Analysis of Differences in Tariff for Health Service Based on Sustability of Diagnosis on Admision and Summary Discharge Form with INA-CBGs Verification

Abstract

The implementation of the National Health Insurance starting in January 2014 made a change in the payment system from the Retrospec-tive Paymant System to the Prospective Payment System with INA-CBG's rates. The difference in INA-CBG's rates and hospital rates is a fundamental problem so that hospitals must make efforts to achieve quality and cost control. the purpose of this research was to deter-mine the Analysis of Differences in Tariff for Health Service Based on sustability of Diagnosis on the admision and discharge summary form (RM1) with INA-CBGs Verification at Hospital Dr. Reksodiwiryo Padang. The results of the study found that the accuracy of dis-ease diagnosis and patient medical treatment was on the RM1 form (21.7%), on the INA-CBGs verification (56.5%). Differences in dis-ease diagnosis and patient medical treatment on RM1 form with INA-CBGs verification (63.0%), and differences in health service fees based on accuracy of patient diagnosis and medical treatment on RM1 form with INA-CBGs verification (63.0%). There is a significant relationship between the difference in the Tariff of health services with the accuracy of diagnosis on the RM1 form and the INA-CBGs verification which is quite large, due to the discrepancy in writing the diagnosis on RM1 with the INA-CBGs verification.