.

Abstract

When it comes to provider payment system, no one shoe fits all including DRG payment system which in Indonesia are known as INA-CBGs. In some countries that used DRG have mixed it with Global Budget in various mechanisms to maintain the sustainability of the national health insurance system in their countries. BPJS Kesehatan initiated a three-stage pilot study on the implementation of the mixed-method hospital payment system INA-CBGs and Global Budget starting in 2018. The first stage is the Non-Risk stage which aims to test the accuracy of the global budget calculation and prediction and to identify the challenges faced when the mixed-method payment is implemented. The pilot was conducted in 5 districts in 30 hospitals. Initial results show that the calculation and prediction method is accurate to predict the actual hospital claims in the following year. The calculation of the global budget at the district level is more accurate than the hospital level because it accommodates patient transfer from one hospital to another due to changes in hospital capacity. Changes in hospital capacity in the current year and the COVID-19 pandemic requires some adjustments to the budget calculation.


Keywords


Sistem Pembayaran, INA-CBGs, Global Budget

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Full Text: PDF

DOI: 10.7454/eki.v5i2.4819

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