Aristhasari Putri, 050980124 (2016) ANALISIS PERBANDINGAN BIAYA PELAYANAN STROKE ISKEMIA DENGAN KOMORBIDITAS DAN KOMPLIKASI BERDASARKAN BIAYA RIIL DENGAN KLAIM INA-CBG’s (Penelitian dilakukan di SMF Ilmu Penyakit Saraf RSUD Dr. Soetomo Surabaya). Thesis thesis, Universitas Airlangga.

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Abstract

BACKGROUND: Stroke is a leading cause of death and disability in the world. The prevalence of stroke patients in Indonesia increases from 8.3 per 1000 to 12.1 per 1000 population for over 6 years. It is caused by risk factors including hypertension, diabetes mellitus, heart disease, smoking, lifestyle and unhealthy eating habits. There are two main types of stroke, the prevalence of ischemic stroke is 87% and hemorrhagic stroke is 13%, each with its own complexity. The high prevalence of ischemic stroke can be seen in the Dr. Soetomo Hospital namely +50 patients/month with the complexity of high risk of disability. Therefore, a study related to the allocation of health insurance in Indonesia (BPJS) funds is performed and compared with the real cost of ischemic stroke services at the Dr. Soetomo Hospital. OBJECTIVE: Identify the scope of BPJS components (category of mild, moderate, severe infarct) and the real cost of hospital services (ward services cost, medical services and medical support) in the Neurology Department Dr. Soetomo Hospital for +3 months starting in September 2015. METHOD: The prospective study, the subjects are ischemic stroke patients (radiodiagnostic, NIHSS, laboratory test); class 3 BPJS participants (high prevalence); comorbidities: hypertension, diabetes mellitus, dyslipidemia; complications. The selected patients are at least 30 patients and were initiated in September, the data include NIHSS score, comorbidities, complications, length of stay, the real cost of service and INA-CBG's claims. Allocation of BPJS funds includes mild infarct: without comorbidities and complications; moderate: mild comorbidities and complications; severe: major comorbidities and complications, while the real cost of hospital services related to factors: NIHSS score, comorbidities, complications, length of stay. Statistical analysis is to analyse the relationship between the factors and cost. RESULTS: During September-November 2015, it was obtained 41 patients met the inclusion criteria, 21 male patients and 20 female patients; age of 32 – 79 years; NIHSS score of 2 – 36; 14 patients of mild infarct, 21 patients of moderate infarct and 6 patients of severe infarct; the main comorbidities are hypertension, diabetes mellitus and dyslipidemia; the complications require additional treatment and the length of stay. The results of cost analysis, the difference of BPJS allocation and the real cost per patient for mild category: exceeds 9%; moderate: deficit 0,1%; and severe: deficit 35%. Correlation analysis shows that length of stay, complications and NIHSS scores have a relationship with the increased service cost of ischemic stroke patients (p <0.05). CONCLUSION: The allocation of funds provided by BPJS per ischemia stroke patient of mild cattegory is sufficient and moderate category is relatively sufficient, while for severe category (major comorbidities and complications), allocation of BPJS funds is insufficient for hospital expenses. KEYWORD: real cost, ischemic stroke, length of stay, NIHSS, INA-CBG's claims

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