ANALISIS SELISIH TARIF RILL RUMAH SAKIT DAN TARIF INA-CBGs PASIEN RAWAT JALAN DI RUMAH SAKIT X

Abstract

Health Insurance is a government program aimed at fulfilling the basic healthcare needs of the community. The principles governing its implementation are mutual cooperation, non-profit, portability, and mandatory participation. The National Health Insurance Program, which is expected to improve the welfare of the community's health, has, in reality, led to an increase in the number of patients. Hospitals have experienced a decline in service quality, and differences in payment systems have resulted in tariff discrepancies. The research aims to determine the disparity between hospital rates and INA-CBGs rates. The method employed in this research is the Qualitative Observational method. The population in this research consists of 47,774 cases from a total of five ICD-X diagnoses, with a sample size of 100 patients for each diagnosis. The research outcomes indicate that 293 (58.6%) patients resulted in negative differences, while 207 (41.4%) patients had positive differences. The difference between hospital rates and INA-CBGs rates with a negative gap was observed in the diagnosis of Gonarthrosis [arthrosis of the knee] amounting to Rp. 1,514,147 (3.06%),  Hyperplasia of prostate Rp.27.318.983 (38,21%), Stroke, not specified as haemorrhage or infarction Rp. 2.789.859 (7,09%), Congestive heart failure Rp. 12.284.098 (23,01%). And the hospital rate that yielded a positive difference is Respiratory tuberculosis, not confirmed bacteriologically, amounting to Rp. 10,036,038 (34.76%).