EVALUASI PILOT PROJECT GLOBAL BUDGET : STUDI KASUS DI RSU RIZKI AMALIA

Health insurance payments have recently run into serious problems in Indonesia. In 2019 BPJS Kesehatan lost almost 11.6 trillion. BPJS arrears to hospitals reached 6.5 trillion. This reflects the gap between the expectations and reality of bpjs health payment system. Starting in 2020 BPJS piloted a global budget project in Kulon Progo, Yogyakarta, including at RSU Rizki Amalia. The purpose of this study is to get a broad and detailed evaluation of the implementation of the 2020 global ptoject pilot budget at RSU Rizki Amalia. The purpose in particular is to know the difference in calculations between planning and realization of the global budget, knowing the causes of different calculations that occur and making a follow-up plan based on the results of the findings of the cause. This research is qualitative study with case studies. The data is drawn from observations and in-depth interviews. The conclusion of this study is that there are significant difference between the calculation of projections on the realization of visits and case mix index of hospitalization, hospitalization budget, budget top up and total budget in 2020. The causes of the anticipated calculation differences are service reductions, credential changes and changes the number of beds. Causes that cannot be anticipated are pandemic covid 19, the number of participants, regional characteristics, complexity of diagnoses, changes in regulations, refer back program policies and adjustment factors. Things that can be done to overcome the causes are the availability of human resources and reliable hospital management to maintain services and visits, conduct internal evaluation of hospitals, joint evaluation between hospitals and BPJS, make projections with accurate data, agreement if there are service changes, calculation methode and force majeur, recalculation in the middle of the year, regulatory certainty and referral zoning