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"Sistem pembayaran prospektif dengan paket tarif INACBG untuk kasus dengan jaminan BPJS menuntut rumah sakit agar dapat melakukan kendali biaya. Penelitian ini bertujuan untuk menilai upaya cost containment RSUD Kota Bogor melalui penerapan Clinical Pathway, formularium, dan struktur insentif. Studi dilakukan pada kasus Sectio Caesarea periode Januari-Maret 2016 secara kuantitatif, dengan membandingkan selisih klaim BPJS dan tagihan RS serta menilai penerapan Clinical Pathway (n=133), dan secara kualitatif dengan wawancara mendalam (10 informan). Selisih kurang yang didapat sebesar Rp.1.014.125.684,00 dengan rata-rata selisih kurang sebesar Rp.4.899.157,89 per kasus. Didapatkan 84% kasus memiliki length of stay sesuai Clinical Pathway. Dari kasus tersebut, 96% visitasi dokter sesuai, 21% penggunaan obat dan BHP sesuai, dan 48% pemeriksaan laboratorium sesuai. Formularium yang digunakan sesuai dengan formularium nasional. RSUD Kota Bogor belum memiliki sistem evaluasi untuk menilai penerapan clinical pathway dan penggunaan obat. Struktur insentif yang digunakan adalah sistem fee-for-service yang tidak sesuai dengan metode pembayaran prospektif.

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Prospective payment system with INACBG tariff for cases using BPJS Insurance demands hospital to control their cost. This study aims to see the cost containment in Kota Bogor Regional Hospital through the implementation of Clinical pathway, drug formulary, and incentive structure. The study looked into Sectio Caesarea cases from January to March 2016, using quantitative method, comparing BPJS claim and hospital billing and the implementation of clinical pathway (n=133), and using qualitative method through in depth interview (10 informants). It is noticed the deficit amount Rp.1.014.125.684,00 and the average of deficit per case is Rp.4.899.157,89. Eighty four percent of cases have length of stay in accordance with clinical pathway. From those cases, 96% has concordant doctors visit, 21% has concordant drug usage, and 48% has concordant laboratory diagnostic test. The hospital formulary uses the national formulary. It is found that Kota Bogor Regional Hospital does not have an evaluation system for clinical pathway implementation and drug usage. The incentive structure that is used is fee-forservice system which is not suitable for prospective payment method."

"Di era JKN ini, rumah sakit dituntut harus efisien dalam mengendalikan biayalayanan agar tidak melebihi tarif INA CBGs dengan catatan mutu layanan harustetap terjaga dengan baik. Penelitian deskriptif kuantitatif ini bertujuanmenganalisis biaya berdasarkan tarif rumah sakit dan klaim INA CBGs padapasien peserta BPJS kasus sectio caesarea di RSUD dr. Doris Sylvanus padaJanuari sampai Agustus Tahun 2016. Berdasarkan hasil penelitian diketahui biaya yang tidak dibayar sesuai tarifrumah sakit sebesar Rp 1.708.663.354 42 . Biaya pelayanan persalinan sesarringan sesuai tarif rumah sakit pada kelas 1 sebesar Rp 10.267.710,-, kelas 2sebesar Rp 9.441.399,- dan kelas 3 sebesar Rp 8.591.730,-. Komponen biayatertinggi adalah biaya tindakan operasi. Sehingga perlu dilakukan kajian ulangtarif pelayanan Sectio caesarea.

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In this National Health Insurance period, hospital ospitals are required to beefficient in controlling the cost of services so as not to exceed the tariff of INACBGs with the quality record of the service must be maintained properly. Thisquantitative descriptive study aims to analyze the cost of Sectio caesarea of BPJSparticipants based on hospital rates and INA CBGs rates in dr. Doris Sylvanusregional public hospital on January until August 2016.

The result revealed that the unpaid cost according to hospital rates is Rp1.708.663.354 42 . The cost of light cesarean delivery service according tohospital rates in grade 1 is Rp 10,267,710, , 2nd grade is Rp 9,441,399, and grade3rd is Rp 8,591,730, . The highest cost component is the cost of surgery. So it isnecessary to review the hospital rates of cesarean delivery service."

"Pendahuluan: Persalinan Sectio Caesarea SC adalah prosedur pembedahan dimana janin dilahirkan melalui sayatan di perut dan Rahim ibu. Persalinan SC di dunia terus mengalami peningkatan prevalensi. Organisasi kesehatan dunia WHO menetapkan standar rata-rata SC di sebuah Negara adalah sekitar 5-15% per 1000 kelahiran di dunia. Saat ini 25% dari semua kelahiran di Inggris melalui metode SC, lebih dari 30% di Australia dan Amerika, serta lebih dari 50% di Brazil dan China. Berdasarkan data Survei Demografi Kesehatan Indonesia SDKI 2017, sebanyak 17% persalinan melalui SC. Berdasakan laporan Badan Penyelenggara Jaminan Sosial BPJS Kesehatan tahun 2017 sepuluh kode case base groups CBG terbanyak pada tingkat layanan rawat inap tindak lanjut/ RITL kasus terbanyak adalah SC ringan menempati urutan pertama. Penelitian ini dilakukan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian SC pada peserta Jaminan Kesehatan Nasional JKN di RSUD dr. Slamet Kabupaten Garut selama tahun 2018. Metode: Penelitian ini menggunakan pendekatan kuantitatif dengan menggunakan desain studi cross sectional. Analisis penelitian menggunakan anlisis univariat, analisis bivariat dengan Chi-Square, dan analisis multivariat dengan metode regresi logistik model determinan. Hasil: Kejadian SC di RSUD dr. Slamet Kabupaten Garut masih tinggi sebanyak 72,8% dibandingkan dengan persalinan pervaginam sebanyak 27,2%. rentang usia ibu bersalin secara SC sebanyak 70,9% diantara 20-35 tahun, dengan paritas 2-3, pada kelas 2 BPJS. pada usia dan paritas tersebut merupakan usia normal dan paritas aman, tidak termasuk kedalam kategori ibu hamil risiko tinggi. Kesimpulan: Semua variabel, baik vaiabel karakteristik sosiodemografi usia, kelas JKN, naik kelas rawat, medik obstetri paritas, serta indikasi medik faktor ibu, bayi, penyakit penyerta mempunyai dampak yang signifikan terhadap jenis persalinan. Faktor yang yang paling mempengaruhi terhadap jenis persalinan paling besar adalah faktor paritas. Hasil R squared semua variabel independen dapat menjelaskan variabel dependen sebesar 60%, sisanya dijelaskan oleh variabel lain diluar model.

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Background: Sectio Caesarea SC is a surgical procedure to deliver babies through incision in mother's abdomen and uterus. The prevalence of SC continues increasing. The World Health Organization WHO recommended the standard for SC in a country to be around 5-15% per 1000 births in the world. At present the delivery using SC in the UK, Australia and America, Brazil ans China are 25%, more than 30%, more than 50% of all births respectively. Based on data from the 2017 Indonesian Health Demographic Survey SDKI, there were 17% of deliveries through SC. Based on the 2017 Health Insurance Agency BPJS report, the ten highest cases base groups CBG codes at the follow-up inpatient service level are SC surgery. This study was conducted to determine the factors influencing the incidence of SC among JKN participants in the RSUD dr. Slamet Garut Regency during 2018.

Method: This study uses a quantitative methodology used a cross sectional study design. The data analysis used univariate analysis, bivariate analysis with Chi-Square, and multivariate analysis using the determinant logistic regression method.

Result: the incidence of SC in RSUD dr. Slamet Garut regency was still high as 72.8% compared to vaginal delivery as much as 27.2%. As many as 70.9% of mothers give birth between of 20-35 years, with 2-3 parity in 2 class BPJS which were a normal age and parity for pregnancy or not included in high risk.

Conclusion: All variables, both sociodemographic characteristics age, JKN class, JKN grade increase, obstetric medical parity, and medical indications maternal, infant, comorbidities have a significant impact on the type of labor. The most influential factor for the largest type of labor is the parity factor. R squared results that independent variables can explain the dependent variable by 60%, and the rest is explained by other variables outside the model."

"Di tahun 2021 COVID-19 masih menjadi wabah pandemik di seluruh dunia, yang menimbulkan disrupsi ekonomi di berbagai industri termasuk rumah sakit. Angka kunjungan rawat jalan dan rawat inap rumah sakit menurun di tahun 2020 sebanyak 80% yang berdampak pada penurunan pendapatan bulanan rumah sakit sampai ke 40% (Persi, 2021). Dalam menjaga layanan yang komprehensif dan bermutu, ada tambahan biaya operasional yang meningkat termasuk untuk perlindungan staf berupa Alat Perlindungan Diri (APD) terutama bagi tenaga kesehatan. Sebagai salah satu Rumah Sakit rujukan COVID-19, RS Bunda Palembang mengalami penurunan pasien rawat inap sebesar 55,2% di tahun 2020 dibanding tahun sebelumnya. Pelayanan unggulan yang diberikan adalah layanan persalinan ibu bagi peserta Jaminan Kesehatan Nasional (JKN), termasuk layanan Sectio Caesarean (SC). Walau telah disadari terdapat kesenjangan antara tarif RS dan tarif INA-CBGs sebelum COVID-19, tim manajemen internal RS belum mempunyai analisis biaya persalinan SC. Beban operasional yang semakin bertambah di era COVID-19, memaksa tim manajemen mempunyai informasi biaya satuan SC ringan. Menggunakan data biaya aktual tahun 2021, biaya satuan tindakan SC ringan tanpa komplikasi dihitung dengan metode Double Distribution dan Relative Value Unit. Hasilnya menunjukkan bahwa biaya satuan SC ringan di ruangan SVIP sebesar Rp 11.877.883, ruangan VIP sebesar Rp7.782.915, ruangan Kelas I sebesar Rp 6.388.681, Kelas II yaitu Rp 6.009.725, dan Kelas III sebesar Rp 5.753.963. Secara keseluruhan, tingkat pengembalian biaya (CRR) terhitung sebesar 124,2%, dimana dari perspektif keuangan angka ini dianggap cukup ideal oleh manajemen. Pembelajaran yang dapat dipetik dalam menghadapi masa pandemi ke depan yaitu rumah sakit sebaiknya bersiap dalam menghadapi berbagai disrupsi kesehatan ke depannya dengan memfasilitasi tindakan ANC dan SC untuk seluruh pasien termasuk pasien infeksius.

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In 2021, COVID-19 is still a worldwide pandemic, causing economic disruption in various industries, including hospitals. The number of outpatient visits and hospitalization decreased in 2020 by 80%, which resulted in a decrease in hospital monthly income of up to 40% (Persi, 2021). In maintaining comprehensive and quality services, additional operational costs increase, including staff protection in the form of Personal Protection Equipment (PPE), especially for health workers. As one of the COVID-19 referral hospitals, Bunda Palembang Hospital experienced a decrease in hospitalizations of 55.2% in 2020 compared to the previous year. The superior service provided is maternal delivery services for National Health Insurance (JKN) participants, including Caesarean Section (C-Section) services. Even though it was realized that there was a gap between the hospital rates and the INA-CBGs rates before COVID-19, the hospital's internal management team still needed an analysis of the cost of delivering a C-Section. Operational expenses are increasing in the era of COVID-19, forcing the management team to have information on low C-Section unit costs. Using actual cost data for 2021, the unit cost for mild C-Section without complications is calculated using the Double Distribution and Relative Value Unit method. The results show that the unit cost of light C-Section in the SVIP room is IDR 11,877,883, the VIP room is IDR 7,782,915, the Class I room is IDR 6,388,681, Class II is IDR 6,009,725, and Class III is IDR 5,753,963. Overall, the cost recovery rate (CRR) is calculated at 124.2%, which management considers ideal from a financial perspective. The lesson that can be learned in dealing with future pandemics is that hospitals should be prepared to face various health disruptions by facilitating ANC and C-Section actions for all patients, including infectious patients."

"Penelitian ini bertujuan untuk mengetahui efisiensi tindakan bedah caesar di RS X dan RS Y tahun 2016. Penelitian ini menggunakan desain cross sectional dengan pendekatan kuantitatif. Efisiensi tindakan bedah caesar diukur dengan menggunakan software clinical pathway untuk mengetahui kepatuhan pelayanan dan metode Activity Based Costing (ABC) untuk mengetahui efisiensi biaya. Penelitian dilakukan di RS X dan RS Y dengan masing-masing jumlah sampel sebesar 47 kasus tindakan bedah caesar. Hasil perhitungan kepatuhan pelayanan didapatkan RS Y lebih patuh dari RS X. Hal ini terlihat dari kesesuaian output software clinical pathway dengan clinical pathway RS Y dan KMKRI nomor 1051/MENKES/XI/2008 tentang pelayanan obstetri terkait lama hari rawat, layanan konsultasi dokter, layanan laboratorium, layanan tindakan bedah caesar dan layanan obat-obatan RS Y.Hasil perhitungan efisiensi biaya didapatkan RS X lebih efisien daripada RS Y. Hal ini terlihat dari selisih biaya satuan aktual dan biaya satuan normatif di RS X sebesar Rp.1.514.638 dan selisih biaya satuan aktual dan biaya satuan normatif di RS Y sebesar Rp.2.905.715. ketidakpatuhan pelayanan RS X disebabkan belum adanya clinical pathway yang mengatur secara teknis lama hari rawat tindakan bedah caesar yang dilakukan selama masa perawatan pasien sedangkan ketidakefisienan RS Y terkait efisiensi biaya disebabkan pemakaian utilites (listrik, air dan telepon) yang cukup besar di ruang bedah (OK).

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This study aims to understand sectio caesarea efficiency in a hospital X and hospital Y Year 2016 . This study used a cross-sectional design with quantitative approach. Sectio Caesarea efficiency measured by used software clinical pathway to know compliance services and Activity Based Costing (ABC) methods to know of cost efficiency. The research was done in a hospital X and hospital Y with each the sample of the of 47 cases the patient the act of sectio caesar. Result of compliance services or hospital Y more obedient of hospital X. This can be seen from conformity output software clinical pathway with clinical pathway hospital Y and KMKRI number 1051/MENKES/XI/2008 provider obstetrics related long day for, consultation doctor, laboratory services, services of sectio caesar and services drugs hospital Y.

Result of cost efficiency calculation obtained RS X more efficient than RS Y this seen from difference of actual unit cost and normative unit cost in RS X equal to Rp.1.514.638 and difference of actual unit cost and normative unit cost in RS Y equal to Rp.2.905. 715. The inefficiency of RS Y caused considerable utilites (electricity, water and telephone) in the operating room (OK)."

"Program Jaminan Kesehatan Nasional menerapkan sistem pembayaran prospektif yaitu dengan tarif INA CBG?s untuk pelayanan di rumah sakit. Tujuan penelitian ini yaitu untuk menganalisis selisih biaya layanan dengan tarif INA CBG?s dan tarif rumah sakit khusus kasus sectio caesaria dengan kode ICD X (O.342) pada pasien BPJS berdasarkan komponen biaya serta mengetahui gambaran perbedaan biaya layanan tersebut berdasarkan karakteristik pasien. Jenis penelitian ini adalah deskriptif kuantitatif dengan metode cross sectional dengan sampel sebanyak 89 pasien. Dari hasil penelitian didapat rata-rata selisih biaya layanan untuk kasus sectio caesaria dengan diagnosa utama O.342 terhadap tarif rumah sakit adalah selisih negatif (efisien) sebesar Rp 1,236,793,- dengan CRR (cost recovery rate) 120% dan terhadap tarif INA CBG?s adalah selisih positif (tidak efisien) sebesar Rp 1,974,050,- dengan CRR (cost recovery rate) 68% Gambaran perbedaan biaya layanan berdasarkan karakteristik pasien yang memiliki hubungan dengan besarnya biaya layanan adalah kelas rawat (p=0,000), diagnosis sekunder (p=0,050) dan lama hari rawat (p=0,046), sedangkan yang tidak memiliki hubungan dengan besarnya biaya layanan adalah umur pasien (p=0,956).

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The National Health Insurance Scheme implementing prospective payment system INA CBG's rates for hospital services. The purpose of this study is to analyze the difference in cost services with INA CBG's rates and hospitals rates specialty in patients BPJS with sectio caesaria cases with ICD X (O.342) based component costs and reveal the differences in cost of these services is based on the characteristics of the patient. This type of research is quantitative descriptive cross sectional method with a sample of 89 patients. The result is the average difference between the cost of services for Caesaria sectio cases with primary diagnosis O.342 against hospital rates are negative difference (efficient) to Rp 1,236,793, - with the CRR (cost recovery rate) of 120% and against the CBG's INA rates are positive difference (inefficient) to Rp 1,974,050, - with the CRR (cost recovery rate) of 68% service charge difference picture based on the characteristics of patients who have a relationship with the cost of the service is ambulatory class (p = 0.000), a secondary diagnosis (p = 0.050) and the length of stay (p = 0.046), whereas no relation to the cost of the service is the age of the patients (p = 0.956)."

"ABSTRAKDalam rangka universal health coverage, Indonesia mempersiapkan pelaksanaan BPJS-SJSNyang akan dimulai bulan Januari tahun 2014. Perbedaan tarif BPJS dan rumah sakit menjadimasalah mendasar. RSIA swasta Hermina Bogor mempersiapkan diri mengantisipasipelaksanaan BPJS dengan tujuan agar tetap survive.Melalui desain kuantitatif dilakukan analisis tagihan tindakan Sectio Caesaria (SC) pasienkelas III, dengan komponen tagihan : jasa medis, penunjang medis, alat medis, kamarperawatan, biaya lain - lain dan administrasi. Wawancara mendalam dilakukan kepadamanajemen rumah sakit.Rata ? rata tagihan SC pasien kelas III = Rp.11,13 juta. Uji multivariat membuktikan bahwajenis tindakan paling mempengaruhi variasi tagihan. Rumah sakit diharapkan mampumengendalikan biaya penunjang medis, jasa medis dan anjuran pemeriksaan kehamilankepada pasien.

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ABSTRACTIndonesia is on the move to prepare the implementation of Universal Health Coverage to beconducted in 2014. The difference between BPJS tarieff and actual billing of hospitalsbecome a serious problem. Billing components comprised of doctor?s fee, medical support(laboratorium, drugs, blood, Rontgent), room charges, medical equipments rent andadministrative cost. This quantitative and qualitative study of Sectio Caesaria patients, 3rdclass at Hermina MCH private hospital Bogor found that the average billing is Rp 11,1million. Type of surgical action contributed most to the variation of billing.Recommendationsto the hospital are : to control usage of medical support, rental of medical equipments and toencourage ANC to patients. Government to study further on tarieff variations of privatehospitals."

"Angka kejadian asfiksia neonatorum masih menjadi masalah serius di Indonesia. Salah satu penyebab tingginya kematian bayi di Indonesia adalah asfiksia neonatorum yaitu sebesar 33,6%. Salah satu faktor persalinan yang berhubungan dengan kejadian asfiksia neonatorum adalah persalinan dengan sectio caesarea. Tujuan penelitian ini adalah mengetahui hubungan persalinan tindakan dengan sectio caesarea dengan kejadian asfiksia neonatorum setelah di kontrol variabel kovariat. Penelitian ini menggunakan rancangan desain kasus control dengan menggunakan data sekunder dari rekam medis ibu bersalin di RSIA Budi Kemuliaan, Jakarta pada tahun 2013. Sampel penelitian ini adalah neonatus asfiksia. Analisis menggunakan regresi logistic. Hasil penelitian menunjukkan 66,2% bayi asfiksia dilahirkan dengan persalinan sectio caesarea. Selain didapatkan bahwa hubungan persalinan tindakan sectio caesarea dan kejadian asfiksia secara statistik mempunyai hubungan yang bermakna dengan p-value 0,042 dimana ibu yang melahirkan dengan persalinan tindakan sectio caesarea memiliki resiko 2 kali (95% CI 1,03-4,32) untuk terjadi asfiksia pada bayi yang dilahirkan dibanding ibu yang melahirkan dengan persalinan pervaginam (normal) setelah dikontrol dengan variabel kelainan letak, gawat janin, dan preeklamsi.

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The incidence of neonatal asphyxia remains a serious problem in Indonesia. One of the causes of the high infant mortality in Indonesia is asphyxia neonatorum is equal to 33.6%. One of the factors associated with the incidence of birth asphyxia neonatorum is the Sectio Caesarea delivery. The purpose of this study was to determine the relationship of labor action by sectio Caesarea with the incidence of neonatal asphyxia after covariate control variables. This study used a case control design design using secondary data from maternal medical records in RSIA Budi Kemuliaan, Jakarta in 2013 samples of this study was neonatal asphyxia. Analysis using logistic regression.

The results showed 66.2% of babies born with birth asphyxia sectio Caesarea. In addition it was found that labor relations act sectio Caesarea and asphyxia events have statistically significant association with a p-value of 0.042 where the mother who gave birth to the labor action sectio Caesarea has 2 times the risk (95% CI 1.03 to 4.32) for the case of asphyxia in infants born to mothers who gave birth compared with vaginal delivery (normal) after controlled with variable layout abnormalities, fetal distress, and preeclampsia."

"[ABSTRAKPenelitian ini dilatarbelakangi kenyataan bahwa Kamar bersalin merupakan suatu unit gawat darurat khusus kebidanan yang dituntut untuk memberikan pelayanan yang cepat dan tepat untuk keselamatan ibu dan bayinya.Tujuan penelitian ini untuk mengetahui gambaran umum waktu tunggu persiapan operasi cito sectio caesarea di Kamar bersalin RSU Kota Tangerang Selatan dan faktor-faktor yang berhubungan dengan waktu pelayanan terhadap pasien yang akan menjalani cito sectio caesarea.Jenis penelitian ini merupakan studi kasus dengan pendekatan kualitatif dan Kuantitatif. Data dan informasi mengenai proses pelayanan diperoleh melalui wawancara mendalam, observasi partisipatif dan telaah dokumen. Sedangkan data mengenai waktu pelayanan diperoleh melalui pencatatan waktu pelayanan mulai dari tahap penetapan operasi sampai saat dilakukan sayatan pertama di meja operasi.Hasil penelitian menunjukan bahwa waktu tunggu persiapan operasi cito Sectio Caesarea berhubungan dengan faktor kesiapan SDM kamar operasi termasuk dokter operator dan dokter anestesi, dan faktor unit penunjang laboratorium.Untuk mempersingkat waktu pelayanan terhadap pasien yang akan menjalani operasi cito sectio caesarea, RSU Kota Tangerang Selatan perlu menetapkan kebijakan tentang penanganan pasien operasi cito sectio caesarea, menambah kamar operasi untuk operasi cito, memperbaiki manajemen SDM Kamar operasi dan menambah alat pemeriksaan laboratorium cito.

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ABSTRACTThe background of the research was the fact that Delivery Room unit is a part of emergency care unit especially obstetric which has to able to respond quickly and effectively for safety of mother and baby.The purpose of this research was to know the general picture about the waiting time of cito operations sectio caesarea in the delivery room at South Tangerang Hospital and the factors associated with the time of service to patient who will undergo cito operation sectio caesarea.This type of research was a case study with a qualitative and quantitative approach. Data and information regarding the service process were obtained from in depth interviews, participant observation and the document review, while data regarding the service time was gained from recording and calculating the time taken starting from the moment of surgery decision until the moment of the first incision on the operating table.The result from the research showed that waiting time for the cito operation sectio caesarea associated with human resources in the operating room including surgeon and anaesthetist, and laboratory test.The minimize the waiting time for cito operation sectio caesarea at South Tangerang Hospital need to establish polices regarding the handling of patients cito operation sectio caesarea, building the cito operating room, to improve human resource management and procurement of laboratory equipment., The background of the research was the fact that Delivery Room unit is a part of emergency care unit especially obstetric which has to able to respond quickly and effectively for safety of mother and baby.The purpose of this research was to know the general picture about the waiting time of cito operations sectio caesarea in the delivery room at South Tangerang Hospital and the factors associated with the time of service to patient who will undergo cito operation sectio caesarea.This type of research was a case study with a qualitative and quantitative approach. Data and information regarding the service process were obtained from in depth interviews, participant observation and the document review, while data regarding the service time was gained from recording and calculating the time taken starting from the moment of surgery decision until the moment of the first incision on the operating table.The result from the research showed that waiting time for the cito operation sectio caesarea associated with human resources in the operating room including surgeon and anaesthetist, and laboratory test.The minimize the waiting time for cito operation sectio caesarea at South Tangerang Hospital need to establish polices regarding the handling of patients cito operation sectio caesarea, building the cito operating room, to improve human resource management and procurement of laboratory equipment.]"

"Dilaksanakannya program Jaminan Kesehatan Nasional, diharapkan memberikepastian jaminan kesehatan menyeluruh bagi semua lapisan masyarakat. Sistemklaim pelayanan kesehatan di Rumah Sakit era JKN, dilakukan dengan tarif INACBGs.Namun terdapat keluhan adanya ketimpangan biaya tindakan dengan tarifINA-CBGs terutama pada tindakan bedah kelas III. Penelitian ini bertujuanmenganalisis selisih biaya aktual pelayanan dengan tarif INA-CBGS pada tindakanSectio Caesarea pasien JKN kelas III di Rumah Sakit Wisma Prashanti. Diambilsampel dari periode bulan Januari - Oktober 2017 sebanyak 27 pasien dengan kriteriainklusi pasien JKN kelas III dengan diagnosa utama maternal care due to uterinescar from previous surgery, untuk mengetahui perbandingan pemanfaatan layananaktual dengan Clinical Pathway Sectio Caesarea. Perhitungan biaya aktual dilakukandengan menggunakan metode double distribution berdasarkan data dari bagiankeuangan dan laporan rumah sakit. Hasil penelitian mendapatkan bahwa biaya aktualpelayanan tindakan SC pada pasien kelas III yakni Rp. 5.658.016,75 dengan tarifINA CBGs yang dibayarkan adalah Rp.5.019.900,00, sehingga terdapat selisihnegatif sebesar Rp. 638.116,75. Komponen biaya yang dinilai dapat dikontrol adalahkomponen biaya operasional seperti biaya listrik, air, telepon, serta bahan medishabis pakai. Meskipun demikian, belum patuhnya staf terhadap Clinical Pathway CP juga berpotensi menyebabkan variasi komponen pelayanan, yang berdampakterhadap kenaikan biaya pelayanan. Pembentukan Tim Kendali Mutu dan KendaliBiaya dan Tim Anti Fraud diperlukan agar dapat secara rutin berkoordinasi denganmanajemen sehingga diketahui lebih dini penyimpangan yang ada untuk mencegahkemungkinan kerugian rumah sakit lebih banyak. Koordinasi antara manajemendengan dokter spesialis terkait Clinical Pathway juga perlu diintensifkan agarClinical Pathway menjadi kesepakatan bersama, serta adanya sosialisasi danpengawasan pelaksanaannya. Selain itu upaya efisiensi juga dapat dilakukan melaluibriedging Sistem Informasi Manajemen RS SIMRS dengan sistem INA-CBGS, danpelaksanaan analisis unit cost setiap tahunnya untuk mengetahui tingkat efisiensi danpencapaian kinerja unit.

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The implementation of the National Health Insurance JKN program, is expectedto provide health coverage for all levels of society. The claim system of health services at the Hospital, conducted by INA CBGs tariff. However, there arecomplaints of cost difference between actual cost with INA CBGs tariff especiallyfor surgical treatment on the patients of class III. This study aims to analyze thecost differences between the actual cost of Sectio Caesarea services and INACBGStariffs on patients JKN class III at Wisma Prashanti Hospital. 27 sampleswere taken from the period time of January October 2017 with the inclusioncriteria are patients of JKN class III with a primary diagnosis of maternal caredue to uterine scar from previous surgery, to determine the actual serviceutilization compare with Clinical Pathway of Sectio Caesarea. Actual costcalculation is done by using double distribution method based on data fromfinancial section and hospital report.

The results of the study found that the actualcost of SC services in patients class III is Rp. 5,658,016.75 with INA CBGs tariffpaid is Rp.5.019.900,00, so there is a negative difference of Rp. 638.116,75. Costcomponents that are assessed to be controlled are the components of operationalcosts such as electricity, water, telephone, and medical consumables. However,the lack of compliance of staff to CP also has the potential to cause variations inservice components, which have an impact on the increase in service costs. It isrecommended to establish a Quality and Cost Control Team and an Anti FraudTeam that can routinely coordinate with the management so that we have knownthe irregularities earlier to prevent hospital losses. There should be acoordination between management and specialist doctors related to ClinicalPathway as a mutual agreement, as well as the socialization and supervision of itsimplementation. In addition, efficiency efforts can also be done through briedgingthe hospital management information system with INA CBGS system, andimplementation of unit cost analysis every year to know the level of efficiency andachievement of unit performance."