IMPLEMENTASI TARIF LAYANAN TRAUMA BERBASIS ASKES DI RSU GRHA BHAKTI MEDIKA KLUNGKUNG-BALI

Abstract

Abstrak

Artikel ini bertujuan membahas urgensi standarisasi tarif layanan trauma berbasis asuransi kesehatan dan implementasinya di RSU Grha Bhakti Medika (GBM) Klungkung. Desain penelitian ini adalah penelitian kualitatif dengan pendekatan studi kasus. Proses pengumpulan data dilakukan melalui studi dokumen, observasi partisipasi, Fokus Grup Diskusi dan wawancara mendalam dengan 11 informan yang ditentukan secara purposive sampling. Analisa data dilakukan secara kualitatif deskriptif. Hasil penelitian menunjukkan bahwa standarisasi tarif layanan trauma center berbasis asuransi kesehatan di RSU GBM Klungkung dinilai amat urgen dikembangkan karena mayoritas pasien trauma ditanggung oleh asuransi kesehatan, standarisasi tarif layanan trauma berbasis asurasi kesehatan diperlukan sebagai dasar dalam menentukan biaya layanan, sebagai realisasi atas misi sosial rumah sakit dan realisasi visi organisasi RSU GBM Klungkung. Implementasi tarif layanan trauma berbasis asuransi kesehatan dihitung dengan prinsip full-cost pricing dan kontrak-cost-plus sejak pasien masuk IGD sampai yang bersangkutan keluar dari rumah sakit. Keuntungan yang diperoleh rumah sakit relatif kecil (15%-20%) sehingga imbalan dokter spesialis juga minim. Solusi terhadap hal ini, manajemen RSU GBM Klungkung meningkatkan frekwensi kunjungan dokter spesialis kepada pasien kasus trauma yang sedang dirawat di rumah sakit serta menerapkan tarif layanan trauma dengan prinsip cost sharing, yaitu cost sharing antara asuransi kesehatan pemerintah dengan asuransi kesehatan swasta nasional dan asing, dan cost sharing antara unit layanan trauma dengan unit layanan RS lainnya.

Kata Kunci: Implementasi tarif, Trauma Center, Berbasis Askes

ABSTRACT

This article aims to discuss the urgency of standardizing trauma service rates based on health insurance and its implementation at Grha Bhakti Medika (GBM) General Hospital in Klungkung. The research design is qualitative research with a case study approach. The data collection process was carried out through document studies, participant observation, focus group discussions, and in-depth interviews with 11 informants who were determined by purposive sampling. Data analysis was carried out in a qualitative descriptive manner. The results showed the standardization of trauma center service rates based on health insurance at GBM General Hospital Klungkung was considered very urgent to be developed because the majority of trauma patients were covered by health insurance, standardization of trauma service rates based on health insurance needed as a basis for determining service costs, as a realization of the social mission of the hospital and the realization of the organizational vision of the GBM General Hospital Klungkung. The implementation of trauma service rates based on health insurance is calculated on the principle of full-cost pricing and cost-plus contracts from the time the patient enters the emergency room until the person concerned leaves the hospital. Hospital profits are relatively small (15%-20%) so specialist doctors' fees are also minimal. The solution to this, the management of the GBM General Hospital Klungkung increased the frequency of visits by specialist doctors to trauma patients who were being treated at the hospital and implemented trauma service rates with the principle of cost-sharing between the national government health insurance and foreign private health insurance, and cost-sharing between trauma service units and other hospital service units.

Keywords: Tariff Implementation, Trauma Center, health insurance.