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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.
Analysis of Patient Characteristics, Financing of Actions and Diagnosis of Disease in BPJS Patients Syagran, Evy; Setianto, Budhi; Adriansyah, Agus Aan; Setiyowati, Eppy; Sa'adah, Nikmatus
Journal for Quality in Public Health Vol. 5 No. 1 (2021): Journal for Quality in Public Health
Publisher : Master of Public Health Program Institut Ilmu Kesehatan STRADA Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30994/jqph.v5i1.225

Abstract

Background: Dental and oral health services are a form of professional service that is an integral part of health services for the community, families or individuals3. Implementation of a dental specialist clinic at the 2nd health facility is a referral from the health facility 1 All financing is borne by BPJS with INA CBGS financing. Purpose: This study aims to determine patient characteristics and disease diagnosis of BPJS patients in specialist dental clinic in Islamic Hospital Surabaya. Methods: This study used a qualitative research method with a descriptive analytic study. From the BPJS TXT data for January - December 2019, there were 7153 patient visits at the dental specialist clinic of the Islamic Hospital in Surabaya, the TXT data is data issued by the BPJS as a result of purification of billing file data recognized by the BPJS. Results: Based on the results of the study, it was found that most of the patients were male, with the largest age ranges being <25 years and> 50 years. The implementation of the tariff difference between INA CBGS and the fare difference of the Islamic Hospital in Surabaya is - 128,091,924 with an average of - 17,907 / patient. Of the total TXT, the largest financing of the INA CBGS tariff is the doctor service rate with a percentage of 54.90%. Conclusion: the implementation of BPJS examination of specialist dental polyclinic at RS Islam Surabaya did not give the maximum benefit.
Co-Authors Abd Ghafar, Siti Aisyah Afina, Rizka Dany Agus Aan Adriansyah Ahda Mas Ulah Ahda Mas Ulah Aizatun Nisa Akas Yekti Pulih Asih Andi Roesbiantoro Anggarwati, Fauziah Rizki Annisa Putri Arindis, Pinky Ayu Marsela Asmarani, Yolanda Kartika Asri, Arilis Larasati Ode Bagus Soebadi Binti MU’AROFAH Budhi Setianto Budhi Setianto Chasanah, Niswatun Dany Afina, Rizka Diffran Nobel Bistara Difran Nobel Bistara Dita Eri Triana Dwi Indah Pertami, Sawitri Effendi Effendi Effendi Effendi Effendi Effendy Effendy Eka Putri Pertiwi Eka Resti Efrata Elyana Asnar Endah Kusumastuti Eppy Setiyoati Eppy Setiyowati Evy Afifah Syagran Evy Afiyah Syagran Evy Afiyah Syagran Gadis Meinar Sari Gustina, Mara Hartatiek Nila Karmila Hartatiek Nila Karmila Hartatik Nila Karmila Hening Tuti Hendarti Herlambang Prehananto Herlambang Prehananto Herlambang Prehananto, Herlambang Ida Wahyuningsih Indah Lestari Indah Lestari Indah Lestari, Indah Iqbal Firdaus Iqbal Firdaus Istiati, Istiati Karmila, Hartatik Nila Kombih, Muhammad Fifin Kusumawati, Diah Retno Lailatul Arofah, Nur Lukis, Prima Agusti Mahayatma Soendoro Makki Makki Maya Purnia Sari Merry Susantri Mery Susantri Moelok, Iqbal Moch Muhammad Zahid Abdillah Multia Ranum Sari Nailah Tri Iswira Nashifah, Nur Sa'adah Nathalya Dwi Kartika Sari Niswatun Chasanah Niswatun Chasanah Niswatun Chasanah Nur Dianawati Nurul Jannatul Firdausi Pertami, Sawitri Dwi Indah Pinky Ayu Marsela Arindis Pinky Ayu Marsela Arindis Pulih Asih, Akas Yekti Puspa Dila Rohmaniar Puspa Dila Rohmaniar Ricky Ramadhan Rizka Dany Afina Rizki Astri A Rizqullah, Widaad Roesbiantoro, Andi Rohmaniar, Puspa Dila Rudi Irawan Rusdianingsih Rusdianingsih Sari, Ernita Sawitri Dwi Indah Pertami Sawitri Dwi Indah Pertami Sawitri Dwi Indah Pertami Sholihah, Mufidatus Silvia Veronica, Silvia Siti Mutmainah Suyitno Suyitno Syagran, Evy Thoifur Mashudi Tuti Hendrarti, Hening Ulah, Ahda Mas Umi Hanik Umi Hanik Umi Hanik Wahyu Eka Kurniawan Wisnu Abiarto N Yauwan Tobing Lukiyono Yuliani, Kartika