TOTAL LOSS MODEL FOR INDONESIA-CASE BASED GROUPS (INA-CBGS) PAYMENT SYSTEM IN NATIONAL HELATH INSURANCE (Case Study at D-Type Hospital in East Nusa Tenggara)

• Main Author: SEJAHTERA (NIM : 20813017); Pembimbing : Dr. Sapto Wahyu; Indratno dan Ocke Kurniandi, M. Si, , MILLA
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/20285
• Institution: Institut Teknologi Bandung

In Indonesia, national health insurance is a social security program for health protection, held by Social Security Institution of Health and all Indonesian must be participated in it. One of the payment system used to pay claims from health facilities such as hospital is Indonesia-Case Based Groups (INA-CBGs), i.e. prospective <br /> <br /> <br /> <br /> payment system which set from diagnose and procedure grouping, without count its kind and amount of health service provided. This research aims to construct the total loss model for inpatient and outpatient services in hospital using Compound model, where its claim severity model constructed from INA-CBGs tariff using modified empirical distribution based on low, medium and high cost level. Whereas its frequency claim model constructed from frequency of case groups happened in <br /> <br /> <br /> <br /> hospital using Poisson regression as a special case of Generalized Linear Models (GLM). The data used in this research is inpatient and outpatient claim data during <br /> <br /> <br /> <br /> 2014 in a D-type hospital in East Nusa Tenggara. In claim severity model, probability of INA-CBGs tariff for low cost level is greater than its tariff for medium and high cost level for both inpatients and outpatients. In claim frequency model, the same significant factors that influence case groups for 1st class inpatients and outpatients are: gender (male and female), and age (children and adults); for 2nd class inpatients are: gender (male and female), and age (adults only); for 3rd class inpatients are the same as 1st class factors plus patient way home (reconciliation).