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All Journal Jurnal Ekonomi Kesehatan Indonesia Jurnal Kesehatan Masyarakat
Baros, Wan Aisyiah
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Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Health Professions Medicine & Pharmacology Public Health

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Sistem Pembayaran Mixed Method INA-CBGs dan Global Budget di Rumah Sakit: Tahap 1 Uji Coba Mixed Method INA-CBGs-Global Budget di Indonesia Idris, Fachmi; Nurwahyuni, Atik; Baros, Wan Aisyiah
Jurnal Ekonomi Kesehatan Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Abstract

When it comes to provider payment system, no one shoe fits all including DRG payment system which in Indonesia are known as INA-CBGs. In some countriesthat used DRGhave mixed it with Global Budget in various mechanisms to maintain the sustainability of the national health insurance system in their countries. BPJS Kesehatan initiated a three-stage pilot study on the implementation of the mixed-method hospital payment system INA-CBGs and Global Budget starting in 2018. The first stage is the Non-Risk stage which aims to test the accuracy of the global budget calculation and prediction and to identify the challenges faced when the mixed-method payment is implemented. The pilot was conducted in 5 districts in 30 hospitals. Initial results show that the calculation and prediction method is accurate to predict the actual hospital claims in the following year. The calculation of the global budget at the district level is more accurate than the hospital level because it accommodates patient transfer from one hospital to another due to changes in hospital capacity. Changes in hospital capacity in the current year and the COVID-19 pandemic requires some adjustments to the budget calculation.
Contracts between Referral Health Facilities and Social Health Insurance in Indonesia and England Puspandari, Diah Ayu; Rimawati, Rimawari; Aristianti, Vini; Fadlika, Findri; Septiani, Trisna; Ruby, Mahlil; Wibowo, Mulyo; Febriyanti, Maya; Siregar, Dedy Revelino; Baros, Wan Aisyiah; Manurung, Kathrina
Jurnal Kesehatan Masyarakat Vol. 20 No. 3 (2025)
Publisher : Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v20i3.21231

Abstract

Purchasers and providers are important in providing quality health services for participants. This is formally regulated through a contractual mechanism to achieve the potential benefits of strategic health purchasing (SHP) and ensure effectiveness, efficiency, and quality. The experience of contracting with providers differs in each country due to underlying determinants. This study aims to identify differences in contracts between referral health facilities and social health insurance in Indonesia and England. A normative legal research approach is used, utilizing secondary data sources such as literature, regulations, and contractual arrangements. Important clauses in the contract, such as rights and obligations, service tariff setting, agreement period, monitoring and evaluation, settlement of expired or disputed claims, mechanisms for providing information, and handling complaints, have been regulated in contracts in both Indonesia and England. Unlike the case in England, incentive payment policies have not been further regulated in Indonesia’s contracts. Additionally, notification and communication procedures for the parties involved have been integrated into the system in England. It is expected that learning from the NHS contracts will provide the potential for developing a more ideal contract implementation, effective monitoring and evaluation, and the delivery of optimal and high-quality health services.
Co-Authors Fachmi Idris Fadlika, Findri Febriyanti, Maya Manurung, Kathrina Nurwahyuni, Atik Rimawati, Rimawari Ruby, Mahlil Septiani, Trisna Siregar, Dedy Revelino Vini Aristianti, Vini Wibowo, Mulyo