BEKASI IN 2021

Taufiq, R. Fresley Hutapea, Muhammad Fachruddin Arrozi Adhikara

Universitas Esa Unggul

Email: taufiq.abakar@gmail.com, freslayhutapea@yahoo.com, arrozi@esaunggul.ac.id

Introduction

In Indonesia, health has not become a

top priority for state administration. Policy-

wise, the health budget in Indonesia for 40

years has never been more than 3% and this

amount is still below the budget for fuel and

electricity which reached six times (Arfiani &

Fahlevi, n.d.) . The health services needed by

most residents are high quality and low cost.

Taufiq, R. Fresley Hutapea, Muhammad Fachruddin Arrozi Adhikara

which have great potential but have not been

used optimally, large public funds are mostly

used to finance out-of-pocket treatment, the

role of the business world that has not been

explored, the amount of the health budget

which is small (only 2.9% of the APBN,

compared to the WHO standard of 5%).

The National Health Insurance

Program (JKN) was launched on January 1,

2014. This JKN is a guarantee in the form of

Administration (BPJS), which is a change

from PT ASKES. The hospital as an

advanced level referral health facility is one

of the important components for health

service providers and providers in the

implementation of the JKN program. The

JKN program is part of public policy as a

result of the good will of the Government.

The success of the Government's program in

JKN depends, among other things, on the

Advanced Level Health Facilities in the

implementation of the Health Insurance

Program, the payment method to first level

health facilities is pre-employed based on a

capitation of the number of participants

registered at the health facility. For health

services provided to participants by advanced

level referral health facilities, BPJS

Kesehatan makes payments based on the

groupings. INA-CBG's tariffs have 1,077

tariff groups consisting of 789 group

codes/inpatient groups and 288 outpatient

group codes. By using the INA-CBGs system,

the calculation of service rates is more

objective based on the actual costs. Through

INA-CBG's, it is expected to improve the

quality and efficiency of hospitals.

hospital located in Bekasi Regency. As one of

lowest possible use of resources with optimal

results. The number of visits to Tarumajaya

Hospital was dominated by outpatients

compared to inpatients. This is known from

secondary data from the Tarumajaya

Hospital. (Denzin, 2017)This shows that

customers are more interested in outpatient

units which are also one of the entrances to

inpatient care.(Arikunto, 2013)

Hospital and BPJS, the number of insured

patients exceeds the number of general

patients. Even though the management sees

that there are still many local residents who

do not have guarantees and usually seek

treatment by means of public payments. The

hospital also sees that there are still many

potential potential customers for at least the

next two years.(I. Aulia et al., 2018)

Implementation Analysis Of Ina-Cbg's Claims Implementation Of Quality Control And Cost

of general patients who seek treatment at their

own expense is felt to be very small

compared to JKN. Based on BOR (Bed

Occupation Ratio) data from 2017 to 2019

showing a fluctuating trend, the highest BOR

occurred in 2017 which showed an

achievement rate of 50.01% and the lowest

was in 2019 which showed a figure of

44.35%. The average BOR for the last 5 years

has been around 46.34%, the BOR in 2015

bed had fluctuated, the worst condition

occurred in 2018 which was 3.3 days and the

best condition in 2019 was 2.80 days. The

national standard ranges from 1±3 days.

the JKN era basically consisted of the

interaction of three parties, namely: (1) BPJS,

(2) health service providers which included

health service facilities and their health

workers and (3) patients as part of the

service for specialists in forensic medicine

and medicolegal who so far have the ability to

analyze medico-etholegal and expert

opinions/opinions in forensic evidence of

crimes involving the human body. In the era

of National Health Insurance (JKN), hospitals

cooperate with the Social Security

Administering Agency (BPJS), so that in

providing health services, quality control and

CBG's Claims on Quality Control and Cost

Control at Tarumajaya Hospital, Bekasi

City."(Bustami, 2011)

Presidential Regulation No. 12 of 2013 that

the implementation of the National Health

Insurance requires quality, affordable, and

safe health services which are carried out

helping the community reduce health costs

from their own pockets out of pocket, in

difficult amounts. For this reason, guarantees

are needed in the form of health insurance

because participants pay premiums at a fixed

amount. Thus, health financing is borne

jointly by all participants, so it is not

burdensome on an individual basis. The

National Health Insurance (JKN) developed

in Indonesia is part of the National Social

application. The INA CBG's application

replaces the function of the INA DRG

application which was then used in 2008 to

manage financing. Implementation of JKN

with the INA CBG's system is one of the

important instruments in submitting and

paying claims for health care payments that

have been carried out by FKRTL in

collaboration with BPJS Health, so the

Taufiq, R. Fresley Hutapea, Muhammad Fachruddin Arrozi Adhikara

methods used, namely the retrospective

payment method and the prospective payment

method. Retrospective payment method is a

method of payment made for health services

provided to

provided, the more health services provided,

the greater the cost to be paid. Prospective

Perdiem, capitation and case based payments

(Permenkes No. 76, 2016), (D. Aulia et al.,

2017).

Implementation Analysis Of Ina-Cbg's Claims Implementation Of Quality Control And Cost

of JKN. INA-CBG claims have a

variables implementing the JKN Claims INA-

CBGs and cost control. Second, there are

three instruments used to obtain research data,

namely: (1) Implementation of JKN Claims

INA-CBGs (X1), (2) Quality Control (Y1),

and (3) Cost Control (Y2). The three

variables in terms of terminology and

scientific understanding are difficult to stand

alone so that the answer to one variable in the

respondent's mind is usually related to other

understood as data developers (data

enhancers). When the data is developed, it

will be possible to see the key aspects of a

case more clearly (Neuman, 2016).

Qualitative methods cause the scope of

research cannot be generalized in general.

Neuman explained that the nature of

qualitative research data is soft data in the

form of impressions, words, sentences,

photographs, symbols, and so on (Neuman,

things are in the object of research than to

determine how many things are in it.

Qualitative researchers use a transcendent

perspective, apply logic in practice, and

follow a non-linear research flow. They

emphasize the conduct of detailed case

examinations that arise in the natural flow of

social life. Qualitative researchers usually try

to present sensitive authentic interpretations

Taufiq, R. Fresley Hutapea, Muhammad Fachruddin Arrozi Adhikara

the needs of the respondent and the nature of

the subject being studied. Data were obtained

from a limited number of individuals, so that

data analysis was more interpretive, explicit,

creative, and personal. In other words, the

qualitative approach is more concerned with

the individual's understanding of the meaning

of a thing. In qualitative research, there are no

wrong or bad values. The interpretation

obtained from each individual will be used as

research method used to examine the

condition of natural objects where the

researcher is the key instrument, the data

collection technique is done by triangulation

(combined), the data analysis is inductive,

and the results of qualitative research

emphasize meaning rather than

generalization.

The characteristics of qualitative research

(Sugiyono, 2013) are:

provide an overview of the implementation of

the INA-CBG's Claims National Health

Insurance (JKN) policy at Tarumajaya

Hospital.

Implementation Analysis Of Ina-Cbg's Claims Implementation Of Quality Control And Cost

2. Observation

survey to the research location and observed

the objects that were the target of the

research, namely Tarumajaya Hospital,

Bekasi City. Through this technique,

researchers hope to understand the objective

conditions of various things that are the target

of observation, and through this technique,

primary and secondary data will be obtained.

Hospital. Then the researcher recorded,

recorded, and described things related to the

object of research. Researchers make

observations or direct observations at

Tarumajaya Hospital.

3. Interview

In this study in-depth interview method is

one of the techniques used to collect data and

information. The use of this method is based

on two reasons; First, with in-depth

and future. In in-depth interviews, researchers

ask questions more freely and freely, without

being bound by a set of questions that have

been prepared in advance.

4. Documentation

Documentation study is an attempt to

collect data by reading, collecting literature

that has to do with research problems for

discourse. This documentation study is

carried out to underlie and support the

focusing on the object. The research is in the

form of a document regarding the

implementation of the INA-CBG's Claim

National Health Insurance (JKN) policy at

Tarumajaya Hospital.

Results and Discussion

Quantitative Research Results

The National Health Insurance Program

(JKN) is a health service assistance program

from the government that has been organized

by the Social Security Administering Agency

(BPJS) simultaneously as of January 1, 2014.

Based on Law Number 24 of 2011 concerning

the Social Security Administering Body

(BPJS), This institution is an institution in the

Taufiq, R. Fresley Hutapea, Muhammad Fachruddin Arrozi Adhikara

funds. Based on Law Number 40 of 2004

article 5 paragraph (1) concerning the

National Social Security System (SJSN), in

which there is a flagship program

implemented by the Government, namely the

National Health Insurance (JKN) program.

The JKN program is held nationally

based on the principles of social insurance

and equity principles and is an individual

service in the form of health services that

occur in the implementation of a program.

The Social Security Administering

Body Program is a state program that aims to

provide certainty of social protection and

welfare for the entire community. In order to

realize the objectives of the national social

security system, it is necessary to establish an

organizing body in the form of a legal entity

based on the principles of mutual cooperation,

nonprofit, openness,prudence, accountability,

are Recipients of Health Insurance

Contribution Assistance (PBI), namely the

poor and the underprivileged who are

registered by the Government and Non-

Recipients of Health Insurance Contribution

Assistance (Non PBI) consisting of Wage

Recipient Workers (PPU), Workers Not

Wage Recipients (PBPU) or individuals, and

Not Workers (BP). In this case the

Statistical Descriptive Analysis

Implementation is a dynamic process,

where policy implementers carry out an

activity or activity, so that in the end they will

get a result that is in accordance with the

goals or objectives of the policy itself

that implementation is what happens after the

law is enacted. laws are enacted that give

authority to programs, policies, benefits, or

some type of tangible output. Implementation

provide health protection to the community.

In its implementation, the Government takes

steps including by establishing the National

Social Security Administering Agency

(BPJS) and establishing regulations and

regulations regarding the implementation of

the JKN program.

The National Health Insurance

forward by Grindle, according to Grindle

(1980) in Agustino (2016) a public policy

implementation is determined by the level of

implementation consisting of policy content

and policy context.

If Grindle's theory results with findings

in the field, the process of implementing the

National Health Insurance (JKN) program in

improving health, including the content of