EVALUASI IMPLEMENTASI INA-CBGs KASUS DIABETES MELLITUS PASIEN JAMKESMAS RAWAT INAP DI RSUD A.WAHAB SJAHRANIE SAMARINDA

Background: Jamkesmas is social aid to ensure health of poor community in Indonesia financed by the government. An effort to reduce cost for health in the program of Jamkesmas is the utilization of prospective payment system, i.e. Indonesia Case Base Groups (INA �CBGs). In this sytem health providers partially take the financial risk whenever they are inefficiency in budget utilization. One of the problems of INA- CBGs implementation is negative difference in certain cases. This condition also happens at A.Wahab Sjahranie Hospital Samarinda. Causes of negative difference are mostly lack of understanding of doctors, incomplete medical records, and lack of effort to control quality and cost. Objective: To evaluate implementation of INA-CBGs in DM cases of Jamkesmas inpatients at A. Wahab Sjahranie Hospital on control over cost and quality. Method: The study was descriptive with holistic single case study design. Unit of analysis was implementation of INA-CBGs at A. Wahab Sjahranie Hospital Samarinda in DM cases of Jamkesmas inpatients in 2011. The variables studied were understanding of the doctors on payment system of Diagnosis Related Group (DRG), hospital policy that supported control over cost and quality, completeness of medical records, compliance with prescription according to the formularium, relevance of coding, difference between average length of stay (ALOS) and ALOS of INA-CBGs difference between hospital tariff and INA-CBGs tarif. Subjects of the study were doctors providing the service, hospital management, medical records and prescription. Result: Doctors providing health service lacked understanding on INA-CBGs payment system due to minimum socialization. There was hospital policy that enforced control over cost and quality, as indicated from the availability of Integrated Management Team of Community Health Service Insurance, obligation to prescribe according to Jamkesmas formularium, standard operational procedures of DM and medical records. Incomplete medical records reached 74.98%. Compliance with Jamkesmas formularium was 97.48%. As much as 11.36% of coding was irrelevant and this caused lower amount of claim. Difference between ALOS and ALOS of INA-CBGs was 68.18%. There was tarif difference of 67.84% between hospital tarif and INA-CBGs tarif. Conclusion: The results of this study can be concluded that the Management RSUD A. Wahab Sjahranie has attempted to control cost and quality, but not effective in the case of diabetes with the peripheral circulatory disorders Jamkesmas inpatients in 2011