Analisis Tarif INA-CBGS Kasus Persalinan dengan Penyulit Disertai Prosedur Sectio caesarea

Abstract

Pembiayaan prosedur Sectio caesarea (SC) dalam INA-CBGs dilakukan atas dasar indikasi medis tertentu. Ketika terdapat selisih tarif INA CBGs dengan tarif rumah sakit, rumah sakit mengalami kerugian. Penelitian ini bertujuan mendeskripsikan tarif INA-CBGs pada berbagai tingkat keparahan dengan mempertimbangkan karakteristik dan keadaan klinis ibu bersalin. Jenis penelitian adalah deskriptif kuantitatif. Peneliti mengobservasi 142 data klaim persalinan dengan penyulit disertai prosedur SC. Analisa data secara deskriptif. Hasil menunjukkan bahwa sebagian besar pasien berumur 26-30 tahun (34,51%), indikasi medis riwayat SC (27,46%), dan kelas perawatan di kelas 3 (54,93%), lama perawatan 4 hari (66,90%), diagnosis utama O34.2 (31,69%), dan tingkat keparahan I (76,06%). Diagnosis sekunder komplikasi paling banyak terjadi adalah riwayat SC (12,37%) dan anemia (12,37%). Tarif rumah sakit cenderung beragam dan terdapat selisih kekurangan tarif berkisar 40 juta rupiah. Rumah sakit perlu melakukan validasi internal klaim secara ketat, memastikan kelengkapan dokumen, meningkatkan koordinasi antar unit serta melakukan pelatihan rutin bagi staf terkait aturan klaim terbaru.Financing for Sectio caesarea (SC) procedures within the INA-CBGs system is determined based on specific medical indications. When discrepancies arise between INA-CBGs reimbursement rates and hospital service rates, hospitals may experience financial losses. This study aims to describe INA-CBGs tariffs across various severity levels by considering the characteristics and clinical conditions of delivering mothers. This research employed a descriptive quantitative design. The researcher observed 142 claim data entries for complicated deliveries involving SC procedures, and the data were analyzed descriptively. The results showed that most patients were aged 26–30 years (34.51%), had a medical indication of previous SC (27.46%), were treated in class III wards (54.93%), had a length of stay of four days (66.90%), had a primary diagnosis of O34.2 (31.69%), and were categorized as severity level I (76.06%). The most common secondary diagnoses were a history of SC (12.37%) and anemia (12.37%). Hospital tariffs varied considerably, and the deficit between INA-CBGs rates and hospital rates reached approximately 40 million rupiah. Hospitals should implement strict internal validation of claims, ensure complete documentation, strengthen inter-unit coordination, and provide regular training for staff on updated claim regulations.