Pelayanan Kesehatan BPJS Clinical Based Practice

Pelayanan Kesehatan BPJS Clinical Based PracticeAgus Harsoyo, MD

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiovascular Intervention, Department of Cardiology, Gatot Soebroto Army Centre Hospital, Jakarta, Indonesia

2014Background Permenkes nomor 28 tahun 2014 Pedoman Pelaksanaan Program Jaminan Kesehatan Nasional

UU nomor 24 tahun 2011 Badan penyelenggara Jaminan social

Permenkes nomor 69 tahun 2013 Standar Tarif Pelayanan Kesehatan pada faskes tk Pertama dan faskes tk lanjutan dlm penyelenggaraan Jaminan kesehatan

Permenkes nomor 27 tahun 2014 Petunjuk teknis system Indonesian Case Base Group ( INA CBG )

IntroductionIndonesia a low- and middle-income countries to improve their health financing systems and implement universal health coverage (UHC) all people can access quality health services without the risk of financial hardship.

The 2005 World Health Assembly Resolution (WHA 2005) and the 2010 World Health Report (WHO 2010) focus on social health protection and equity in access to health care (WHO 2010) the 2010 World Health Report on universal coverage the approval of the United Nations General Assembly Resolution on UHC in December 2012.

The movement toward UHC is becoming a key focus of the post- Millennium Development Goals (MDGs) development agenda

IntroductionIndonesian : Simmonds A , Hort K, 2013, Nossal Institute for Global Health, Univ of Melbourne : The universal health coverage (UHC) by 2019 to cover a projected population of 257.5 million.

Currently, around 63 %, or 151.5 million , are covered by some form of health insurance.

INA-Medicare will integrate existing schemes, combining contributions from the formal and informal workforce with the governments contributions for the poor into a single pooled fund, Regional government schemes will also be progressively integrated.

The launched its Road Map toward National Health InsuranceUniversal Coverage in 2012

Introduction Donabedian A, 1990 Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtain the greatest health improvement at the lowest cost; (4) optimality: the most advantageous balancing of costs and benefits; (5) acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care; (6) legitimacy: conformity to social preferences concerning all of the above; (7) equity: fairness in the distribution of care and its effects on health

Clinical Based Practice Control action of Unit cost medical supply ( w/ approve hospital and government policy )

Used ICD 10 and ICD 9CM

Internal Subsidised based on trivial to moderate to severe case

Unit Verification

Clear Hospital management

ReferenceJoumard I, Hoeller P, Andr C, Nicq C. Health Care Systems. Efficiency and Policy Settings. OECD. 2010.

Bauer JC. Paradox and Imperatives in Health Care Redirecting Reform for Efficiency and Effectiveness. Revised Edition. CRC.2015.

Jacobs R, Smith P, Atreet A. Measuring Efficiency in Health Care. Analytic Techniques and Health Policy.

Woolhandler S, Himmelstein D. The Deteriorating Administrative Efficiency of the U.S. Health Care System. 1991. N Engl J Med;324:1253-8.

Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et.al, Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. 2006. Ann Intern Med;144:742-752.

ReferenceKhangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S. Primary care professionals providing non-urgent care in hospital Emergency Departments. 2012. Europe PubMedCenter.

Simmonds A, Hort K. Institutional analysis of Indonesias proposed road map to universal health coverage. 2013. Nossal Institute for Global Health, University of Melbourne

Edmunds M, Sloan FA, Steinwald AB ( Editors ). Geographic adjustment in medical care. Phase II : Implication for access, Quality and Efficiency, 2012. The National academic Press.

Thank you