Evaluasi Penerapan Tarif Paket Pelayanan Esensial Pada Pelayanan Kesehatan Bagi Keluarga Miskin = Evaluation of Essential Service Package Tariff Implementation on Poor People Health Service.

• Main Author: Perpustakaan UGM, i-lib
• Format: Article NonPeerReviewed
• Published: [Yogyakarta] : Universitas Gadjah Mada 2006
• Subjects: Jurnal i-lib UGM
• Online Access: https://repository.ugm.ac.id/25485/; http://i-lib.ugm.ac.id/jurnal/download.php?dataId=8480
• Institution: Universitas Gadjah Mada

Background: In order to control service cost for poor patient, on July 2004 Wates District Hospital implemented essential service package tariff. This was essential service package tariff that implemented in Yogyakarta province based on the agreement of 5 district hospitals in Yogyakarta Province and service institution on social and health assurance, especially for 14 disease diagnoses of 4 basic specializations: pediatric, internal, obstetrics-gynecology, and surgery. Purpose : The study aimed to find out the impact of hospital implemented essential service package tariff toward specialist phycisian's behavior in controlling service cost, specialist's perception toward hospital implemented essential service package tariff, and environtment factor that influenced. Method: This was descriptive case study method. Analysis unit of the study was Wates District Hospital at Kulonprogo. Subject of the study was medical record of poor patient in Wates District Hospital since July-Desember 2004 wih patient who returned home as a diagnosis in essential service package tariff and all specialist physicians that involved on the implementation of that tariff. Data of service cost were analyzed qualitatively, while the result of in depth interview with specialist physicians was analyzed qualitatively. Results: Most of total service cost in Wates District Hospital was higher than total cost of essential service package tariff. It was caused by the high drug cost as a result of the high consumtion of patent drug than generic one. Specialist phycisian's perception toward the implementation of essential service package tariff tends to vary depend on individual factors and environment factors that influenced. Environment factor that influenced specialist phycisian's behavior in controlling cost, i.e. essential service package tariff that did not comply with the compiling standard, hospital management function that was not working well (Management Information System, and Medical Committee), and the influence of pharmacy factory. Conclutions: The implementation of essential service package tariff in Wates District Hospital is not influence on some specialist phycisian's behavior in controlling cost. Specialis phycisian's perception toward essential service package tariff tends to vary depends on individual and environment factor that influenced. Keywords : package tariff, service cost, poor people. Latar Belakang: Untuk mengendalikan baiaya pelayanan bagi pasien Gakin, mulai juli 2004 di RSUD Wates diterapkan Tarif Paket Pelayanan Esensial (PPE). Tarif PPE ini merupakan tarif PPE Provinsi Daerah Istimewa Yogyakarta (Provinsi DIY) yang merupakan hasil kesepakatan 5 RSUD di Provinsi DIY dengan Bapel Jamkesos khusus untuk 14 diagnosa penyakit dari 4 spesialisasi dasar: anak, penyakit dalam, kebidanan-penyakit kandungan dan bedah. Tujuan: Untuk mengetahui dampak penerapan tarif PPE terhadap perilaku dokter spesialis dalam pengendalian biaya pelayanan, mengetahui persepsi dokter spesialis terhadap penerapan tarif PPE, serta mengetahui faktor lingkungan yang berpengaruh terhadap perilaku dokter spesialis dalam pengendalian biaya pelayanan. Metode: penelitian ini merupakan studi kasus yang bersifat deskriptif. Unit analisis adalah RSUD Wates Kabupaten Kulonprogo. Subjek penelitian: berkas rekam medis penderita Gakin yang dirawat di RSUD Wates sejak bulan Juli � Desember 2004 dengan diagnosa pulang merupakan diagnosa yang termasuk dalam. Tarif PPE serta seluruh dokter spesialis yang terkait dengan penerapan tarif PPE tersebut. data biaya pelayanan dianalisis secara kuantitatif, analisis data ini untuk mengetahui dampak penerapan tariff PPE terhadap pengendalian biaya pelayanan di RSUD Wates, sedangkan hasil wawancara mendalam dengan dokter spesialis dianalisis secara kualitatif untuk mengetahui persepsi dokter spesialis terhadap tarif PPE, serta faktor lingkungan yang mempengaruhi. Hasil: Total biaya pelayanan di RSUD Wates sebagian besar masih melebihi total biaya dalam tarif PPE, yang disebabkan tingginya biaya obat akibat tingginya pemakaian obat paten dibanding obat generik. Persepsi dokter spesialis terhadap penerapan tarif PPE cenderung bervariasi, tergantung faktor individu dan faktor lingkungan yang mempengaruhinya. Faktor lingkungan yang mempengaruhi perilaku dokter spesialis dalam pengendalian biaya diantaranya: lemahnya mekanisme pengendalian pihak pembayar, tarif PPE yang belum memenuhi standar penyusunan, fungsi-fungsi manajemen rumah sakit yangelum berjalan dengan balk (SIM, Komite Medik), ketersediaan obat generic serta pengaruh pabrik farmasi. Kesimpulan: Penerapan tarif PPE di RSUD Wates tidak erdampak pada perilaku sebagian dokter spesialis dalam pengendalian bisaya. Persepsi dokter spesialis terhadap tarif PPE cendurung bervariasi, tergantung faktor individu dan faktor lingkungan yang mem-pengaruhinya. Kata kuncl : tarif paket, biaya pelayanan, keluarga miskin