materi 2 - national casemix center kemenkes ri.pptx
Transcript of materi 2 - national casemix center kemenkes ri.pptx
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TARIF INA – CBG’S DALAM
IMPLEMENTASI
JAMINAN KESEHATANNASIONAL
Kalsum KomaryaniNational Casemix CenterKementerian Kesehatan RI
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1. METODA PEMBAYARAN INA-CB!"#. PRO"E" PEMBENT$KAN TARI% INA-CB!"
&. RE$'A"I TARI% INA-CB!" DA'AM (KN). MA"A'A*+. "ARAN YAN PER'$ DI'AK$KAN R" DA'AM
ERA (KN
,. KE"IMP$'AN
SISTEMATIKA PENYAJIAN
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&
$NIER"A'*EA'T*
COERAE
O$TO%
POCKE T
COMM$NITYBA"ED *I
*EA'T*IN"$RANCE
TA BA"ED%$NDIN
PRIORITI/ATION
0TARET BENE%ITETC2
OA'"3
*EA'T*%INANCIA'
PROTECTION"ATI"%ACTION
UNIVERSAL HEALTH COVERAGE
E4$ITY4$A'ITYACCE""
+ CONTRO'KNOB"3
%INANCINPAYMENT
RE$'ATIONORANI/ATI
ONPER"$A"ION
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1. METODA PEMBAYARAN INA-CB!"
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Retrospective Payment
Payment are made or agreed upon after
provision of services Fee-for-service
Payment per itemised bill Payment per diem
Prospective PaymentPayment are made or agreed upon in
advance before provision of services Case based payment/case mix Capitation payment
Global budget
METODA PEMBAYARANPROVIDER
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RETRO"PEKTI% FEE FOR SERVICE0%%"2
KELEBIHAN KEKURANGANPro5i6er Risi7o 7euan8an
san8at 7e9il Ti6a7 a6a insenti: untu7yan8 mem;eri7an
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PRO"PEKTI% CA"EMI0INA-CB2
KELEBIHAN KEKURANGAN
Pro5i6er Pem;ayaran le;ih a6ilsesuai 6en8an7om
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• Meru
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• Meru
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10
"e
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11
A 1 2 3 III
CG Case !ypeCB!
s Ty
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C $SE %$IN GROU&S0CM2
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• 3 untu7 Ra?at alan
• I Rin8an 3 untu7 ra?at ina< 6en8an tin87at7e
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1. R" 7elas D
#. R" 7elas C
&. R" 7elas B). R" 7elas A
+. R"$ Ruu7an Nasional
,. R"K Ruu7an Nasional
KELOMPOK KELAS RSTARIF INA-CBG’S JKN
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#. PRO"E" PEMBENT$KAN TARI% INA-CB!"
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K OMPONEN "I"TEM CA"EMI
KlasiG7asi
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DATA DA"ARDATA
TEMP'ATE
TEMP'ATE TT%I'E
CB"-N-'O"01) AR2
C'EANIN
EK"P'ORIN
$NIT CO"T
ANA'I"A
REKAPARIABE'
CMI
CO"T =EI*T
PRE'EMINARY TARI%
TARI%
INP$T CCM TRIMIN
A%
INA-CBG’S
*BR
DATA CO"TIN DATA CODIN
CB!" CO"T
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!.R"F &ospital ase rate x Cost eig2t x aF
A5era8e 9ost :or s
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• Men6oron8 a8ar R" menerima
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J&i4 P,5%%&T%,i7 INA-DRG
(2.)T%,i7 INA-CBG
(213)T%,i7 INA-CBG (218
JKN)
Data Co6in8 1#++) re9or6 1)F)+ re9or6 ,.. re9or6
Data Costin8 1+ R" 1 R" 1& R"
Tahun Data Kostin8 #, #1 #11
Kontri;utor 6ata 9ost Kls A J B Kls ABCD JKhusus
"emua 7ls s?asta
Distri;usi Kasus Ti6a7 Normal Ti6a7 Normal normal
Meto6e Trimmin8 '&*& I4R I4R
Pilihan Tari: Mean Me6ian Mean
(umlah rou< CB 6r6ata 7o6in8ter7umINA-CB
1 1 1 , "
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NO RUMAH SAKITTOTALPASIEN
T"%! K!%i# INA-CBG
T"%! T%,i7 RS S!i4i9
1 R"$P "AR(ITO +#) +F++,) ,+11F+ 0,+,##,2
# R"$P =A*IDIN1,1 1F+F)1++, 1,F#)&#
1,#,1&)
& R"$P M.*OE"IN1& 1&&#&&#, 1))&+&#&
011&+1)+,F2
) R"$P %ATMA=ATI#) )+,1)+1 ,F++&#&F +)&+F#1&
+ R"$P KARIADI1 #+&& #1F#&
,)1)#),)
, R" $'IN 1#+)FF&& ))))+#1 ##+)F#1#
R"PER"A*ABATAN 11 1F+)1& FF)F# ##)1,+&#,
F R" *ER(ANF #F1,#&) 1,F&F,1+ 11+&+
R"CM1#& &++)# #1),,&, )&++
1 R"(P *ARAPANKITA
& #)&,+#, 1&#,) F1&&&F&
11 R" D*ARMAI"#) &&&F)1& )))#&F# 01,F+#1)2
1# R"KO
1 #1F#1) ##)1)&,) 0+#++21& R"O
) ) #)# # 1 # # +, )# 1 +1# +& +1
P,5%%& "%! k!%i# %&%,% %,i7 INA-CBG’4 &+%& %,i7 RS$%% $!%:%&%& ,%0% i&%$ P,"+,%# JKN i 55,%$% RS
($,i" ; 1 - 31 J%&%,i 218)
P 5 ! k! i i7 INA CBG’ i7 RS
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P,5%%& "%! k!%i# %&%,% %,i7 INA-CBG’4 &+%& %,i7 RS$%% $!%:%&%& ,%0% '%!%& P,"+,%# JKN i 55,%$% RS
($,i" ; 1 - 31 J%&%,i 218)NO RUMAH SAKIT
TOTALPASIEN
T"%! K!%i#INA-CBG
T"%! K!%i# T%,i7RS
S!i4i9
1 R"$P "AR(ITO&+1 #,#)FFFF& &11) 11+)+1+,
# R"$P =A*IDIN1#)) )1+#F1+ &#F1,#+
F11##&)
) R"$P %ATMA=ATI&1,, 1#F,)))#) ),,)F,F
F1+F1,
+ R"$P KARIADIF+ +,F),)++ &F#1)F
&#,#)+)
, R" $'IN+,,+ &+,&+),& 1,&&,1 1+&1&))
R" PER"A*ABATAN,+F &1+11F, 1#1F&,+F 1F+)
F R" *ER(AN##++ 1)1&+F+& ,&)+)&1 )11,)&
R"CM,#+) ++,,#F) &)F&)&+ 11&1+F+
1 R"(P *ARAPAN KITA )#,#
&&F#,1 1)&F111) 11+1)
11 R" D*ARMAI")1, +F#,,F1&1 )+F&1F&)# 1),F
1# R"KO#,) )&,,++#, ,)+&)1 0#1FFF)2
1& R"O)#, #),FF+#, )1#&) 1#F,1##
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&. RE$'A"I TARI% INA-CB!" DA'AM (KN
REGULASI TARIF INA CBG’S DALAM
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• Permen7es No , tahun #1& tentan8 stan6ar tari:
• "E Men7es no &1 6an no tahun #1)
• Masih a6a tari: INA-CB!s yan8 se6an8 6alam
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+. MA"A'A*
PERMASALAHAN
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PERMASALAHAN
1. BE'$M DIPA*AMINYA KON"EP INA-CB!" "ECARA$T$*
#. "$PP'IER IND$CED DEMAND " "$PP'IER RED$CEDDEMAND
ATA$
OER TREAMENT " $NDER TREATMENT
&. PEMBAIAN (A"A PE'AYANAN
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,. "ARAN YAN PER'$ DI'AK$KAN R"DA'AM ERA (KN
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iIURAN NON
PBI; PEKERJADAN PEMBERIKERJA
P#5%:%,%& k$F%4k4P,i#,
P#5%:%,
%& k$F%4k4
L%&'%&
J%4%P!%:%&%&
('%4% #ik<
!!) J%4% S%,%&%(O5%< BMHP
= A!k4)
Bi%:%O$,%4i"&%!
!%i&&:%
BPJS
KES
#F
ALUR DANA JKN
Bi%:%$!%:%&%&
k49%%&
Bi%:%"$,%4i"&%!
Bi%:%
>%%&+%&
IURAN PBI;APBN
1 MENINGKATKAN EFISIENSI
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POTENSI INEFISIENSI PELAYANAN RUMAHSAKIT
• %armasi
• Alat me6i7 ha;is
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Mi>%!R>",
CBGG,"$C"i&
+
2? PERBAIKI MUTU REKAM MEDIK
3 PERBAIKI KECEPATAN DAN
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Ber
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In
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SARAN LAINNYA
• 'a7u7an
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. KE"IMP$'AN
KESIMPULAN
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• Meto6e
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Terima
Era BaruMeto6a Pem;ayaran Rumah
"a7it