ANALISIS KLAIM PEMBIAYAAN KEMENKES DAN BIAYA RIIL RS PADA COVID-19 DI RSUD CEMPAKA PUTIH JAKARTA

Abstract

Coronavirus Disease 2019 (COVID-19) merupakan penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Kasus COVID-19 diperparah oleh beragam komorbid, menyebabkan biaya per pasien menjadi bervariasi. Pemerintah mengalokasikan dana yang tinggi sebagai strategi dalam upaya percepatan penanggulangan wabah COVID-19 yang teknis pengajuan klaimnya merujuk pada Keputusan Menteri Kesehatan 446/2020 dan 4344/2021. Penelitian ini bertujuan untuk mengetahui selisih biaya yang diterima oleh rumah sakit dari Kementerian Kesehatan (Kemenkes) dengan biaya riil rumah sakit. Pada penelitian observasional ini, sampel (236 responden) diambil secara acak dari populasi pasien rawat inap COVID-19 derajat sedang periode Januari–Juni 2021 (597 pasien) menggunakan tabel Krejcie dan Morgan. Data restrospektif diambil dari rekam medis, casemix, dan penagihan (billing), secara potong-lintang. Hasil analisis deskriptif yang dilakukan menunjukkan bahwa pasien COVID-19 dalam penelitian ini sebagian besar adalah perempuan (139 orang, 58,9%), rentang usia 18–82 tahun dan sebagian besar dari kelompok usia 26–45 tahun (102 orang, 43,2%), tidak memiliki komorbiditas (121 orang, 51,3%), dengan rerata lama rawat-inap (LoS) 10 hari. Terkait biaya, total realisasi klaim pembiayaan periode Januari–Juni 2021 yang diterima dari Kemenkes mencapai Rp18.659.815, atau lebih tinggi secara signifikan dibanding total biaya riil rumah sakit (Mann-Whitney, p <0,05). Dari biaya riil rumah sakit Rp2.286.282.430, komponen terbesar adalah obat Rp557.193.006 (24,37%). Rerata selisih antara klaim dan biaya riil yang cukup tinggi, Rp57.860.630 -Rp76.870.587 per pasien tersebut belum memperhitungkan biaya investasi yang dikeluarkan rumah sakit dalam bentuk berbagai peralatan (seperti ventilator) dan fasilitas lainnya (ruang isolasi bertekanan negatif, penambahan ruangan ICU dan HCU) yang belum tentu produktif setelah pandemi berlalu, sehingga dapat dikatakan wajar. Selisih positif tersebut menurun setelah diberlakukannya Keputusan Menteri Kesehatan Nomer 4344/2021 untuk periode 20 April 2021 sampai 30 Juni 2021 sebagai bentuk evaluasi secara berkesinambungan dari pemerintah terhadap pembiayaan COVID-19.

Kata Kunci: COVID-19; analisis biaya; realisasi klaim; biaya riil; selisih biaya

 

Abstract

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Cases of COVID-19 are exacerbated by various comorbidities which lead to various per patient costs. The government allocates high funds as a strategy to accelerate the management of the COVID-19 outbreak, wherein the technical claims refer to the Decree of the Minister of Health number 446/2020 and 4344/2021. This study aims to determine the difference between costs received by hospitals from the Ministry of Health and the real costs incurred by the hospitals. This was an observational study which involved 236 respondents who were randomly selected from the population of moderate-degree COVID-19 inpatients for the period January–June 2021 (597 patients) by using Krejcie and Morgan table. Retrospective data were taken from medical records, casemix, and billing, cross-sectionally. The results of the descriptive analysis conducted showed that most of COVID-19 patients in this study were women (139 respondents or 58.9%). Age of respondents ranged from 18–82 years old and most of respondents were involved in the age group of 26–45 years (102 respondents or 43, 2%). Furthermore, most of respondents had no comorbidities (121 respondents or 51.3%), with the mean length of stay (LoS) of 10 days. Regarding costs, the total realization of financing claims for the period January–June 2021 from the Ministry of Health was IDR 18,659,815, or significantly higher than the total real hospital costs (Mann-Whitney, p < 0.05). Of the real hospital costs of IDR 2,286,282,430, the largest component was medicine by IDR 57,193,006 (24.37%). The mean difference between claims and real costs was quite high by IDR 57,860,630 – IDR 76,870,587 per patient, by not considering the investment costs incurred by the hospital in the form of various equipment (such as ventilators) and other facilities (negative pressure isolation rooms, as well as additional ICU and HCU wards) which are not necessarily productive after the pandemic has passed. Thus, it can be said that such difference was natural. The positive difference decreased after the enactment of Decree of the Minister of Health No. 4344/2021 for the period April 20, 2021 to June 30, 2021 as a form of continuous evaluation provided by the government towards COVID-19 financing.

Keywords: COVID-19; cost analysis; claim realization; real cost; difference in cost