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Analisis Pemanfaatan Clinical Pathway Sectio Caesaria Di Rumah Sakit Dalam Program Jaminan Kesehatan Nasional Penelitian ini bertujuan menganalisis hubungan antara faktor sosial ekonomi dan klinis ibu melahirkan Sectio Caesaria (SC) di Rumah Sakit (RS) dengan pemanfaatan Clinical Pathway (CP), outcome klinis serta pembayaran klaim. Studi desain Cross Sectional pada unit analisis 1155 data rekam medis ibu melahirkan SC periode 1 Januar-31 Desember 2018 di 3 RS. Hasil penelitian menunjukan pemanfaatan CP peserta Jaminan Kesehatan Nasional (JKN) yaitu sebanyak 939 Ibu melahirkan SC proporsinya sebesar 43.1% masih menunjukkan pemanfaatan yang kurang baik. Pemanfaatan CP terkait penyimpanan dokumen Clinical Pathway ibu melahirkan SC peserta JKN sebanyak 71.8% tidak tersimpan di Rekam Medis, 72.6% tidak lengkap pengisiannya dan 64.6% kondisi klinis Ibu melahirkan SC tidak sesuai dengan PPK RS. RS Pemda memiliki Proporsi tertinggi skor pemanfaatan CP yang kurang baik sebesar 76.8%, kemudian diikuti RSP (36.8%). RSNP menunjukkan proporsi skor pemanfaatan CP baik. Jenis RS (p=0.000), Kelas rawat (p=0.014) dan Rujukan (p=0.008), jenis SC (p=0.005), Usia Ibu (p=0.053), Paritas (p=0.016), Riwayat ANC (p=0.000), Kondisi Panggul p=0.000), kondisi plasenta (p=0.001), penyakit penyerta (p=0.000) dan riwayat SC (p=0.000) menunjukkan berhubungan secara signifikan dengan pemanfaatan CP (p<0.05). Pemanfaatan CP ibu melahirkan SC peserta JKN menunjukan adanya hubungan yang signifikan dengan Outcome klinis (p=0.002). Outcome Klinis ibu melahirkan SC menunjukkan sebesar 67.5% bermasalah antara lain terkait LOS yang tidak sesuai Panduan Praktek Klinis (PPK) RS, Ibu memiliki komplikasi klinis paska SC atau kondisi bayi saat dilahirkan tidak normal. Pemanfaatan CP berhubungan secara signifikan dengan pembayaran klaim (p=0.000). Pembayaran klaim ibu melahirkan SC peserta JKN bermasalah sebesar 39.3% terkait jangka waktu pembayaran klaim dari BPJSK ke pihak RS. Pembayaran klaim yang tidak bermasalah pada pemanfaatan CP yang kurang baik lebih banyak. Monitoring dan evaluasi yang komprehensif pada pemanfaatan CP, outcome klinis dan proses pembayaran klaim sebagai kendali mutu pelayanan ibu melahirkan SC dalam JKN oleh RS, Organisasi Profesi dan Pemerintah. Pemerintah harus membuat payung hukum yang bersifat operasional pada pemanfaatan CP Ibu melahirkan SC di RS dalam program JKN, sehingga kendali mutu dan kendali biaya pelayanan ibu melahirkan SC menjadi efektif dan efisien. Pedoman Nasional Pelayanan Kedokteran perlu segera diterbitkan dan disosialisikan ke Rumah Sakit. Kata kunci: SC, Sosial-ekonomi dan Klinis, Pemanfaatan Clinical Pathway, Outcome Klinis, Klaim Pembayaran

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Analysis of Sectio Caesarea Clinical Pathway Utilization in Hospital Under National Health Insurance This study aims to analyze the relationship between socioeconomic and clinical factors of women giving birth to Sectio Caesaria (SC) in Hospitals (RS) with the utilization of Clinical Pathway (CP), clinical outcomes and claim payment. Cross Sectional design study in the 1155 unit of analysis of medical records of women giving birth to SC for the period January 1 to December 31, 2018 in 3 hospitals. The results showed that the utilization of CP for mothers giving birth to SC (939) participants of the National Health Insurance (JKN) from the 3 research study hospitals, the proportion of 43.1%, still showed poor utilization. Utilization of CP related to document keeping of mother who gave birth SC to JKN participants as much as 71.8% were not kept in the Medical Record, 72.6% were incomplete filling and 64.6% of clinical conditions of mother who gave birth to SC were not in accordance with PPK RS. Regional Government Hospital has the highest proportion of poor CP utilization scores of 76.8%, followed by RSP (36.8%). RSNP shows the proportion of good CP utilization scores. Type of hospital (p = 0.000), nursing class (p = 0.014) and type of referral (p = 0.008), type of SC (p = 0.005), maternal age (p = 0.053), parity (p = 0.016), ANC history (p = 0.000), Pelvic Conditions (p = 0.000), placental conditions (p = 0.001), comorbidities (p = 0,000) and history of SC (p = 0,000) showed significant correlation with CP utilization (p <0.05). Utilization of CP for mothers giving birth to SC JKN participants showed a significant relationship with clinical outcome (p = 0.002). Clinical Outcomes of mothers giving birth to SC showed that 67.5% had problems, among others related to LOS that was not in accordance with the Clinical Practice Guidelines (PPK) of the Hospital. CP utilization was significantly related to claim payment (p = 0,000). Claim Payment of mothers with SC under JKN participants was 39.3% related to the period of payment of claims from BPJSK to the hospital. The utilization of CP which were under score mean seems not having administration problem and paid by JKN earlier and without any problem. Comprehensive monitoring and evaluation of the utilization of CP , clinical outcomes and the process of claim as a quality control service for SC mothers in JKN by hospitals, professional organizations and the government. The government must make an operational legal policy on the utilization of CP for women giving birth to SC in hospitals under the JKN program, so that quality control and cost control of maternal care services for SC become effective and efficient. National Guidelines for Medical Services need to be immediately published and disseminated to hospitals. Keywords: SC, Socio-economic and Clinical, Clinical Pathway Utilization, Clinical Outcome, Payment Claims

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"Indonesia telah mengimplementasikan Universal Health Coverage sejak 1 Januari 2014, ini merupakan suatu prestasi sekaligus tantangan. Maka dari itu, strategi rumah sakit dalam meningkatkan mutu dan mengendalikan biaya adalah dengan membuat clinical Pathway, salah satu perangkat yang digunakan untuk memperbaiki proses pelayanan. Penelitian ini menggunakan pendekatan deskriptif kuantitatif bersifat cross sectional, mengambil data sekunder dari rekam medik dan berkas billing pasien yang dirawat 1 januari ? 31 Desember 2014 di Rumah Sakit Hermina Depok, populasi 1107 pasien dan sampel dipilih berdasarkan variasi terbanyak yaitu pasien dengan riwayat Sectio caesaria sebanyak 265 pasien. Diolah menggunakan software ?Tools Pengembangan Pra Clinical Pathway dan Evaluasi Clinical Pathway? serta pengolahan data univariat. Hasil penelitian menunjukkan bahwa pasien yang memiliki resiko tinggi persalinan operasi 26.4%, lebih rendah daripada pasien yang tidak memiliki resiko persalinan operasi yaitu sebesar 73,6%. Pasien dengan jenis pembayaran pribadi lebih banyak yaitu 53.6% daripada pasien asuransi 45.3% dan JKN BPJS hanya 1.1%. Kamar perawatan kelas II lebih banyak dipilih oleh pasien yaitu 33%, VIP 29%, kelas III 23%, dan paling sedikit adalah kelas I yaitu 15%. ALOS sebesar 3.16 dan 99.6% hari perawatan sudah sesuai. Tidak semua pasien dilakukan visite berturut-turut selama masa perawatan. Terdapat 11 parameter pemeriksaan laboratorium, pemeriksaan paket ibu 94.3% lebih banyak dilakukan dibandingkan dengan pemeriksaan paket persiapan operasi 25.7% dan hematologi rutin 8.7%, terdapat 8 parameter lain yang dilakukan terpisah dari paket dan tidak ada dalam clinical pathway. Pemeriksaan CTG 40% ini lebih banyak dilakukan dibandingkan pemeriksaan USG 0.8%. Penggunaan kelas terapi obat telah sesuai dengan clinical pathway yaitu; ringer laktat, RL/D5, obat-obatan anestetik, analgesik, antibiotik, uterotonika, roborantia, dan lactagogue. Kelas terapi yang tidak terdapat dalam clinical pathway adalah antiemetik. Tindakan operasi Sectio caesaria dan pemasangan infus adalah 100%, pemasangan oksigen 93.2%, sedangkan pemasangan kateter 75%. Kesesuaian utilisasi layanan di hari pertama, seluruh variabel menunjukkan adanya perbedaan dengan rencana perawatan dalam clinical pathway. Hari kedua, masih ada tindakan operasi sebesar 15.5%, konsultasi 5%, pemeriksaan laboratorium 78.5% dan pemeriksaan radiologi 4.2%. Hari ketiga, masih ada tindakan operasi sebesar 1.5%, konsultasi 8%, dan pemeriksaan laboratorium 0.04%. Utilisasi layanan di hari keempat dan kelima, utilisasi sudah sesuai dengan clinical pathway.

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Indonesia has implemented a Universal Health Coverage since January 1, 2014, this is an achievement and a challenge. Therefore, the strategy of hospitals in improving quality and controlling costs is to make a clinical pathway, one of the devices that are used to improve the service process. This research uses descriptive quantitative approach is cross sectional, taking secondary data from medical records and billing files hospitalized patients from January 1 - December 31, 2014 at the Hermina Depok Hospital, a population of 1107 patients and samples selected based on variations of the most is patients with a Sectio Caesaria history as 265 patients. Processed using software 'Tools Pre-Clinical Development and Evaluation of Clinical Pathway' as well as data processing univariate too.

Results showed that patients who are at high risk 26.4% is lower than patients who do not have the risk of delivery operations in the amount of 73.6%. Patients with the type of personal payment is 53.6% more than insured patients of 45.3% and JKN BPJS only 1.1%. Treatment rooms class II preferred by patients is 33%, 29% VIP, 23% Class III, and the least is the Class I is 15%. ALOS at 3,16 and 99.6% of treatment days was appropriate. Not all patients got visited row during treatment. There are 11 parameters of laboratory tests, examination of 94.3% mothers pack a lot more done than the preparation packet inspection operation of 25.7% and 8.7% routine hematology, there are 8 other parameters are done separately from the package and not in clinical pathways. CTG examination is 40% more than an ultrasound examination carried 0.8%.

The use of therapeutic classes of drugs are in compliance with clinical pathways, namely; Ringer's lactate, RL/D5, anesthetic drugs, analgesics, antibiotics, uterotonic, roborantia, and lactagogue. Therapeutic classes that are not included in the clinical pathway is an antiemetic. Surgery and the infusion was 100%, 93.2% oxygen installation, while the catheter 75%. Suitability utilization of services in the first day, all the variables showed a difference in treatment planning in clinical pathways. The second day, there is still a surgery operation 15.5%, 5% consultations, 78.5% laboratory tests and radiological examinations 4.2%. The third day, there is still an operation of 1.5%, 8% consultations, and 12.04% laboratory tests. Utilization of services in the fourth and fifth days, the utilization is in accordance with clinical pathways."

"Nasional di Rumah Sakit (Analisis Data Sekunder Tahun 2017) Angka kejadian sectio caesaria terus meningkat baik di rumah sakit pemerintah maupun di rumah sakit swasta di Indonesia. Peningkatan jumlah persalinan melalui sectio caesaria ini juga dapat terlihat pada peserta JKN, dimana sejak tahun 2014 hingga 2017, operasi pembedahan sesar selalu menduduki peringkat pertama kode CBG terbanyak di rawat inap tingkat lanjutan dan menjadi penyerap biaya manfaat jaminan kesehatan tertinggi. Belum adanya dokumentasi formal berdasarkan evidence based yang memperlihatkan evaluasi implementasi kebijakan penjamina persalinan, khususnya kasus sectio caesaria, pada peserta JKN menjadi penyebab sulitnya para pemangku kebijakan dalam menyusun kebijakan.Metode penelitian yang digunakan dalam penelitian ini adalah metode implementation research dengan pendekatan kuantitatif. Metode implementation research digunakan melalui pengumpulan rekap data klaim sectio caesaria peserta JKN di rumah sakit sepanjang tahun 2017.Hasil analisis menunjukkan bahwa dari 5 variable yang diteliti terdapat 3 variable yang terbukti secara signifikan mempengaruhi rate section caesaria, yaitu: 1) Hak kelas perawatan peserta JKN (p= 0,020 dan t hitung= 2,327), dimana semakin besar persentase peserta dengan hak kelas perawatan I di suatu kabupaten/kota maka semakin tinggi rate sectio caesaria, 2) Jenis kepemilikan rumah sakit (p= 0,035 dan t hitung = -2,119), dimana semakin besar persentase RS pemerintah pada suatu kabupaten kota maka semakin rendah rate sectio caesaria dan 3) Jumlah dokter spesialis kebidanan (p= 0,05 dan t hitung = -1,957), dimana semakin banyak jumlah dokter spesialis di kabupaten kota (rasio dokter spesialis terhadap penduduk semakin kecil), maka semakin tinggi angka rate sectio caesaria. Sedangkan variable jenis kelas rumah sakit (p= 0,912 dan t hitung= 0,111) dan nilai PDRB Per Kapita (p = 0,135 dan t hitung = -1,498) tidak terbukti secara signifikan mempengaruhi rate sectio caesaria. Faktor determinan yang paling dominan terhadap rate sectio caesaria adalah hak kelas perawatan dengan nilai Koef. beta= 3,372.Perlu dilakukan berbagai upaya dalam mengendalikan rate sectio caesaria yang dilakukan baik oleh pemerintah, BPJS Kesehatan maupun manajemen rumah sakit. Manajemen rumah sakit sebagai salah satu aktor yang berperan penting dalam kesuksesan program JKN juga perlu melakukan beberapa upaya dalam rangka mengendalikan angka sectio caesaria, antara lain pembuatan kebijakan dan pedoman pencegahan kecurangan, pengembangan pelayanan kesehatan yang berorientasi kendali mutu kendali biaya, pengembangan budaya pencegahan kecurangan sebagai bagian dari tata kelola organisasi dan klinis.

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The incidence of sectio caesaria continues to increase both in government hospitals and in private hospitals in Indonesia. The increase in the number of deliveries through sectio caesaria can also be seen in JKN participants, where from 2014 to 2017 cesarean section surgery was always ranked first in the most CBG codes hospitalized at the advanced level and absorbed the highest cost of health insurance benefits. The absence of formal evidence-based documentation that shows an evaluation of the implementation of maternity insurance policies, particularly in cases of sectional caesarean section, for JKN participants is the cause of difficulties for policy makers in drafting policies.

The research method used in this study is the method of implementation research with a quantitative approach. The implementation research method is used through collecting recapitulation of claims data on JKN participants in hospitals throughout 2017.

The results of the analysis show that of the 5 variables studied there were 3 variables which proved to significantly affect the caesaria section rate, namely: 1) Right to care for JKN participants (p = 0.020 and t count = 2.327), the greater the percentage of participants with the right of class I care in a district / city, the higher the rate of sectional caesaria, 2) Types of hospital ownership (p = 0.035 and t count = -2.119) , the greater the percentage of government hospitals in a city district, the lower the rate of sectional caesarea and 3) the number of obstetricians (p = 0.05 and t count = -1,957), the increasing number of specialists in the district, the higher rate of Caesarean section. While the hospital class type variables (p = 0.912 and t count = 0.111) and the Per Capita GRDP value (p = 0.135 and t count = -1.449) were not proven to significantly affect the rate of caesarean section. The most dominant determinant factor for the rate of sectio caesaria is the right of treatment class with Coef value. beta = 3.372.

It is necessary to do various efforts in controlling the rate of sectio caesaria carried out by the government, BPJS Health and hospital management. Hospital management as one of the actors who played an important role in the success of the JKN program also needed to make several efforts to control the sectio caesaria number, including making fraud prevention policies and guidelines, developing health services oriented to cost control quality control, developing fraud prevention culture as part of organizational and clinical governance."

"Clinical Pathway (CP) Apendisititis Akut (AA) memberikan gambaran secara rinci tahap-tahap pelayanan yang akan diberikan kepada pasien. Implementasi CP AA di RSI Ibnu Sina Pekanbaru diharapkan dapat mengendalikan variasi proses perawatan dalam upaya meningkatkan kendali mutu dan kendali biaya. Tujuan penelitian ini adalah untuk melihat peran implementasi CP AA dalam meningkatkan efisiensi biya apendiktomi pasien JKN di RSI Ibnu Sina Pekanbaru. Desain penelitian ini adalah cross sectional menggunakan pendekatan kuantitatif dengan menghitung tagihan biaya pasien yang menjalani apnediktomi sebelum dan sesudah implementasi CP AA dan diolah dengan uji statistik. Pendekatan kualitatif melalui wawancara mendalam dengan informan yang terkait dalam implementasi CP AA. Hasil penelitian terjadi pemendekan Length of Stay (LOS) secara bermakna (P<0.001) pada kelompok pasien sesudah implementasi CP dibandingkan sebelumnya. Terjadi penurunan rata-rata total biaya apendiktomi sebelum dan sesudah implementasi CP (Rp. 5.214.188.02 vs Rp. 4.436.438.37) yang bermakna (P<0.001) dengan persentase selisih 17,5%. Penurunan varian pelayanan berupa utilisasi alat kesehatan (Alkes), obat dan pemeriksaan laboratorium mempengaruhi peningkatan efisiensi biaya apendiktomi. Adanya varian dalam implementasi CP AA menjadi masukan untuk mencapai implementasi CP yang ideal. Varian berupa pengurangan pelayanan yang seharusnya diberikan kepada pasien harus ditinjaklanjuti dengan melakukan penilaian outcome pasien seperti tingakat kejadian readmission dan kondisi pasien ketika melakukan kontrol setelah pulang dari Rumah Sakit (RS).

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Clinical pathway for acute appendicitis provides a detailed description of the steps of healthcare to be given to patients. Implementation of clinical pathway for acute appendicitis at Ibnu Sina Islamic Hospital Pekanbaru is expected to be able to control variations in the treatment process in an effort to improve quality and cost control.The purpose of this study aimed to see the role of implementation of clinical pathway for acute appendicitis in improving appendectomy cost efficiency in The Indonesian National Health Insurance patients at Ibnu Sina Islamic Hospital Pekanbaru. The study design was cross sectional with a quantitative approach through calculating the cost bills of patients who underwent appendectomy before and after the implementation of clinical pathway and processed with statistical tests. Qualitative approach through indepth interviews with informants who were involved in the implementation of CP. The results of the study showed shortening length of stay statistically significant as (P <0.001) in the patient group after the implementation of the clinical pathway compared to before. There was a decrease in average total costs of appendectomy before and after the implementation of clinical pathways (IDR.5.214.188.02 vs IDR.4.436.438.37) statistically significant as (P <0.001) with a percentage difference of 17.5%. Decreasing service variants in the form of the utilization of medical equipment, drug, and laboratory test affected the increase in appendectomy cost efficiency. The existence of variants in the implementation of CP can be used as input to achieve the ideal CP. Variants in the form of reducing services that should be given to patients must be followed up by evaluating patient outcomes such as readmission rates and the patient's condition when controlling after returning from the hospital. "

"Latar belakang. Masalah yang sering dihadapi pada pelayanan pasien Jaminan Kesehatan Nasional adalah kesenjangan biaya perawatan pasien stroke dengan tarif INA-CBGs. Hal ini terkait dengan biaya perawatan dan Clinical Pathway. Tujuan. Mengetahui biaya perawatan pasien stroke di Rumah Sakit Pusat Otak Nasional. Metoda. Penelitian kuantitatif deskriptif mengikutsertakan 277 subjek penyakit stroke yang diperoleh di Rumah Sakit Pusat Otak Nasional Jakarta selama Januari ? Juni 2015. Biaya perawatan stroke dihitung berdasarkan biaya satuan (unit cost) dengan menggunakan metode activity based costing dan Clinical Pathway. Hasil. Biaya satuan perawatan stroke iskemik dan stroke hemoragik berdasarkan Clinical Pathway, dengan memperhitungkan biaya investasi dan biaya gaji, tanpa memperhitungkan jasa medis berturut-turut adalah Rp 311,860,860.83 dan Rp 585,083,610.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif rumah sakit adalah Rp 321,682,940.73 dan Rp598,929,450.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif IDI adalah Rp 318,360,860.73 dan Rp 594,333,610.01; tanpa memperhitungkan biaya investasi, biaya gaji, dan jasa medis adalah Rp30,361,681.00 dan Rp25,698,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan tarif rumah sakit adalah Rp 40,183,761.00 dan Rp 39,544,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan IDI adalah Rp 36,861,681.00 dan Rp 34,948,199.46. Simpulan: Dijumpai selisih biaya perawatan berdasarkan biaya satuan dan Clinical Pathway, baik yang memperhitungkan biaya investasi, gaji, dan jasa medis, maupun tanpa memperhitungkan biaya investasi, gaji, dan jasa medis, dengan tarif layanan existing dan tarif INA-CBGs.

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Background. Problem often encountered in patient care National Health Insurance is the gap between the cost of stroke treatment with INA-CBGs tariff. This is related to the cost of treatment and the Clinical Pathway.

Aim. Knowing the cost of stroke treatment in the National Brain Center Hospital Jakarta.

Methods. Descriptive quantitative study involving 277 subjects stroke obtained at the National Brain Center Hospital Jakarta during January - June 2015. The cost of stroke treatment are calculated based on the unit cost using activity-based costing method and Clinical Pathway.

Results. The unit cost of ischemic stroke and hemorrhagic stroke treatment by Clinical Pathway, taking into account investment costs and salary costs, regardless of medical services is IDR 311,860,860.83 and IDR 585,083,610.01; taking into account investment cost, salary cost, and medical services tariff based hospital is IDR 321,682,940.73 and IDR 598,929,450.01; taking into account investment cost, salary cost, and medical services tariff based IDI is IDR 318,360,860.73 and IDR 594,333,610.01; without taking into account investment cost, salary cost, and medical services are IDR 30,361,681.00 and IDR 25,698,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based hospital is IDR 40,183,761.00 and IDR 39,544,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based IDI is IDR 36,861,681.00 and IDR 34,948,199.46.

Conclusion. Found difference in the cost of stroke treatment is based on unit cost and Clinical Pathway, both of which take into account the investment, salaries, and medical services cost, and without taking into account investment, salaries, and medical services cost, with existing services and tariff rates INA-CBGs."

"Rumah sakit sebagai penyelenggara layanan kesehatan mempunyai beban tersendiri untuk bisa memberikan pelayanan kesehatan yang bermutu dan adil bagi masyarakat. Hal ini mendorong seluruh elemen, baik pihak rumah sakit maupun stakeholder untuk menghitung secara riil berapa biaya pelayanan yang dibutuhkan sehingga bisa menjadi alat advokasi dalam pembiayaan pelayanan kesehatan. Analisis biaya melalui perhitungan biaya per unit (unit cost) dapat dipergunakan rumah sakit sebagai dasar pengukuran kinerja, penyusunan anggaran dan subsidi, alat negosiasi pembiayaan kepada stakeholder terkait dan dapat pula dijadikan acuan dalam mengusulkan tarif pelayanan rumah sakit yang baru dan terjangkau masyarakat.Penentuan unit cost dalam analisis biaya diperlukan untuk mengetahui besarnya biaya yang benar?benar dibutuhkan untuk menghasilkan suatu produk, tujuan lainnya menilai efisiensi dalam anggaran. Tindakan terbanyak pada di RS X unit Obstetri dan Ginekologi adalah persalinan sectio caesaria sehingga RS X menciptakan paket operasi yaitu Paket Hemat Sectio Caesaria. Permasalahan yang terjadi yaitu pihak manajemen rumah sakit X tidak mengetahui apakah revenue rumah sakit tindakan sectio caesaria Pahe A selama ini sudah menutupi seluruh biaya yang terjadi. Oleh karena itu, tujuan dari penelitian ini adalah untuk mendapatkan gambaran biaya satuan tindakan sectio caesaria Paket Hemat A tahun 2009.Jenis penelitian ini adalah studi kasus analitik dengan pendekatan deskriptif kuantitatif. Metode analisis biaya dengan metode Real Cost. Data yang digunakan adalah data sekunder yang tercatat di keuangan pada tahun 2009. Dari hasil penelitian, didapat biaya satuan aktual untuk tindakan sectio caesaria Paket Hemat A termasuk biaya obat/BHP dan biaya jasa medis sebesar Rp. 2.804.652, sedangkan biaya satuan normatif untuk tindakan sectio caesaria Paket Hemat A termasuk biaya obat/BHP dan biaya jasa medis sebesar Rp. 2.719.458.Maka dengan hasil tersebut, disarankan untuk menjadi pertimbangan bagi manajemen rumah sakit dalam menentukan kebijakan dan mengambil keputusan mengenai tarif untuk pelayanan tindakan sectio caesaria pada umumnya dan tindakan Paket Hemat A pada khususnya.

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Hospitals as health care providers have the burden to be able to provide the high quality health care and fair for the society. This encourages all elements, both the hospitals and stakeholders to calculate in real how much cost is needed so that can be a tool in advocacy and health care financing. Cost analysis by calculating the cost per unit (unit cost) can be used by hospital as a base performance assessment, budgeting and subsidies, financing negotiating tools to the relevant stakeholders and also can be used as a reference in proposed new rates of hospital services and affordable to the society.

The determination of unit costs in the cost analysis is needed to determine the costs actually required to produce a product, the other purposes is to assess the efficiency of budgeting. The most health care in Hospital X Obstetry and Ginekology unit is Sectio Caesaria so that Hospital X creating operation packages named Sectio Caesaria Economical Package. The problems that occurred, is the management of Hospital X did not know whether the hospital's revenue in Sectio Caesaria Economical Package A for all this time was covered all the costs that incurred. Therefore, the purpose of this research is to obtain the unit cost of Sectio Caesaria Economical Package A year 2009.

The research design is an analytical case studies with quantitative descriptive approach. Method of cost analysis by Real Cost method. The data used in this research are secondary data that was recorded in finance unit year 2009.

From the results of the research, obtained the actual unit cost for Sectio Caesaria Economical Package A includes the cost of drugs/consumables and medical fees is Rp. 2,804,652, whereas normative unit cost for Sectio Caesaria Economical Package A includes the cost of drugs/consumables and medical fees is Rp.2,719,458. So with these results, it is suggested to be a consideration for the hospital management in setting the policies and making decisions on tariffs for Sectio Caesaria services in general and Economical Package A in particular."

"[Program Jaminan Kesehatan Nasional menerapkan sistem pembayaran prospektifyaitu dengan tarif INA CBG?s untuk pelayanan di rumah sakit. Tujuan penelitianini yaitu untuk menganalisis selisih biaya layanan dengan tarif INA CBG?s dantarif rumah sakit khusus kasus sectio caesaria dengan kode ICD X (O.342) padapasien BPJS berdasarkan komponen biaya serta mengetahui gambaran perbedaanbiaya layanan tersebut berdasarkan karakteristik pasien. Jenis penelitian iniadalah deskriptif kuantitatif dengan metode cross sectional dengan sampelsebanyak 89 pasien. Dari hasil penelitian didapat rata-rata selisih biaya layananuntuk kasus sectio caesaria dengan diagnosa utama O.342 terhadap tarif rumahsakit adalah selisih negatif (efisien) sebesar Rp 1,236,793,- dengan CRR (costrecovery rate) 120% dan terhadap tarif INA CBG?s adalah selisih positif (tidakefisien) sebesar Rp 1,974,050,- dengan CRR (cost recovery rate) 68% Gambaranperbedaan biaya layanan berdasarkan karakteristik pasien yang memilikihubungan dengan besarnya biaya layanan adalah kelas rawat (p=0,000), diagnosissekunder (p=0,050) dan lama hari rawat (p=0,046), sedangkan yang tidakmemiliki hubungan dengan besarnya biaya layanan adalah umur pasien(p=0,956).;The National Health Insurance Scheme implementing prospective paymentsystem INA CBG's rates for hospital services. The purpose of this study is toanalyze the difference in cost services with INA CBG's rates and hospitals ratesspecialty in patients BPJS with sectio caesaria cases with ICD X (O.342) basedcomponent costs and reveal the differences in cost of these services is based onthe characteristics of the patient. This type of research is quantitative descriptivecross sectional method with a sample of 89 patients. The result is the averagedifference between the cost of services for Caesaria sectio cases with primarydiagnosis O.342 against hospital rates are negative difference (efficient) to Rp1,236,793, - with the CRR (cost recovery rate) of 120% and against the CBG'sINA rates are positive difference (inefficient) to Rp 1,974,050, - with the CRR(cost recovery rate) of 68% service charge difference picture based on thecharacteristics of patients who have a relationship with the cost of the service isambulatory class (p = 0.000), a secondary diagnosis (p = 0.050) and the lengthof stay (p = 0.046), whereas no relation to the cost of the service is the age of thepatients (p = 0.956)., The National Health Insurance Scheme implementing prospective paymentsystem INA CBG's rates for hospital services. The purpose of this study is toanalyze the difference in cost services with INA CBG's rates and hospitals ratesspecialty in patients BPJS with sectio caesaria cases with ICD X (O.342) basedcomponent costs and reveal the differences in cost of these services is based onthe characteristics of the patient. This type of research is quantitative descriptivecross sectional method with a sample of 89 patients. The result is the averagedifference between the cost of services for Caesaria sectio cases with primarydiagnosis O.342 against hospital rates are negative difference (efficient) to Rp1,236,793, - with the CRR (cost recovery rate) of 120% and against the CBG'sINA rates are positive difference (inefficient) to Rp 1,974,050, - with the CRR(cost recovery rate) of 68% service charge difference picture based on thecharacteristics of patients who have a relationship with the cost of the service isambulatory class (p = 0.000), a secondary diagnosis (p = 0.050) and the lengthof stay (p = 0.046), whereas no relation to the cost of the service is the age of thepatients (p = 0.956).]"

"Clinical Pathway (CP) merupakan perangkat alat multidisiplin ilmu yang digunakan untuk perawatan kesehatan berbasis bukti (evidence based). CP memiliki fungsi menyeragamkan terapi sehingga mampu meminimalkan komplikasi dan kesalahan pengobatan. Rumah Sakit Pusat Otak Nasional (RS PON) merupakan rumah sakit rujukan otak dan persarafan nasional. Stroke perdarahan menjadi penyakit kedua tertinggi di RS.PON. Keberagaman keputusan dilakukannya operasi atau tidak, meskipun sudah masuk indikasi, menjadi poin penting untuk menganalisis implementasi pelaksanaan Clinical Pathway ini.Tujuan penelitian: menilai implementasi CP stroke perdarahan yang telah dijalankan sehingga diharapkan mampu menjadi dasar penentu kebijakan rumah sakit jejaring maupun rumah sakit seluruh Indonesia. Menilai hubungan antara variabel-variabel dalam clinical pathway terhadap Length of Stay (LOS), morbiditas dan mortalitasMetode: ​​Penelitian ini menggunakan metode mixed method, dengan pendekatan retrospektif. Dalam penelitian kuantitatif dilakukan analisis univariat dan multivariat, dimana menggunakan data sekunder dari rekam medis pasien stroke perdarahan yang dirawat di RS PON pada januari 2020 - Desember 2021. Dari total populasi 1254 pasien setelah dilakukan kriteria inklusi dan inklusi didapatkan 1001 pasien. Penelitian kuantitatif, dilakukan dengan menganalisis pengaruh implementasi CP terhadap lama hari rawat, morbiditas (nilai NIHSS) dan mortalitas. Faktor risiko dan efek atau penyakit yang terjadi di masa lampau diukur melalui catatan historis. Sementara pengumpulan data secara kualitatif menggunakan kuisioner dan wawancara secara mendalam kepada Kepala Bidang Pelayanan Medis, Kepala Komite Medis, Kepala Komite Keperawatan, Kepala Divisi Vaskular, Dokter Spesialis Neurologi, Dokter Spesialis Bedah Saraf, Dokter IGD, Perawat, Fisioterapi, Terapi wicara, Gizi dan Farmasi untuk mengetahui tahapan proses Clinical Pathway di RS PON. Total responden 129 orang. Penelitian kualitatif menilai pengetahuan tenaga medis dan paramedis terkait CP, implementasi, supervisi, monitoring dan evaluasi.Hasil: penelitian kuantitatif menemukan adanya hubungan antara beberapa variabel yang berada dalam CP, seperti pemeriksaan penunjang, terapi sesuai indikasi dan penyakit komorbid terhadap LOS, morbiditas dan mortalitas. Sementara pada penelitian kualitatif menilai implementasi CP di RS PON memerlukan perbaikan dari segi sosialisasi, implementasi, monitoring dan evaluasi.

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Clinical Pathway is a multidisciplinary toolkit used for evidence-based health care. The Clinical Pathway has the function to unify the therapy so as to minimize complications and medication errors. The National Brain Center Hospital (PON Hospital) is a national brain and nervous referral hospital. Hemorrhagic stroke is the second-highest disease in PON Hospital. The diversity of decisions to have surgery or not, even though it is indicated, is an important point to analyze the implementation of this Clinical Pathway.

Objective: to evaluate the implementation of CP bleeding stroke that has been carried out so that it is expected to be the basis for determining policy for network hospitals and hospitals throughout Indonesia. Assessing the relationship between variables in clinical pathways on Length of Stay (LOS), morbidity, and mortality

Methods: This study uses a mixed-method, with a retrospective approach. In this quantitative study, univariate and multivariate analyzes were carried out, which used secondary data from the medical records of hemorrhagic stroke patients treated at the PON Hospital in 2020-2021. From the total population of 1254 patients, after the inclusion and inclusion criteria were carried out, there were 1001 patients. Quantitative research was conducted by analyzing the effect of Clinical Pathway implementation on length of stay, morbidity (NIHSS value), and mortality. `Risk factors and effects or diseases that occurred in the past are measured through historical records. Meanwhile, qualitative data collection used in-depth interviews with the Head of Medical Services, Head of the Medical Committee, Head of Nursing, Head of the Vascular Division, Neurology Specialist, Neurosurgeon Specialist, Emergency Room Doctor, Nurse, Farmation, physiotherapist, speech therapist, nutritionist to find out the stages of the Clinical Pathway process at the PON Hospital. The total number of respondents are 129 people. Qualitative research assesses the knowledge of medical and paramedical personnel related to CP, implementation, supervision, monitoring, and evaluation.

Result: Quantitative research found a relationship between several variables in CP, such as investigations, therapy, and comorbid with LOS, morbidity, and mortality. Meanwhile, qualitative research showed that the implementation of CP in the PON Hospital was still unsatisfactory in terms of socialization, implementation, monitoring and evaluation.

Conclusion: Implementation of CP is associated with clinical outcomes of hemorrhagic stroke patients."

"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."

"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."