materi 2 - national casemix center kemenkes ri.pptx

8/16/2019 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


10/36

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&&#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 )#,#

&#1&&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

materi 2 - national casemix center kemenkes ri.pptx

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