Professional Documents
Culture Documents
BPJSK Persi PDF
BPJSK Persi PDF
- Socrates -
Tanggapan Umum
Berbagai Alternatif
Regulasi JKN untuk
Meningkatkan Mutu
dan Efisiensi RS
Total Jumlah MISI
Rumah Sakit PERSI
Seluruh
Berperan aktif mewujudkan:
Indonesia 1. Kebijakan dan regulasi yang berpihak
pada RS dalam kendali mutu kendali
biaya.
2. Tatakelola korporasi rumah sakit yang baik.
2.841 3. Tatakelola klinis rumah sakit yang baik.
4. Tatakelola etik yang baik.
Tanggung jawab PERSI 5. Tatakelola pelayanan yang baik.
untuk mewakili dalam
penyusunan regulasi 6. Kerjasama dengan stakeholder dan
terkait rumah sakit shareholder di bidang perumahsakitan.
Goes back a long way…
Accessible
In addition, in order to realize the benefits of
Defining quality health care, health services must be:
quality health care • Timely: reducing waiting times and
sometimes harmful delays for both those who
Quality health care can be defined in many receive and those who give care.
ways but there is growing • Equitable: providing care that does not vary in
acknowledgement that quality health quality on account of age, sex, gender, race,
services across the world should be: ethnicity, geographical location, religion,
§ Effective: providing evidence-based socioeconomic status, linguistic or political
health care services to those who affiliation.
need them. • Integrated: providing care that is coordinated
§ Safe: avoiding harm to people for across levels and providers and makes available
whom the care is intended. the full range of health services throughout the
§ People-centred: providing care that life course.
responds to individual preferences, • Efficient: maximizing the benefit of available
needs and values. resources and avoiding waste.
Ø Major Problems of Ø Drivers of Health Care
Health Care System Costs
• Increased Costs • Technological advances
• Decreased Access • Aging of population
• Variable Quality
• Increase in chronic disease
• Increased Fragmentation
• Inefficiency and redundancy
• Increased Administrative
Burden of private insurers
• Technological Imperative • Health industry
• Medicolegal Liability • Consumer demand
• System Out of Control • Defensive medicine
GLOBAL HOSPITAL TREND
Profit
Capping
Value based
service
Less person
Use of
Artificial
Digitalized
intelligence
Hospital.
RS
Jhony S, 2016
MUTU & BIAYA: di Indonesia?
PELAYANAN
EFEKTIF-EFISIEN VS
KENDALI MUTU-
Best
BIAYA
Practice
Utilization
Review
UHC WITHOUT
HARM ?
PENGERTIAN HVB = P4P
Pay for Performance in
healthcare (P4P), also known as
value-based payment,
comprises payment models that
attach financial incentives
/disincentives to provider
performance
https://catalyst.nejm.org/pay-for-performance-in-
healthcare/
Tanggapan Umum
Disampaikan terutama bagi para
pengelola RS seluruh Indonesia,
khususnya RS yang akan menjadi
lokasi uji coba HBV
SDM dan
sarana Persentase
prasarana RS kejadian
<80% sesuai infeksi
ketentuan nosokomial
>1,5%
Terdapat kejadian
phantom
billing/procedur
yang telah
dibuktikan melalui
berita acara
*dalam dokumen
istilahnya “penyesuaian
besaran pembayaran Beberapa Indikator yang diusulkan
klaim ” ( dari 3 indikator input dan 7 indikator proses )
Hasil Sistematik Review tentang HVB
P4P / HVB bertujuan baik yaitu meningkatkan mutu dan efisiensi, namun
apakah terbukti?
Three years after the introduction of the US national pay for performance
program—Hospital Value-Based Purchasing (HVBP)—we find no evidence
that it has led to better patient outcomes (Jha, 2016)
Hospital-Acquired Conditions ( HAC ) reduction is applied to total operating and capital payments. For the
Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (VBP) Program,
adjustments are applied to base operating payments
Downloaded from HealthAffairs.org on April 07, 2019. Copyright Project HOPE—The People-to-People Health Foundation, Inc.
For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.