Abstract

Selama penerapan Diagnosis Related Group di Rumah Sakit Umum Pusat (RSUP) Dr. Sardjito, terjadi kesenjangan tarif biaya riil pelayanan kesehatan dengan tarif Indonesia Case Base Groups (INA-CBGs). Penyebab terbesar kesenjangan tarif tersebut adalah pelayanan obat dan penggunaan sumber daya laboratorium yang tidak efisien. Biaya pelayanan penunjang medis untuk pasien leukemia limfoblastik akut adalah sekitar 23,8% dari total biaya pelayanan kesehatan. Penelitian ini bertujuan untuk mengetahui tingkat efisiensi penggunan sumber daya laboratorium dan pengaruh terhadap kesenjangan tarif. Penelitian ini menganalisis semua rekam medis dan data biaya pelayanan laboratorium pasien leukemia limfoblastik akut tahun 2009-2010 di RSUP Dr. Sardjito Yogyakarta. Pemeriksaan kimia klinik menunjukkan pola pasien yang semakin parah, proporsi biaya pemeriksaan kimia klinik semakin rendah. Kondisi ini juga terjadi pada pemeriksaan radiologi, urine dan tinja rutin. Sementara pada pemeriksaan hematologi, mikrobiologi, dan imunologi/serologi menunjukkan pola semakin parah pasien maka semakin tinggi proporsi biaya pemeriksaan. Analisis regresi menemukan pemeriksaan kimia klinik meliputi mikrobiologi darah, ureum, magnesium, creatine kinase MB (blood) menyebabkan kesenjangan tarif semakin meningkat atau rumah sakit semakin dirugikan. Model regresi linier ini mempunyai nilai R2 sebesar 0,834 dengan nilai F = 84,475 (P < 0,05). Ketidakefisienan penggunaan sumber daya laboratorium pada pemeriksaan kimia klinik terdapat pada kelompok pasien tingkat keparahan ringan.

Problems occurred during the implementation of Diagnosis Related Group in Sardjito Hospital Yogyakarta. There was gap price between the real cost of health care and Indonesia Case Base Groups (INA-CBGs) cost. The cause of the gap price was drug delivery and use of laboratory resources inefficiently. Cost of medical support services for acute lymphoblactic leukemia patients about 23.8% of the total cost of health care. This study aimed to analyze efficiency of the use of laboratory resources and their effect to discrepancy of price. This study analyzed all medical records and laboratory services cost data in 2009-2010 acute lymphoblastic leukemia patients at Sardjito Hospital Yogyakarta. Clinical chemistry test showed a pattern of more severe patients, the lower the percentage of clinical chemistry fees. This condition also occurs in radiological, urine test, and stool. While the test of hematology, microbiology and immunology/serology showed a pattern, the more severe the patient, the higher the percentage of the cost of the test. The results of the regression analysis showed that the more higher cost of clinical chemistry test (blood microbiology, urea, magnesium, creatine kinase MB (blood)) the higher discrepanct of price which causes the hospital getting harmed. Linear regression model has a value of determination coeficient 0.834 with a value of F = 84.475 (P < 0.05). Inefficiency of resource use in the test of clinical chemistry laboratory located on the mild severity of the patient group.

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