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All Journal Maksimum : Media Akuntansi Universitas Muhammadiyah Semarang Media Kesehatan Masyarakat Indonesia Health Science Journal of Indonesia Jurnal Kebijakan Kesehatan Indonesia ADVANCE Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Jurnal Online Mahasiswa (JOM) Bidang Keguruan dan Ilmu Pendidikan Jurnal Kesehatan Masyarakat (JKM) CENDEKIA UTAMA JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) PENELITIAN DAN KARYA ILMIAH Syntax Literate: Jurnal Ilmiah Indonesia PENTAS : Pendidikan Bahasa dan Sastra Indonesia Jurnal Organisasi Dan Manajemen Media Kesehatan Politeknik Kesehatan Makassar Jurnal Ilmu Kesehatan Masyarakat (The Public Health Science Journal) Proceedings of the International Conference on Applied Science and Health Journals of Ners Community Jurnal Keperawatan Respati Yogyakarta Media Karya Kesehatan Magisma: Jurnal Ilmiah Ekonomi dan Bisnis J-Kesmas: Jurnal Kesehatan Masyarakat (Indonesian Journal of Public Health) Grouper: Jurnal Ilmiah Perikanan Jurnal Medika Hutama Jurnal Inovasi Penelitian Jurnal Sibernetika Jurnal Kesehatan Tambusai AN-Nur: Jurnal Kajian dan Pengembangan Kesehatan Masyarakat Jurnal Riset Manajemen dan Bisnis Media Publikasi Promosi Kesehatan Indonesia (MPPKI) Jurnal Teknologi Kesehatan Journal of Islamic Economics and Finance PEKBIS Berita Kedokteran Masyarakat Jurnal Penelitian dan Karya Ilmiah Lembaga Penelitian Universitas Trisakti Journal of Islamic Economics and Finance Jurnal Penelitian Pendidikan Indonesia Neurona Jurnal ARSI : Administrasi Rumah Sakit Indonesia Journal of Indonesian Health Policy and Administration Equilibrium Point : Jurnal Manajemen Bisnis Jurnal Ekonomi Kesehatan Indonesia
Nurwahyuni, Atik
Departemen Administrasi Dan Kebijakan Kesehatan, Fakultas Kesehatan Masyarakat, Universitas Indonesia
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ANALISIS CASE MIX INDEX PELAYANAN RAWAT INAP RUMAH SAKIT YANG BEKERJA SAMA DENGAN BPJS KESEHATAN TAHUN 2019-2020 Ambarita, Anna Tirawani; Nurwahyuni, Atik
Jurnal Ekonomi Kesehatan Indonesia Vol. 8, No. 2
Publisher : UI Scholars Hub

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BPJS Health experienced various challenges in achieving Universal Health Coverage / Jaminan Kesehatan Nasional (JKN), including a referral system. According to the 2018 National Health Account, curative spending costs reached 69.1%. The Case Mix Index (CMI) is a benchmark for hospital performance abroad, but Indonesian hospitals have not used it. In 2019, BPJS Health tested CMI in 30 hospitals. The research uses sample data from 2019-2020 based on province, hospital type and ownership. The methods used are anova test, independent T, linear regression and multiple linear regression. The research results show a decrease in cases in 2019-2020. The highest CMI was in region 1, hospital A, and the private sector. The beta coefficient value for the proportion of male gender, elderly age, PBI APBD participants, and class 1 is greater than for CMI. CMI inpatients in 2019 is related to region, type of hospital, hospital ownership, proportion of children, proportion of productive, proportion of elderly, proportion of BP, proportion of PBI APBN, proportion of PBI APBD, proportion of PBPU, and proportion of class 1. CMI of inpatients in 2020 related to region, type of hospital, hospital ownership, proportion of men, proportion of women, proportion of children, proportion of productive, proportion of elderly, proportion of BP, proportion of PBI APBN, proportion of class 1, and proportion of class 3. It is hoped that the government will accelerate the distribution of services health and BPJS Health monitor hospital CMI.
BIAYA PENGOBATAN PASIEN RAWAT INAP COVID-19 DI RUMAH SAKIT X TAHUN 2021 Giusman, Reli; Nurwahyuni, Atik
Jurnal Ekonomi Kesehatan Indonesia Vol. 7, No. 2
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The COVID-19 pandemic has caused various hospitals in the world to experience difficulties in providing services because the number of patients has soared in a short time. The widespread pandemic with high mortality in various parts of the country has resulted in high hospitalizations for patients due to COVID-19, so the cost of treatment has also increased. The purpose of this study was to analyze the cost of treating COVID-19 inpatients at Hospital X. The data used is secondary data derived from INACBG's data and medical records as many as 1,196 samples in the period August 2020 to April 2021. Statistical tests using the Mann Whitney Test, Kruskal Wallis Test and Spearman Test. The results showed that the average cost of treating COVID-19 inpatients at X Hospital was Rp.43,595,339.94. The difference between the real cost of treating COVID-19 inpatients with a positive claim fee of Rp. 48,622,313.07. The factors that influence the increase in the cost of treatment for COVID-19 inpatients at Hospital X are advanced age (> 60 years), male gender, higher education level, severity with moderate symptoms, having co-morbidities, length of stay, discharge status with recovery, the Doctor in Charge of the Patient (DPJP) is a lung specialist and collaboration of doctors > 3 doctors.
Analisis Minimalisasi Biaya Obat Antihipertensi antara Kombinasi Ramipril-Spironolakton dengan Valsartan pada Pasien Gagal Jantung Kongestif di Rumah Sakit Pemerintah XY di Jakarta Tahun 2014 Rahmawati, Cyntiya; Nurwahyuni, Atik
Jurnal Ekonomi Kesehatan Indonesia Vol. 1, No. 4
Publisher : UI Scholars Hub

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Hypertension is one of risk factors for congestive heart failure as the top 10 most prevalent diseases in XY Public Hospital in 2014. It has a large number of total cost and cost deviation between hospital and JKN rate. This study aimed to choose an alternative that is more cost-effective to treat congestive heart failure at XY Hospital in 2014. This was a quantitative research using retrospective cross-sectional analysis. The study compared the average value of total cost of two alternative treatments, ramipril-spironolactone with valsartan by using Hospital’s perspective. Direct medical cost components were cost of drugs, cost of physicians’ services and cost of hospitalizations. This study found that: (1) The average total cost of ramipril-spironolactone was Rp.2.527.743; whereas the average total cost of valsartan was Rp.2.430.923; (2) Ramipril-spironolactone’s effectiveness was not significantly different from valsartan; (3) There was cost saving on the average of total cost using valsartan’s drug as many as Rp96.820 per patient; (4) There was cost saving on hospitalization cost using valsartan’s drug for Rp299.031 per patient. Valsartan provided the lowest value and more cost-effective than ramipril-spironolactone for patient with congestive heart failure.
Analisis Klaim Rawat Inap RSUD Kebayoran Baru November 2022 – April 2023: Pendekatan Sistem Rabiulyati, May; Nurwahyuni, Atik; Pujiyanto, Pujiyanto
Jurnal Ekonomi Kesehatan Indonesia Vol. 9, No. 1
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Hospitals receive payments through claim submissions with complete documents to the Social Security Administering Agency (BPJS) Health. However, not all inpatient claims have been submitted to BPJS Health, and there are still 16.97% pending inpatient claims. In claims that are not approved, claims can be resubmitted, but time constraints for the claim process have resulted in 2.64% of inpatient cases in 2022 not resubmitted. Qualitative research through in-depth interviews with 15 respondents aims to analyze the management of inpatient claims for BPJS Kesehatan Kebayoran Baru Hospital from November 2022 to April 2023. The study results showed that not all printed Participant Eligibility Letters (SEP) have been submitted for inpatient claims. There were 10.97% pending claims, with the cause being incomplete doctor's medical resumes for 59 inpatient files (32.2%) and inconsistencies in submitting claim files for 81 inpatient files (44.3%). This is due to the suboptimal feedback and monitoring, so it is necessary to establish a claim management monitoring flow. Hospitals must also establish Standard Operating Procedures (SOP) for integrated claim management. This study is expected to be a strategic guide to improve BPJS Kesehatan claim management with Focus Group Discussion (FGD) efforts for collaboration between agencies/units/teams and better cooperation between hospitals and BPJS Kesehatan. All solutions implemented are expected to improve the quality of hospital claims.
Inpatient Readmission Insidence of National Health Insurance Patients at Partner Hospitals of BPJS-Health in Sukabumi 2015 Atmiroseva, Atmiroseva; Nurwahyuni, Atik
Journal of Indonesian Health Policy and Administration Vol. 2, No. 2
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The INA-CBG payment system in the JKN program allegedly increasing the incidence of readmission. This study aims to map the incidence of readmission in JKN participants admitted to thirteen partner hospitals of BPJS-Health in Sukabumi. The research design is a descriptive study with the unit of analysis is patient. The study used secondary data from inpatient claims in thirteen partner hospitals BPJS-Health Sukabumi which has been verified during 2015. The study found that the number of readmission is 8.81% with the most readmission incidence occurs in the equal CMG category and at the least in the equal severity level category. The cost of inpatient readmission services is more expensive 104-113% of the initial care cost. Moreover, about 15- 16% cases of severity level readmission is increasing and 12-13% of its severity level is decreased. Less than 3% cases of readmission ended not good because they died, were referred, or had to come home forcibly.
Policy Content Analysis in Minister of Health Regulation Number 15 of 2016 about Hajj Health Istithaah Idris, Salman Mauluddin; Nurwahyuni, Atik
Journal of Indonesian Health Policy and Administration Vol. 9, No. 2
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Indonesia has the world's largest Muslim population and sends the most pilgrims to Saudi Arabia. The Hajj Health Istithaah Policy in Minister of Health Regulation Number 15 of 2016 is the government's effort to carry out health screening for pilgrims before leaving so that they can perform the Hajj in a healthy and independent condition. This research was conducted using a qualitative approach by collecting data through in-depth interviews and document reviews. In this study, Walt and Gilson's Policy Triangle Model was used as a reference for reviewing the Hajj health istithaah policy, especially in the content section of the document and its implementation. The aspects reviewed are the harmonization and relevance of policy content and implementing regulations for the Hajj pilgrimage. Monitoring and evaluation are carried out to monitor the progress and development of policies. Revisions and simplifications of the substance of the policy based on the results of discussions and suggestions from stakeholders are used as input to make improvements to the content of the Hajj health istithaah policy. The conclusion of the review results shows that the policy has been implemented correctly from the center to the regions; research recommendations need revision and simplification of the substance of the Hajj Health Istithaah Policy, as well as other efforts so that pilgrims can achieve health istithaah conditions before leaving to perform the pilgrimage in Saudi Arabia.
Evaluasi KPI Terhadap Maturitas BLU: Studi Kasus Poltekkes Pontianak dan Poltekkes Surakarta Rybob Khomes; Atik Nurwahyuni
Jurnal Teknologi Kesehatan (Journal of Health Technology) Vol. 21 No. 1 (2025): 1
Publisher : POLTEKKES KEMENKES YOGYAKARTA

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Abstract

This study aims to evaluate the indicators on the KPI towards the maturity level of the Public Service Agency (BLU), especially the financial and service aspects at the Poltekkes Kemenkes Pontianak and Poltekkes Kemenkes Surakarta. This study is a continuation of the author's previous research entitled "Correlation between Financial Performance and Service Performance to BLU Maturity at Poltekkes Kemenkes 2021 - 2023". This study uses a qualitative method with a case study approach. The data used are the KPI achievements (financial performance and service performance) of Poltekkes Kemenkes Pontianak and Poltekkes Kemenkes Surakarta in 2021 - 2023 and the maturity value of BLU Poltekkes Kemenkes Pontianak and Poltekkes Kemenkes Surakarta in 2021 - 2023 with the assessment aspects: finance and service, this study also uses statistical test data from previous studies. This study uses an in-depth interview approach with stakeholders and secondary data analysis. The results of the study show that although the KPI achievements at Poltekkes Pontianak and Poltekkes Surakarta have mostly reached the target, the level of BLU maturity in the financial aspect at both Poltekkes is still low, namely in the range of 1.50 - 2.97, meaning it is still at level 1 and level 2, so recommendations are needed to improve KPI indicators in financial performance to truly support BLU maturity.
Analisis Klaim Pending, Verifikasi dan Audit Pascaklaim Jaminan Kesehatan Nasional Ulil Amri, Anugrah Aulia; Nurwahyuni, Atik
Jurnal Ekonomi Kesehatan Indonesia Vol. 9, No. 2
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Abstract

The implementation of Indonesia’s National Health Insurance (JKN) poses new challenges for hospitals as service providers. Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, the program’s administrator, now routinely conducts post-claim verifications and audits after claims have been paid. This often results in claim adjustments or even full reversals of previously reimbursed amounts. This case study examines JKN claim management at a Type D General Hospital in 2022, focusing on pending claims, verification, and post-claim audits, using a systems theory framework. Key issues in pending claims include incomplete medical records (29%), insufficient supporting documents (24%), and coding errors (21%). Post-claim problems primarily stem from problematic service episodes (39%), coding errors (31%), and incomplete medical records (22%). These challenges arise from systemic issues in the hospital's JKN claim management, necessitating improvement. Recommendations emphasize internal hospital reforms, including enhanced training programs, improved communication with leaders, accurate ICD-based diagnoses and procedures, redesigned medical record formats, and the development of electronic medical records. The study also suggests appointing functional medical staff, training for Medical Committee Chairs, and advocating for budget allocation. Furthermore, the study recommends that the Health Office improve inter-agency coordination and provide constructive input to the government regarding BPJS Kesehatan’s post-claim audit practices, which often deviate from regulations. Enhancing the BPJS Kesehatan application is also necessary to establish a more effective feedback mechanism for addressing JKN claim issues.
Co-Authors ', Gusnardi ', Sumarno Adang Bachtiar Adik Wibowo Ahmad Sulaiman Alwahdy Alexsander Putra Ambarita, Anna Tirawani Amelia Intan Andre Yunianto Anis Sakinah Utami Anna Tirawani Ambarita Annathasia Annathasia Asri Hikmatuz Zahroh Athiyah, Athiyah Atmiroseva, Atmiroseva Ayu Novia Kurnia Ayunda Oktavia Bagas Yushila Tamami Rizqo Baros, Wan Aisyiah Benjamin Saut Budi Safari Cicih Opitasari Citra Jaya Cyntiya Rahmawati Cyntiya Rahmawati Daeli, Widi Astutty Casimira Damayan, Anak Agung Istri Agung Sri Stuti Daruki, Maria Wahyu Dedy Revelino Diah Fitri Novita Sari Diah Melly Marlyana Dian Agnesa Sembiring Dian Elawati Dibyo Iskandar Dilla Syamola Dini Karwati Djoko M Hartono Donny Hamid Dwi Budi Prastiani Endah Sih Prihatini Erdayani Erdayani Ery setiawan Ery Setiawan Setiawan Erzan Dhanalvin Estherlina Sitorus Euis Nurjannah Evie Ni'matunnisa Fachmi Idris Fadliyah, Hilyatul Fadllil Kaafi Fahminur ' Faisol Mas’ud Faisol Masud Farianti, Yuli Febriadi, Yudi Felicitas Nia Aryani Firda Jusela Fitri Octaviana Fredinan Yulianda Fuquh Rahmat Shaleh Gani Haryana Garaika Genoveva Maditias Dwi Pertiwi Gimin Gimin Giusman, Reli Gusnardi ' Heny Hendrayati Hilyatul Fadliyah Ida Bagus N Maharjana Idris, Salman Mauluddin Ika Purnamasari Jawanri Citra PS Kurnia Sari Kurnia, Ayu Novia Latanza Shima Lestari, Erna Madya, Sri Denti On Mangunsong, Emmy Ridhawaty Marshia Rehatalanit Megraini, Amila Mirza Aulia Moch Saad, S.Pi.,M.Si Mochamad Achyarsyah Muhammad Lian Kautsar Mukhlisa, Mazda Novi Mukti Ali Mundiharno Mundiharno Nadjib, Mardiati Natalia Melani Nia Priyatiningsih Nurhabibah Nurhabibah Pantri Widyastuti Pantri Widyastuti Pradya Rafthudyanti Prastuti Soewondo Pujiyanto Pujiyanto Pulungan, Nopiana Pusposari Purwoko Rabiulyati, May Rasinta Ria Ginting Rejeki, Vera Marietha Meinar Reli Giusman Renindra Ananda Aman Rina Selva Johan Rira Martaliza Rizki Asriani Putri Rudi Suryo Kristanto Rybob Khomes Sakdanur Nas Salman Mauluddin Idris Sayekti, Sekar Arum Handarbeni Sembiring, Dian Agnesa setyo Pantawis Silvia Vinawaty Soetedja Simbolon, Joni Pranata Sri Denti On Madya Sri Denti On Madya Suarman ' Suci Atiningsih Suherman, Suherman Suryana Suwedia, I Nyoman Gede Bayu Wiratama Tetriadi Tetri Tetriadi Tetriadi, Tetriadi Tetriyadi, Tetriyadi Tiara Aninditha Tri Priyo Anggoro Tri Priyo Anggoro Ulil Amri, Anugrah Aulia Vera Marietha Meinar Rejeki Wahyudi, Chandra Tri Wahyuni, Asri Nur Wahyuningsih, Helmi Wan Aisyiah Baros Widi Astutty Casimira Daeli Widi Astutty Casimira Daeli Widyastuti, Pantri Widyatutti Widyatuti Winnugroho Wiratman, Manfaluthy Hakim, Tiara Aninditha, Aru W. Sudoyo, Joedo Prihartono Yenni Khristiana Yesi Astri Yohanes Fery Cahaya Yuliani Yuliani Yunavita Uzzie Elsanti Yunita Yunita Zahrul Arief Intasar