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Didik Tamtomo
Faculty of Medicine, Sebelas Maret University
Medicine & Pharmacology Public Health

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Factors Influencing the Difference between Indonesian Case-Based Group Reimbursement and Medical Cost for Patients with Chronic Renal Disease Cases in Kasih Ibu Hospital, Surakarta Mardhatillah -; Didik Tamtomo; Bhisma Murti
Journal of Health Policy and Management Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Backgorund: JKN program has stipulated the INA CBGs reimbursement for the payment of treatment in referral health facilities, including for chronic renal disease which is a disease burden. This study aimed to analyze factors influencing the difference between Indonesian case-based group reimbursement and medical cost for patients with chronic renal disease cases in Kasih Ibu Hospital, Surakarta.Subjects and Method: The study design was an analytic observational with cross sectional design. The study was conducted in Kasih Ibu Hospital Surakarta in August-October, 2017. With a total of 231 subjects sample which was selected by using proportional random sampling. The dependent variable was the difference between Indonesian case-based group reimbursement and medical cost. The independent variables were length of stay, type of class, medical treatment/ surgery, ICU treatment, and medication use. The data were analyzed using multiple linear regression.Result: INA CBGs reimbursement (mean= Rp 6,120,000; SD= Rp 2,330,000) paid by BPJS Kesehatan was lower than actual hospital’s medical care cost (mean= Rp 7,070,000; SD= Rp 4,650,000). Factors profitable for hospitals were medical treatments/ surgery (b= 0.032; p= 0.552). Factors that inflicted financial loss were class 1 care (b= -0.104; p= 0.094), class 2 care (b= -0.033; p= 0.590) compared to class 3 care, length of stay (b= -0.541; p<0.001), medication use in accordance with national formulation (b= -0.183; p= 0.008) and the use of ICU (b= -0.045; p= 0.543). Patients who upgraded the class type (mean= Rp 5,526,074; SD= Rp 1,449,621) was higher than hospital’s medical cost for class 2 (mean= Rp 3,933,767; SD= Rp 1,887,900).Conclusion: Mean of INA CBGs reimbursement on inpatient care of chronic renal disease is lower than the mean of hospital’s medical care cost. Length of stay and doctors’ compliance in using national medication formulation are important determinants to increase medical care cost. Hospital obtains profit from patients who upgrade type of class.Key words: care cost, INA CBGs reimbursement, chronic renal diseaseCorrespondence: Mardhatillah. Kasih Ibu Hospital, Surakarta, Central Java. Email: mardhatillah.bws@gmail.com. Mobile: 089510610891.Journal of Health Policy and Management (2017), 2(2): 117-127https://doi.org/10.26911/thejhpm.2017.02.02.03
Patient Characteristics, Financing Type, Accreditation Status, and Quality of Health Services at Community Health Center, Surakarta Yeni Tri Utami; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Policy and Management Vol. 2 No. 1 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: An indicator of quality health service is the extent of patient expectation fulfilment. Perceived quality of health services may be influenced by various factors such as patient socio-demographic factors, financing type, and accreditation status. As statistics have shown, the number of patient visits at Surakarta Community Health Center has been decresing for the last few years. This study aimed to determine the associations between patient characteristics, financing type, accreditation status, and the quality of  health services at community health center.Subjects and Method: This was a quantitative study with cross-sectional design. It was conducted at Community Health Center, Surakarta, Central Java, from May to July 2017. A sample of 120 patients were selected for this study from 2 Community Health Centers selected at random from all 17 Community Health Centers existing in Surakarta. The independent variables were patient characteristics, financing type, and accreditation status of the Community Health Centers selected. The dependent variable was quality of health service. The data were collected using a set of questionnaire and  analyzed using multiple logistic regression.Results: Quality of service was negatively associated with patient education (OR = 0.27 ; 95% CI = 0.08 to 0.90; p = 0.033), being employed (OR = 0.15 ; 95% CI= 0.04 to 0.48; p = 0.002), higher patient income (OR = 0.28 ; 95% CI= 0.08 to 0.94; p = 0.039), being insured (OR = 3.06 ; 95% CI= 0.81 to 11.52; p = 0.099), and higher accreditation status of Community Health Care (OR = 2.96 ; 95% CI= 1.03-8.50; p = 0.044).Conclusion: Quality of service at Community Health Care is negatively associated with patient education, being employed, higher patient income, being insured, and higher accreditation status.Keywords: patient characteristic, financing type, accreditation status, quality of servicesCorrespondence: Yeni Tri Utami. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: yenie_03@yahoo.co.id. Mobile: +6285642339053.Journal of Health Policy and Management (2017), 2(1): 79-90https://doi.org/10.26911/thejhpm.2017.02.01.07 
Path Analysis on the Effects of Motivation and Other Factors on Midwives Performance of Preeclampsia Management in Malang, East Java Nicky Danur Jayanti; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Policy and Management Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: The incidences of preeclampsia and eclampsia remain high worldwide. Preeclampsia and eclampsia remain a major cause (31.04%) of maternal mortality in East Java. It is essential to early detect preeclampsia in order to prevent mortality. Good performance of midwives in the management of preeclampsia may reduce maternal mortality attributable to eclampsia. It is hypothesized that motivation, leadership style, working atmosphere, insentive, skill, and training, all have impact on midwives performance. This study aimed to analyze the effects of motivation and other factors on midwives performance in preeclampsia management in Malang, East Java, using path analysis model.Subjects and Method: This was an analytic observational study with cross sectional design. The study was conducted in Community Helath Centers, Malang, East Java in September 2017. A total sample of 161 midwives were selected using total sampling technique. The endogenous variables were motivation and midwives performance. The exogenous variables were insentive, working atmosphere, leadership style, skill and training. The data were collected using a set of questionnaire and analyzed by path analysis.Results: Midwife performance were positively affected by working atmosphere (b= 0.11; SE=0.04; p= 0.004), leadership style (b= 0.06; SE= 0.02; p= 0.004), skill (b= 0.24; SE= 0.03, p<0.001), and motivation (b= 0.68; SE= 0.03; p<0.001). Motivation was positively afected by insentive (b= 0.25; SE= 0.09, p= 0.006), training (b= 0.89; SE= 0.28; p= 0.001), skill (b= 0.39; SE= 0.06; p<0.001), leadership style (b= 0.08; SE= 0.05; p= 0.110), and working atmosphere (b= 0.35; SE= 0.09; p<0.001).Conclusion: Midwives performance are positively affected by working condition, leadership, skill, and motivation.Keyword: preeclampsia, path analysis, motivation, midwives performanceCorrespondence: Nicky Danur Jayanti. Masters Program in Public Heath, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: nicky_daanty@yahoo.co.idJournal of Health Policy and Management (2017), 2(2): 137-146https://doi.org/10.26911/thejhpm.2017.02.02.05
Co-Authors Bhisma Murti Endang Sutisna Sulaeman Endang Sutisna Sulaeman Mardhatillah - Nicky Danur Jayanti Yeni Tri Utami