Rendahnya kunjungan pasien selama pandemi COVID-19 berakibat turunnya pendapatan rumah sakit secara drastis. Beban rumah sakit yang menangani pasien COVID-19 semakin tinggi dengan adanya keterlambatan pembayaran klaim COVID-19. Kajian ini bertujuan untuk menjelaskan kebijakan pembiayaan COVID-19 di rumah sakit, kendala dari pelaksanaan kebijakan, serta dampaknya pada keuangan rumah sakit di Indonesia. Kajian bersifat deskriptif analitik, pengumpulan data dilakukan melalui penelusuran literatur dari jurnal ilmiah, BPJS Kesehatan, Kementerian Kesehatan, Asosiasi Rumah Sakit, maupun seminar ilmiah di media massa daring. Data BPJS per tanggal 28 Januari 2021 menunjukkan total pengajuan klaim COVID-19 oleh rumah sakit sebanyak 433.077, dari hasil verifikasi tercatat sebanyak 266.737 kasus yang sesuai (61,59%) dan dapat diklaim dengan biaya 17,3 triliun, 165.189 kasus dispute (38,14%) dengan biaya 9,7 triliun dan 1.151 kasus tidak sesuai (0,27%). Total klaim yang diajukan sampai Desember 2020 sebesar Rp. 22.9 triliun, jumlah yang sudah dibayarkan Kementerian Kesehatan kepada rumah sakit sebesar Rp. 14.5 triliun (63.3%) dan sisa yang belum dibayarkan sebesar Rp. 8.4 triliun (36,6%). Kendala yang ditemui dalam pembayaran klaim antara lain; pembayaran tidak tepat waktu, tingginya dispute klaim yang disebabkan perbedaan persepsi terhadap regulasi yang berlaku, dokumen klaim rumah sakit yang tidak lengkap, ketidaksiapan perangkat aplikasi dan jumlah verifikator dispute dari Kementerian Kesehatan dalam melakukan proses verifikasi ulang. Penurunan arus kas mengakibatkan terjadinya hambatan operasional rumah sakit, antara lain penurunan kemampuan kewajiban membayar penyedia obat dan alat kesehatan, termasuk pembayaran gaji tenaga kesehatan dan karyawan rumah sakit.
Acute upper respiratory tract infection (URTI) is one of the health problem in a community with high prevalence and healthcare cost. At the primary health center (PHC), URTI is one of the most common diseases with a prevalence 45.64% in Bogor city on 2015, while Basic Health Research 2013 data showed the prevalence of URTI in Indonesia by 25%. This study analyzes the antibiotic prescription for URTI patients, factors influencing the rationale of antibiotic prescriptions, and the rational use of medicine (RUM) program management at Primary Health Centers at Bogor city. The research was analytic descriptive cross-sectional study by collecting data from medical records of patients diagnosed with non-pneumonia URTI, observation for outpatient health care, and interview with all responsible persons. The data were collected on 16 April-20 May 2018 from primary health centers at Bogor city. The samples were 359 oral antibiotic prescriptions of three physicians and antibiotics were prescribed for 122 (34%) cases from 359 cases of which 102 were evaluated for rationality according to local guidelines issued by the Ministry of Health Republic of Indonesia. The URTI diagnosis is classified into few categories with the prevalence of nasopharyngitis (62.9%), pharyngitis (30.6%), tonsillitis (5.3%), and sinusitis and acute otitis media (0.6%). Most antibiotics used were amoxicillin and cefadroxil. This study revealed that antibiotics prescribed 88% inaccuracy of antibiotics duration, 12% incompatibility with the guidance of antibiotic, 3% incompatibility with guidance and imprecise duration, and 1% inaccuracy of dose. Some factors that influencing rationality of antibiotics prescription was lack of physician's adherence to the clinical guideline, pharmacist role was not optimal, and lack of monitoring evaluating.
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