ANALISIS PERBEDAAN TARIF RIIL DENGAN TARIF PAKET INACBG PADA PEMBAYARAN KLAIM JAMKESMAS PASIEN RAWAT INAP DI RSUD KABUPATEN SUKOHARJO

Abstract

ABSTRAK
Within disparity use of real and Indonesia Case Based Groups (INA-CBG) fare, often triggering
an assumption lead to prejudice of billing fact-manipulation which conducted by hospital
management. The action is often causing financial deprivation over patient or the service payer
(JAMKESMAS). Real fare is carry out by hospital based on fee for service proposal appointed by
local government. INA-CBG is package of billing system based on service group category.
The aim of the research is analyzing the disparity of use between real and INA-CBG fare upon
hospitalized care service toward JAMKESMAS claim-payment at Sukoharjo District General
Hospital.
The research is analytic-observational type using retrospective design. Qualitative and
quantitative data analysis is use, involving document study and in-depth interview as data
gathering technique. Hypothesis verification acquired with the use of Wilcoxon test.
The result exhibit a significant different between real and INA-CBG fare with value of p = 0.001.
The disparity arise as the result of variety of health service tariff standard, length of stay, sofware
utilization, accuracy of diagnose and service procedure coding, and deficiency of clinical pathway
in Sukoharjo District General Hospital.
Key words: claim, Jamkesmas, real fare, INA-CBG