Comparative Of Hospital Tariff And INA-CBG Tariff In Hemodialisa Treatment At Hospital

Abstract

The Government strives in the implementation of the National Health Insurance program organized by the Social Security Administering Body of Health is well implemented. However, the implementation still faces some obstacles, especially regarding the difference between hospital tariff and Indonesian Case Base Groups tariff. The research aims to analyze the calculation of tariff based on Activity Based Cost on Hemodialisa service, tariff difference, determinant influencing difference of tariff difference. Types of quantitative research with cross sectional, sample of 50 people by Purposive sampling. Analysis with Chi Square statistical test. The result of the research shows the result of the cost analysis of hemodialysis service using ABC method got the result of unit cost Rp. 1,836,303, the difference between the difference of Rp. 946603. factors influencing the tariff that is the cost of the drug has an effect on α = 0.05, the supporting cost has an effect on α = 0.05. The conclusion of this research is that there is difference between hospital tariff using ABC method with INA-CBG's tariff. The cost factor of medicines and medical support costs affect the tariff of hemodialysis service. It is suggested to the management to increase in unit cost calculation for Hospital tariff.

Keywords: tariffINA-CBGHemodialysis,

Introduction

The Government strives in the implementation of the National Health Insurance program organized by the Social Security Administering Body Health is well implemented. However, the implementation still faces particular obstacles regarding the difference between hospital tariff and INA CBG'S tariff (Indonesia Case Base Groups) (Bastian, 2008).

Hospital operational costs associated with BPJS Health as JKN executors, hospitals are concerned about the tariffs imposed by referring to INA-CBGs as a paying model used by BPJS Health to replace claims made by the hospital. INA-CBG is a "package" payment system based on the patient's illness. Hospitals will be paid based on INA CBGs tariff which is the average cost spent by a group of diagnoses (Bastian, 2008).

The government is increasingly thinking about health financing by trying to succeed in the current health insurance system by requiring all Indonesian citizens to become and JKN (National Health Insurance). Therefore there are some changes to the existing health care system. Both by government and private (private) health providers. This has had a significant impact on non-government or private providers. Some things that experienced changes directly and felt by the private sector that is seen in the payment system services. So the tariff of medical treatment in the hospital will also adjust to the tariff that has been determined by the government. Private hospitals that join this JKN system should pay more attention to the services that have been running for this. The profit from available services will certainly be different in the JKN era (Kementerian Kesehatan Republic Indonesia, 2012)

The hemodialysis service in 2012 covered by PT Askes and other insurance coverage is 227 billion rupiahs and is a medical act that absorbs the largest portion of healthcare costs. In 2015, health services financing by BPJS as much as 2.68 trillion rupiah spent on kidney disease, both inpatient and outpatient, the number increased from the year 2014 amounted to 2.2 trillion rupiah. Financing kidney disease is the second largest funding ranking of BPJS health after heart disease. Hemodialysis services performed routinely two or three times a week. The hemodialysis process lasts for 2-4 hours. Hemodialysis action in patients with chronic renal failure is needed to support survival (DepartemenKesehatanRepublik Indonesia, 2017).

Febriani (2014) stated that ABC method in determining hospital tariff on hemodialysis service cost that unit cost of hemodialysis action calculated based on ABC modification method is Rp 1.428.020. Calculation of ABC cost modification unit resulted in greater cost than INA-CBG's claim to get the difference of Rp 586,720. Primadinta research, et al (2011) The data shows that hospital tariffs with INA CBG's tariff tend to show significant differences. For tariff of hemodialysis service at RSU. PKU. Muhammadiyah Yogyakarta, the negative difference between unit cost and INA CBGs tariff is Rp. 384684.

DatuBeruTakengon General Hospital Central Aceh is the only public hospital in Aceh Tengah which has hemodialysis services. Based on data recapitulation DatuBeruTakengon General Hospital in January 2017 until September 2017, there are 120 patients who undergo therapy Hemodialysis. Hemodialisa service is the excellent service of DatuBeruTakengon General Hospital. Patients with Chronic Kidney Failure is increasing and one of the therapy procedures performed is hemodialysis resulting in an increase in hospital budget.

Problem Statement

• What is the tariff on hemodialysis service using ABC (Activity Based Cost) method

• Is there any difference in tariff of hemodialysis service based on ABC method and current hospital tariff

• Is the determinant influencing the difference in hospital tariffs using ABC method with INA CBG, S tariff

Research Questions

3.1 Is the tariff on hemodialysis service using ABC (Activity Based Cost) method?

3.2Is there any difference in tariff of hemodialysis service based on ABC method and current hospital tariff?

3.3Is the determinant influencing the difference in hospital tariffs using ABC method with INA CBG, S tariff?

Purpose of the Study

• Analyze tariff calculation based on ABC (Activity Based Cost) method at Hemodialisaservice .

• Analyzing differences between tariff based on the ABC method with the prevailing hospital ward at Hemodialisa service

• Analyzing the determinants that affect the difference in hospitaltariff using ABC method with INA CBG tariff

Research Methods

This research is a quantitative research with cross sectional approach with 50 samples taken in Purposive sampling. Data obtained by interview using observation sheet.Data analysis by statistical analysis of test and analysis with Chi Square statistical test (Sugiyono,2010).

Findings

Conclusion

The conclusion of this research is that there is difference of hospital tarifftariff using ABC method with INA-CBG's tariff. The cost factor of medicines and medical support cost affects the hospital tariff on hemodialisa service while the cost of action and consultation cost does not affect the hemodialysis service at DatuBeruTakengon General Hospital. Suggestion It is suggested to the management to increase in unit cost calculation for hospital tariff to reduce hospital deficit.

References

1. Bastian, I. (2008). Health Accounting. Jakarta: Erlangga.
2. Ministry of Health Republic of Indonesia. (2017). Chronic Kidney Disease Situation Bulletin. Retrieved from www.depkes.go.id/download.php?file=download/.../infodatin%20ginjal%202017.pdf
3. Febriani, Pribadi F dan Dewanto I, (2014). Analysis of Calculation of Cost Unit for Hemodialysis Services Towards the Determination of INA-CBG's Tariffs and Hospital Hospital Medical Rates in Bangka Regency (Case Study in Medical Sciences in the Regency of Bangka). Muhammadiyah University of Yogyakarta. Yogyakarta.http://repository.umy.ac.id/bitstream/handle/123456789/8961/halaman%20judul.pdf?sequence=4&isAllowed=y
4. Republic of Indonesia's Ministry of Health (2012). Handbook on Socialization of National Health Insurance (JKN) In the National Social Security System, Jakarta. http://www.depkes.go.id/resources/download/jkn/buku-pegangan-sosialisasi-jkn.pdf
5. Sugiyono. (2010). Educational Research Methods Quantitative, Qualitative Approach.Bandung: Alfabeta