Perpustakaan Terpadu

Upaya BPJS Kesehatan dalam mengedepankan mutu layanan kesehatan telah nyata.Sasaran pokok peta jalan menuju JKN tahun 2012-2019 menunjukkan bahwa sasaran 2019 adalah “paling sedikit 85% peserta menyatakan puas. Pada Tahun 2019 indeks kepuasan fasilitas kesehatan sebesar 75% dengan standar 65%. Dalam rangka menjamin agar iuran yang telah dibayarkan peserta JKN-KIS dikembalikan dalam bentuk pelayanan yang efektif dan efisien, BPJS Kesehatan membentuk Tim KMKB. RSIA Puri merupakan Provider BPJS Kesehatan yang memiliki Tim Kendali Mutu dan Kendali Biaya namun RSIA Puri belum pernah dilakukan evaluasi tentang KMKB. Tujuan : Untuk mengetahui evaluasi capaian Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan nomor 8 tahun 2016 tentang penerapan kendali mutu dan kendali biaya di RSIA Puri. Metode : Penelitian ini menggunakan metode kuantitatif-kualitatif dengan jenis penelitian studi kasus. Penelitian ini menggunakan pendekatan realist evaluation. Data hasil wawancara atau data kualitatif dianalisis dengan model CMO (Context-Mechanism-Outcome). Hasil : Penelitian kualitatif pada 7 narasumber di RSIA Puri menunjukkan bahwa tim kendali mutu dan kendali biaya belum berjalan. Tugas tim kendali mutu dan kendali biaya meliputi audit medis, utilisasi review, sosialisasi kewenangan, dan etika diplin profesi dilakukan oleh unit Rumah Sakit namun tidak dilakukan oleh tim kendali mutu dan kendali biaya. Kesimpulan : Upaya pengendalian mutu dan biaya yang dilakukan tim kendali mutu dan biaya di RSIA Puri belum berjalan. Meskipun belum berjalan upaya untuk mengimplementasikan kebijakan ini sendiri telah dilakukan. Sehingga diharapkan akan ada perbaikan dari fasilitas kesehatan untuk menjalankan tugas dan tanggung jawab dari tim kendali mutu dan kendali biaya di RSIA Puri.

The efforts of BPJS Kesehatan in prioritizing the quality of health services have been evident. The main target of the road map to JKN for 2012-2019 shows that the 2019 target is "at least 85% of participants are satisfied. In 2019 the health facility satisfaction index was 75% with a standard of 65%. In order to ensure that the contributions paid by JKN-KIS participants are returned in the form of effective and efficient services, BPJS Kesehatan forms a KMKB Team. RSIA Puri is a BPJS Health Provider that has a Quality Control and Cost Control Team, but RSIA Puri has never been evaluated on KMKB. Objective : Knowing the evaluation of the achievements of the Health Social Security Administering Body Regulation Number 8 of 2016 concerning the Implementation of Quality Control and Cost Control at RSIA Puri. Methods: This study uses quantitative-qualitative methods with a type of case study research. This study uses a realist evaluation approach. Data from interviews or qualitative data were analyzed using the CMO model (Context-Mechanism-Outcome). Results : Qualitative research on 7 informants at RSIA Puri showed that the quality control and cost control teams were not yet operational. The duties of the quality control and cost control teams include medical audits, review of utilization, socialization of authority, and professional diplin ethics which are carried out by the hospital unit but not by the quality control and cost control teams. Conclusion : The quality and cost control efforts carried out by the quality and cost control team at RSIA Puri have not yet been implemented. Although there has been no attempt to implement this policy itself, it has been made. So it is hoped that there will be improvements in health facilities to carry out the duties and responsibilities of the quality control and cost control teams at RSIA Puri.