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Roesbiantoro, Andi
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Description Of Characteristics, Diagnosis And Financing Of BPJS Patients In ENT Poly Health Service Facility Level 2 Roesbiantoro, Andi; Budhi Setianto; Adriansyah, Agus Aan; Pulih Asih, Akas Yekti; Setiyowati, Eppy; Bistara, Difran Nobel; Sa'adah, Nikmatus
TEKNOLOGI MEDIS DAN JURNAL KESEHATAN UMUM Vol 6 No 2 (2022): Medical Technology and Public Health Journal September 2022
Publisher : Universitas Nahdlatul Ulama Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/mtphj.v6i2.3081

Abstract

The application of tariff applied in handling BPJS patients references the INA- CBGs and the payment model used by BPJS Kesehatan to replace the total bill by the hospital. Hospitals receive payments based on the INA- CBGs rate, which is the average cost spent by a group of diagnoses. It is expected to improve the quality and efficiency of hospitals. The benefit of implementing INA -CBGs in JKN is the tariffs in the form of packages cover all components of hospital costs. Cost efficiency efforts must be made. That is no deficit from the applicable INA-CBGS tariff. Quality and cost control efforts are very important in the implementation of ENT specialist poly services. This study aims to analyze the demographic characteristics of the patient, the patient's diagnosis, the difference in rates between INA CBGS payments and RSIS rates, the composition of financing and the Unit Cost of ENT Polyclinics. The research type is quantitative observational with cross-sectional design. The research location is at the Surabaya Islamic Hospital with BPJS TXT data, processing in January-December 2019. The results showed, the demographic characteristics of most patients were > 50 years old, and most of them were diagnosed with minor chronic diseases. The difference between Ina-CBGS payments and RSIS rates is Rp. 60,174 which means that each patient contributes a profit of Rp. 60,174. The composition of the financing for implementation of the ENT Polyclinic is the cost of consulting services. The unit cost of ENT Polyclinic patients is Rp. 132,774 per patient.
Analysis of The Effect of INA CBGs Diagnoses on Costs in Outpatient THT Specialist Poly Hospital X Surabaya Roesbiantoro, Andi; Aan Adriansyah, Agus; Dany Afina, Rizka; Sa'adah, Nikmatus; Setianto, Budhi
Jurnal Ilmiah Kesehatan Vol 18 No 01 (2025): Jurnal Ilmiah Kesehatan (Journal of Health Science) 
Publisher : Universitas Nahdlatul Ulama Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/jhs.v18i01.6437

Abstract

BPJS Kesehatan will pay to advanced referral Health Facilities. BPJS Kesehatan pays with the INA CBG's (Indonesia Case Base Groups) package system. INA CBGs is a payment system with a package system based on the diseases suffered by patients (1) knowing the disease pattern in the ENT-KL Polyclinic of RSX Surabaya, (2) calculating the unit cost of the 10 most common diseases, (3) calculating the relationship between age range and INA CBGs coding on drug costs using the relationship test. The method used in this research is a retrospective descriptive study. The population and sample of this study were BPJS patient data. The type of data used was TXT secondary data in the outpatient ENT clinic. The type of data used is secondary data from BPJS patient, the total sample was a population of 750. The data was processed using Chi-Square. From this study, it was found that most of the BPJS patients of the ENT Poli of X Hospital were male, with the highest age range being at the age of 51 - 55 years, with the INA CBGs coding being Q - 5 - 44 - 0 with the diagnosis of Tinnitus / Ringing in the ears with the total average difference per patient against hospital tariff financing compared to the INA CBGs Tariff was 83,593. There is a relationship between the Age Range and INA Cbgs coding on the funding in the Pharmacy Unit, which is ENT.
Evaluation of InaCBGs Tariffs for BPJS Outpatient Patients as an Effort to Control Quality and Costs at the ENT Outpatient Clinic of Surabaya Islamic Hospital Roesbiantoro, Andi; Setianto, Budhi; Adriansyah, Agus Aan; Afina, Rizka Dany; Kusumawati, Diah Retno; Sa'adah, Nikmatus
Jurnal Ilmiah Kesehatan Vol 18 No 03 (2025): Jurnal Ilmiah Kesehatan (Journal of Health Science) 
Publisher : Universitas Nahdlatul Ulama Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/jhs.v18i03.7883

Abstract

This study aims to analyse shifts in demographic profiles and the distribution of BPJS healthcare service financing at the ENT Polyclinic of Surabaya Islamic Hospital from 2023 to 2024. Data indicate an increase in the proportion of adult and elderly patients, as well as a dominance of female patients. Additionally, there has been a change in the financing structure: the proportion of consultation costs has decreased, while expenditures on nursing, medications, and equipment rental have increased. The analysis of the difference between hospital tariffs and INA-CBGs claims indicates improved efficiency despite a decrease in the number of cases. The urgency of this study lies in the hospital's need to adapt to changes in patient characteristics, which are increasingly dominated by the elderly with chronic disease risks, potentially increasing the cost burden. This situation is relevant to national challenges in maintaining the sustainability of the JKN scheme and improving service quality based on accreditation. The results of this study are expected to serve as a basis for developing more adaptive service management strategies, emphasizing the strengthening of primary care, chronic disease control, and the implementation of an integrated health information system to ensure cost efficiency and service quality.
Co-Authors Afina, Rizka Dany Agus Aan Adriansyah Budhi Setianto Budhi Setianto Dany Afina, Rizka Difran Nobel Bistara Kusumawati, Diah Retno Nikmatus Sa’adah Pulih Asih, Akas Yekti