RESPON RUMAH SAKIT SWASTA SOSIAL KEAGAMAAN TERHADAP ASURANSI SOSIAL: STUDI PENANGANAN KASUS MATERNAL DI RUMAH SAKIT NUR HIDAYAH BANTUL, YOGYAKARTA

Arrus Ferry (Minat Manajemen Rumah Sakit, Fakultas Kedokteran, UGM UGM Yogyakarta,)
Mubasysyir Hasanbasri (Departemen Kebijakan dan Manajemen Pelayanan Kesehatan,Fakultas Kedokteran, UGM)
Mohammad Hakimi (Departemen Kebijakan dan Manajemen Pelayanan Kesehatan,Fakultas Kedokteran, UGM)

Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management)
Vol 19 No 1 (2016)

Background: The difference between the hospital real cost andthe tariff of INA-CBGs has negative impact on hospital causesfinancial losses, especially private hospital. The potential for thisloss is likely to encourage hospitals to establish a strategy tominimize losses. There are some distortions induced by theprospective payment system i.e. up-coding, cream skimming,readmission, and unbundling. Objective: The aim of this study was to determine Nur Hidayahhospital behaviour in response to INA-CBGs practice inmaternal management. Methods: This study was a quantitative research uses a casestudy approach. Secondary data from medical records, socialinsurance claim documents, records or reports regardingmaternal care and the regulation of social insurance services inthe period of January-June 2014 were use as the data sourcesof this study. Results: There was no evidence to support the practice of upcoding,cream skimming, readmission and unbundling inmaternal care at Nur Hidayah Hospital. Nur Hidayah Hospitalimplemented efficiency strategies and anti-fraud & abuse todeal with social insurance schemes. Conclusion: The INA CBGs-based payment resulted inincreased efficiency of the maternal care in Nur HidayahHospital.