Evaluation of health care quality among insured patients in Indonesian mother &amp; child hospital: A secondary data analysis

Rachmawaty, Rini; Sinrang, Andi Wardihan; Wahyudin, Elly; Bukhari, Agussalim

doi:10.1016/j.gaceta.2021.10.100

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…The second finding of this study is that patients with the same medical diagnosis can be treated with varying lengths of hospital stays which eventually results in hospital rates exceeding the BPJS health insurance rates. This finding is in line with previous studies where differences in length of hospital stays for patients with similar diagnoses can occur due to the lack of clinical guidelines, the non-implementation of integrated clinical pathways, the lack of interprofessional collaboration, the non-supervision of patient care and periodic audit of patient medical records (Rachmawaty et al, 2021). The research of Van De Vijsel et al (2015) found variations in the length of hospital stays related to diagnosis or procedure and reduced as the pace of application of clinical pathways.…”

Section: Discussionsupporting

confidence: 92%

“…Therefore, the quality of health services received by patients participating in BPJS Kesehatan is important to continue to be evaluated to encourage improvement. Evaluation of the quality of health services received by patients participating in BPJS Kesehatan in Indonesian hospitals during the implementation of the INA-CBGs payment system is still rarely carried out (Rachmawaty et al, 2021). Therefore, it is necessary to conduct research to evaluate and compare the quality of health services received by patients participating in BPJS Kesehatan in two Indonesian hospitals of whose patient satisfaction level is still below the minimum service standard as a basis for improving the quality of health services.…”

Section: Introductionmentioning

confidence: 99%

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Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals

Rachmawaty,

Wahyudin,

Bukhari

et al. 2024

J Holist Nurs

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Background: Hospitals are required to improve the quality of health services provided to patients. Purpose: Evaluating and comparing the healthcare quality received by insured patients hospitalized in two Indonesian regional public hospitals. Methods: Secondary data analysis used the 2019 and 2020 Indonesian National Health Insurance e-claim databases of Hospital A and Hospital B. Descriptive and crosstabs analyses were used to determine INA-CBGs diagnoses that were categorized as high volume, high risk, and high cost. Results: The admissions that caused financial loss at the Hospital A were 21.1% in 2019 and 19.8% in 2020, while 30.3% in 2019 and 27.5% at the Hospital B. More than 60% of these admissions were placed in the 3rd class of inpatient wards of the two hospitals. Of these admissions, < 5% at the Hospital A and >5% at the Hospital B were readmitted within 30 days, although more than 90% were previously discharged based on physicians’ approval. Conclusions: Inadequate healthcare quality received by insured patients. Hence, an integrated clinical pathways based professional nursing practice model is highly recommended to increase patient outcomes and decrease 30 days hospital readmission rates.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals

Rachmawaty,

Wahyudin,

Bukhari

et al. 2024

J Holist Nurs

Self Cite

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“…Hospitals have an important role in the implementation of the referral system with the National Health Insurance Scheme.Hospitals as the health care facilities are obliged to provide excellent health care quality that is safe, effective, patient-centred, timely, efficient, and equitable (Rachmawaty et al, 2021). Governing Law in Indonesia at Government regulation no.…”

Section: Introductionmentioning

confidence: 99%

The Cost Difference of Hospital Rates and Indonesia Case Base Grup (Ina CBGs) Rates of Inpatient with National Health Insurance Scheme at Private Hospital

Fitri,

Sundari

2023

jika

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Background: Universal Health Coverage (UHC) stands for the ideal that everyone should have access to high-quality healthcare without facing financial hardship. Hospitals have an important role in the implementation of the referral system with the National HeaIth Insurance scheme. The porspektif payment system allows for difference between the Hospital rates and the INA CBGs rates. The difference in costs has the potential to cause benefits or losses for hospitals and plays an important role in supporting the sustainability of the hospitals. The challenges faced by private hospitals are different from those of government hospitals. Private hospitals must self-fund all costs incurred including investment costs and operating expenses This study aimed to evaluate the difference between hospital rate and INA-CBG's rate, focus on inpatient with NHI scheme at a private hospital at Yogyakarta, identifying the cases that contributes to a common effect of cost difference and identifying the cost components that have the most impact to the dominant cost difference. Methods: We performed a retrospective quantitative research with secondary data analysis. Data was obtained from hospital billing of a Private Hospital type C at Yogyakarta, a referral hospital in Indonesia, at period of January-December 2021. The data involved of 4474 cases of inpatient with National Health Insurance Scheme. The analysis was carried out with Pareto analysis. Results: The difference between hospital rate and Ina CBGs rate of all case is 32,5 %. The pareto analysis results that there are some NHI inpatient cases contribute a common cost difference as 1389 (31% of total cases) as high-cost case. These cases contribute 80 % of total cost difference. The cost components that have the most impact to the dominant cost difference are surgical prosedurs (26,1 %) and room and acomodation cost (19,7%). Conclusions: There are cost difference in which the hospital rate is higher than the Ina CBGs rate. There are 31 % of total cases as high cost cases, for the bulk of the cost difference. Surgical procedurs, room and acomodation cost are the cost components that have the most impact to the dominant cost differences. This study support the necessary for hospitals to evaluate the cost difference of hospital rate and Ina CBGs rate periodically for improving quality and cost efficiency at hospitals

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“…Irwandy and Syaf [5] found that the productivity level of hospitals has continued to decline since the implementation of BPJS health insurance in Indonesia. Besides that, several studies showed that since the entry into force of BPJS, health service quality and waiting time (WT) in some hospitals did not meet the standard [6]- [8]. West Sumatera is a province with a low HDI compared to other provinces in Indonesia.…”

Section: Introductionmentioning

confidence: 99%

Digitalization of Outpatient Services Based on Lean Management to Reduce Waiting Time in Government Hospital

Astiena¹,

Hadiguna²,

Iswanto³

et al. 2022

Int. J. Adv. Sci. Eng. Inf. Technol.

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Hospital outpatient waiting times in Indonesia do not meet the standards. Lean management reduces waste, while digitalization plays a role in managing service complexity. Implementing lean in parallel with digitalization increases the opportunities for improvements, but empirical research on this is still limited. This study aimed to generate an analytical study of the impact of Lean application in reducing the waste of waiting time for outpatient services at a government hospital. The research design was pre-and post-intervention. The study was conducted in a regional government hospital with 80 people as a sample who was recruited by systematic random sampling. Data collection was carried out through observation and mapping the flow of patient service time from booking to completion of a doctor's consultation using the time stamp. Efforts to reduce waiting time are carried out through a simulation of the Lean-based digitalization model. The variables are the number of Service Steps, Lead Time, Waiting Time, Value-Added Activities, Non-Value-Added Activities and Value-Added Ratio (VAR). The results showed that lean-based service digitalization was able to reduce service steps from 10 to 4 steps, waste waiting from 5 to 2 steps, and Lead Time from 336 to 39 minutes (-88.4%), increasing the VAR from 5.1% to 20.5%. This research is limited to the implementation of lean digitally. It is important to statistically compare the impact of digital and non-digital lean implementation in some hospitals.

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Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis

Cited by 4 publications

References 2 publications

Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals

Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals

The Cost Difference of Hospital Rates and Indonesia Case Base Grup (Ina CBGs) Rates of Inpatient with National Health Insurance Scheme at Private Hospital

Digitalization of Outpatient Services Based on Lean Management to Reduce Waiting Time in Government Hospital

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