Analysis of Differences in Hospital Rates and Rates Ina-CBGS Poly Urology Outpatient Services at Mitra Medika Tanjung Mulia Hospital

Analysis of Differences in Hospital Rates and Rates Ina-CBGS Poly Urology Outpatient Services at Mitra Medika Tanjung Mulia Hospital Muhammad Iqbal, Dede Ruslan, Deli Theo Student of Master's Program in Public Health Sciences, Helvetia Health Institute Medan, Indonesia Lecturer Faculty of Public Health, Helvetia Institute of Health Medan, Indonesia *Corresponding Author: Muhammad Iqbal Article Info Article history: Received 27 February 2021 Received in revised form 05 March 2021 Accepted 14 March 2021


Introduction
Health is a basic necessity that people must have, and is one of the recognized rights of the whole world. People need to make health efforts for the body in order to live activities well, optimally and enable productive life socially and economically. The concept of health and illness is actually not very absolute and universal because there are other factors beyond clinical reality that affect it especially socio-cultural factors. From year to year health care trends evolve according to demographic characteristics, lifestyle, and other population attributes that contribute to the growth of health communication. Health practitioners must also be able to understand the health care system and health care system in order to spread health information effectively (Erawati, 2019). INA-CBGs system is an application used as a claim application for Hospitals, Health Centers and all Health Service Providers for the poor in Indonesia. Case Base Groups (CBGs), which is a way of paying for patient care based on relatively similar diagnoses or cases. Hospitals will get paid based on the average cost spent by a diagnosis group (Wijayanti & Sugiarsi, 2013).  (Handayani et al., 2018).
Health financing is an important part in the implementation of National Health Insurance (JKN). The purpose of health financing is to encourage quality improvement, encourage patient-oriented services, encourage efficiency does not reward providers who over-treatment, undertreatment or adverse events and encourage team services. With the right financing system is expected the above objectives can be achieved (Suhartoyo, 2018).
In the implementation of National Health Insurance there are still many problems that arise, one of which is the concern is the tariff of Indonesian Case Based Groups (INA-CBGs). The government is very likely to realize that there is a discrepancy between INA-CBGs rates and hospital real cost. Based on Decree No. 52 of 2016 on Standard of Service in the Implementation of The National Health Insurance Program, which is a change from Minister of health regulations No. 59 of 2014, the Government has not raised the rate of INA-CBGs, but there is a change in the grouping between Government Hospitals (RS) and Private Hospitals. The amount of INA-CBGs rates that are considered very small from the real-cost of hospitals, often gives the impression that the hospital provides services not optimally accompanied by the friendlessness of officers. For hospitals in Indonesia, JKN is becoming a new era where most hospitals have been using fee for service (FFS)payment mechanisms began to switch to payment mechanisms based on INA-CBGs (Erawati, 2019).

Methods
This research is a mix method research, with the aim to find out the difference in real costs with INA-CBGs rates in outpatients at Mitra Medika Tanjung Mulia Hospital. Data collection was conducted retrospectively through the medical records of outpatients at Mitra Medika Tanjung Mulia Hospital in January 2019. Cost calculation is reviewed from the provider side, namely hospitals against direct medical costs (direct medical costs) of outpatient services. The population of this study is the entire medical record file of outpatient poly urology who underwent treatment at Mitra Medika Tanjung Mulia Hospital in January 2019 as many as 310 people. Quantitative approach sampling techniques in this study in total population, namely the entire population sampled in this study, include all medical records of out patients poly urology who underwent treatment at Mitra Medika Tanjung Mulia Hospital in January 2019 as many as 310 people.

Result and Discussion
After conducting research on Analysis of Differences in Hospital Rates and Tariffs in A-CBGs Poly Urology Outpatient Services at Mitra Medika Tanjung Mulia Hospital in January 2019, the following results were obtained: The total cost of the hospital is the total number of cost components (drug costs, medical device costs, supporting examination costs and action costs) received by patients in obtaining outpatient services. Based on the results of the study it is known that the comparison between the total cost of hospital in outpatients in poly urology with the code Q-5-25-0, Q-5-44-0, Q-5-32-0, N-3-10-0, N-3-14-0, Z-3-23-0 and Z-3-19-0 are lower than the total fare based on INA-CBGs. The biggest difference in the Q-5-44-0 code was another minor chronic disease with 226 cases and a difference of 42,319,300. While for the positive difference is only found in the code Q-5-18-0 that is consultation or other examination with the number of cases 6 and the difference as much as 280,800.   The results showed that there is a difference in hospital rates with INA-CBG rates. Of the 176 cases of disease, positive differences were found on the part of hospitals, both in internal medicine specialists, neurosurgeons, obgyn specialists and pediatricians, while in surgeons, hospitals suffered losses (negative differences) in the factors causing differences in hospital rill rates with ina-CBG package rates in third-class inpatient services at Panti Bakti ningsih Hospital is the standard real tariff of hospitals within a-CBG package tariff and diagnosis coding accuracy (Indrayani, 2018).