BackgroundAllocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system.MethodsA standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country.FindingsSubstantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services.
ABSTRAKHipertensi hingga kini masih menjadi masalah kesehatan di dunia. Terapi yang diberikan kepada pasien hipertensi biasanya dilakukan dalam jangka panjang. Pengobatan hipertensi yang dilakukan sesuai dengan kondisi pasien. Penelitian ini bertujuan untuk mengetahui gambaran pola penggunaan obat antihipertensi pada pasien rawat inap di RSUD Panembahan Senopati. Penelitian dirancang dengan metode deskriptif crosssectional. Subyek penelitian ialah pasien hipertensi rawat inap yang memenuhi kriteria inklusi. Objek pada penelitian ini adalah rekam medis pasien rawat inap hipertensi periode bulan Oktober 2016- Juli 2017. Hasil penelitian menunjukkan bahwa dari 53 pasien yang memenuhi kriteria inklusi, sebanyak 38 pasein (71,8 %) menjalani pengobatan antihipertensi secara politerapi, sedangkan hanya 15 pasien (28,2 %) menjalani pengobatan monoterapi. Pengobatan monoterapi yang paling banyak dipakai golongan diuretik yaitu Furosemid sebanyak 6 pasien (11,3%), sedangkan penggunakan obat politerapi yang paling banyak dipakai yaitu Valsatan+ Amlodipin sebanyak 13 pasien ( 24,5%). Secara keseluruhan, golongan obat yang paling banyak digunakan adalah golongan Calcium Chanel Blocker dengan jenis terbanyak adalah Amlodipin, dilanjutkan golongan Diuretik yaitu Furosemid, dan golongan ARB yaitu Valsartan. Penelitian ini disimpulkan bahwa penggunaan obat sebagian besar politerapi dan secara umum penggunaan obat antihipertensi yang dipakai terdiri dari 6 golongan obat yaitu diuretik, ACE inhibitor, Angiotensin Receptor Blocker, ẞ- blocker. Kata kunci: Pola Penggunaan Obat; Antihipertensi; Rawat Inap. ABSTRACTHypertension is a health problem in the world. Therapy given to hypertensive patients is usually done in the long run. Hypertension treatment is carried out according to the patient's condition. This study aims to determine the pattern of the use of antihypertensive drugs in inpatients at Panembahan Senopati Hospital. The study was designed using descriptive cross sectional method. The subjects of the study were hypertensive inpatients who met the inclusion criteria. The object of this study was the medical record of hypertensive inpatients for the period October 2016-July 2017. The results showed that of 53 patients, 38 patients (71.8%) used antihypertensive treatment by polytherapy, whereas only 15 patients (28.2%) used monotherapy treatment. The most used monotherapy treatment of diuretics is Furosemide with 6 patients (11.3%), while the most used polytherapy drugs are Valsatan + Amlodipin with 13 patients (24.5%). Overall, the most used group of drugs is the Calcium Chanel Blocker with the most types, Amlodipine, followed by the Diuretic group, Furosemide, and the ARB group, Valsartan. This study concluded that the use of drugs is mostly polytherapy and in general the use of antihypertensive drugs used consists of 6 classes of drugs namely diuretics, ACE inhibitors, Angiotensin Receptor Blockers, ẞ-blockers. Keywords: Drug Use Patterns; Anti-hypertension; Inpatient.
Angka pengidap hipertensi pada tahun 2018 sebesar 34,1% dari penduduk Indonesia. Profil data kesehatan Indonesia menyebutkan bahwa secara nasional terjadi peningkatan prevalensi hipertensi dari 25,8% pada tahun 2013 menjadi 34,1% pada tahun 2017. Biaya pasien hipertensi rawat inap di rumah sakit yang bergabung dengan Asuransi Kesehatan JKN diklaim berdasarkan tarif Indonesian-Case Based Groups (INA-CBGs). Penelitian ini bertujuan untuk mengetahui besar perbedaan biaya riil rumah sakit dengan tarif INA-CBGs di Rumah Sakit Umum Daerah (RSUD) Panembahan Senopati menggunakan analisis deskriptif pada perspektif penyedia pelayanan kesehatan yaitu rumah sakit. Pengambilan data biaya medis langsung dilakukan secara retrospektif. Objek pada penelitian ini adalah berkas keuangan rumah sakit dan rekam medis periode Oktober 2016-Juli 2017 RSUD Panembahan Senopati. Sebanyak 53 pasien menjadi sampel penelitian ini. Data dianalisis menggunakan one sample t-test untuk membandingkan biaya riil rumah sakit dengan tarif INA-CBGs. Hasil penelitian menunjukkan besarnya perbedaan antara biaya riil dengan tarif INA-CBGs yaitu sebesar negatif Rp30.993.964. Terdapat perbedaan bermakna antara besar biaya riil yang dikeluarkan rumah sakit terhadap tarif INA-CBGs pada pasien kelas 1 dengan nilai signifikansi p<0,05 (0,039). Persentase total biaya rumah sakit yang digunakan untuk komponen biaya obat yaitu sebesar 26,3%. Simpulan dari penelitian ini adalah rumah sakit dapat mengalami kerugian karena biaya yang dikeluarkan lebih besar dibandingkan tarif klaim INA-CBGs.
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