Background: Indonesia's social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country.Objective: To evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices.Methods: This was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals' procurement prices were collected from the data 3 years before and 3 years under Indonesia's social health insurance JKN (2011JKN ( -2016, and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. Results:The results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non-e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. Conclusion:The pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.
Peningkatan kasus HIV/AIDS yang terjadi setiap tahun menjadi masalah kesehatan di Indonesia. Pasien HIV/AIDS harus menggunakan terapi antiretroviral (ARV) seumur hidup untuk menekan replikasi HIV, sehingga diperlukan pemantauan untuk mendukung keberhasilan terapi ARV. Penelitian ini bertujuan untuk membandingkan efektivitas empat kombinasi ARV yang terdiri dari kombinasi A (AZT+3TC+NVP), kombinasi B (AZT+3TC+EFV), kombinasi C (TNF+3TC+NVP), kombinasi D (TNF+3TC+EFV) dengan menilai kenaikan CD4. Desain studi penelitian adalah cohort longitudinal. Sampel penelitian yang digunakan yaitu seluruh pasien HIV/AIDS rawat jalan di RS Fatmawati Tahun 2016 yang memenuhi kriteria inklusi: pasien dewasa (≥17 tahun) yang mendapatkan terapi salah satu kombinasi ARV, dan memiliki data pemeriksaan CD4 awal, 6-12 bulan setelah terapi. Data diambil dari rekam medis pasien dan dianalisis dengan non-parametrik Kruskal wallis. Hasil penelitian pada 124 pasien menunjukkan semua kombinasi ARV efektif meningkatkan nilai CD4>100 sel/mm 3 setahun. Rata-rata kenaikan CD4 masing-masing kombinasi ARV pada pemeriksaan 1 tahun adalah kombinasi A (73.93), kombinasi B (70.87), kombinasi C (48.73), kombinasi D (55.57). dan terdapat perbedaan kenaikan nilai CD4 yang bermakna pada pasien yang menggunakan ARV kombinasi A-C (p value=0,047), kombinasi AD (p value=0,041), dan ARV kombinasi B-D (p value=0,045) pada saat evaluasi penggunaan rata-rata 1 tahun. Kesimpulan, kombinasi A lebih efektif daripada kombinasi B, D dan C. Kata kunci: HIV/AIDS, Efektivitas, Antiretroviral (ARV), nilai CD4, RS Fatmawati.
Minor Illness adalah kondisi medis yang kurang serius yang tidak memerlukan tes laboratorium atau tes darah. Minor illness juga didefinisikan sebagai kondisi yang akan hilang dengan sendirinya dan dapat sembuh dengan melakukan pengobatan sendiri (swamedikasi). Kebanyakan pasien dapat mengobati penyakit minor illness hanya dengan menggunakan obat-obat OTC (Over-the-Counter). Penelitian ini bertujuan untuk mengetahui persepsi pasien dengan keluhan minor illness terhadap peran apoteker terkait efisiensi biaya obat dan akses pengobatan di era JKN (Jaminan Kesehatan Nasional). Penelitian ini dapat memberikan masukan bagi pemerintah dalam hal ini BPJS (Badan Penyelenggara Jaminan Sosial) sebagai otoritas pelaksana program JKN terkait pentingnya peran apoteker dalam melakukan efisiensi biaya dan kemudahan akses pengobatan pasien dengan keluhan penyakit minor illness. Penelitian ini menggunakan metode observasi dengan pengolahan data secara deskriptif. Penelitian ini dilakukan di apotek yang bekerjasama dengan BPJS di wilayah DKI, dengan sampel sebanyak 99 responden pasien yang melakukan swamedikasi pada bulan Juni 2018. Hasil penelitian menunjukkan bahwa terdapat potensi efisiensi biaya baik dari aspek manajemen, klinis, swamedikasi yang efektif dan terdapat kemudahan akses pengobatan melalui swamedikasi. Kesimpulan, keterlibatan apoteker dalam menangani keluhan minor illness terbukti menghemat biaya dan kemudahan akses pengobatan.
In 2013, Ministry of Health, Republic of Indonesia, launched a new change to drug procurement system, namely e-catalogue, to ensure the availability and affordability of medicines. This system replaces the previous auction drug procurement system. The purpose of the change into e-catalogue system is to facilitate the drug procurement in hospitals without the need to conduct complex negotiation with producers, to reduce the occurrence of mark-ups or inflating drug prices, to equalize drug prices, to support BPJS (Badan Penyelenggara Jaminan Sosial) activities, and to prevent difficulties in drug distribution in all regions in Indonesia. This study aims to get an overview and magnitude of the impact of e-catalogue application on changes in the price of drugs registered and not registered in e-catalogue at Jakarta Islamic Hospital Cempaka Putih. This research is a longitudinal time series study. The data collection was conducted retrospectively in the period of 2011-2015 taken from procurement data, purchase invoices, and e-catalogue prices from hospital pharmacy installation, which were then categorized based on similar drugs in the hospital. The result shows a decrease in the price of drugs on both e-catalogue drugs (generic, trade names and patents) and non e-catalogue drugs (generic, trade names). On the class of therapy, the biggest price reduction occurred in e-catalogue medicine, such as in antineoplastics, intravenous solution, diabetes, Anti-ashma & COPD, and psycholeptics therapy. Meanwhile, on the category of non e-catalogue, price reduction occurred in systemic antibacterials, antineoplastics, analgesics, cardiac theraphy, and A-acis A-flat A Ulcerants therapy. The magnitude of drug prices reduction ranges from 1% to more than 90% both on e-catalogue drugs and non e-catalogue drugs. On the e-catalogue drugs, the highest price reduction (82.36%) occurred in generic and patent drugs, while on non e-catalogue drugs, reduction occurred in drugs with trade names. The price reduction trend in drug prices based on both type of drugs and therapy class shows a significant decrease in drug prices in the period after the implementation of e-catalogue at Jakarta Islamic Hospital in Cempaka Putih, with a decrease of more than 80%.
Breast cancer is a disease of malignant neoplasm which is an abnormal growth of tissue that is different from the surrounding tissue. Various used of chemotherapy in the process of achieving management in cancer that causes the use of benefits and costs. This study aims to determine a more effective therapy in breast cancer patients at RSPAD Gatot Soebroto in 2017. This study was non experimental with comparative study into two group chemotherapy is single group (chemotherapy bondronat) and combination group (chemotherapy doxorubicin-paclitaxel). This study use secondary data from medical records patients on retrospectively. The results showed a decrease in the scale of single chemotherapy (Bondronat) was 82,61% with an average direct medical cost of IDR 9,3 million where as in combination chemotherapy (Doxorubicin-Paclitaxel) 95,65% with an average direct medical cost of IDR 7,6 million. The ACER value in single chemotherapy was IDR 11,3 million and combination chemotherapy was IDR 7,9 million. The ICER value in the two treatment groups was IDR 13,5 million. The conclusion is the combination of chemotherapy of Doxorubicin-Paclitaxel is the most cost-effective than Bondronate single chemotherapy.
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