managed care.pptx
TRANSCRIPT
7/18/2019 MANAGED CARE.pptx
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MANAGED CARE
IKMC-FKM UNAIR
2014
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KELOMPOK 13
• DINDA RAHMANIAR
• NESSIA RACHMA
•
FAROUK ILMID DAVIK • NISA AMIRA
• LULUK NUR KHASANAH
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Implement!" Managed Care #e$%!$&n Pe$t'$n (e$&"t )m"nn
Ke!e*tn N!"+nl
• Lt$ ,el&n )KN
KOMI(MEN GLO#AL.)ENE/A 200
UNIVERSAL HEAL(HCOVERAGE .UHC
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PERA(URAN PRESIDEN REPU#LIK INDONESIANOMOR 12 (AHUN 2013 (EN(ANG )AMINANKESEHA(AN
• P% #, I p!l 41-44 !"!tem &en%l" m't' %n ,"5pen5elen$n 6m"nn &e!e*tn te$t'l"! ,*7 – Pel5nn &e!e*tn &ep% Pe!e$t )m"nn Ke!e*tn *$'! mempe$*t"&n
m't' pel5nn berorientasi pada aspek keamanan pasien, efektitastindakan, kesesuaian dengan kebutuhan pasien, serta esiensi biaya.
– Pene$pn !"!tem &en%l" m't' pel5nn )m"nn Ke!e*tn %"l&'&n !e8$
men5el'$'* mel"p't" pemen'*n !tn%$ m't' F!"l"t! Ke!e*tn mem!t"&np$+!e! pel5nn &e!e*tn ,e$6ln !e!'" !tn%$ 5n %"tetp&n !e$tpemnt'n te$*%p l'$n &e!e*tn Pe!e$t9
– Ketent'n menen" pene$pn !"!tem &en%l" m't' pel5nn )m"nnKe!e*tn %"t'$ %enn Pe$t'$n #P)S9
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UNDANG-UNDANG REPU#LIK INDONESIA NOMOR 40 (AHUN 2004 (EN(ANG SIS(EM )AMINAN SOSIALNASIONAL
Dlm p!l 24 5t 3 %"!e,'t&n Badan Penyelenggara Jaminan Sosial mengembangkan sistem pelayanankesehatan, sistem kendali mutu pelayanan, dansistem pembayaran pelayanan kesehatan untuk
meningkatkan efsiensi dan eektiftas.
PERA(URAN MEN(ERI KESEHA(AN REPU#LIK
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PERA(URAN MEN(ERI KESEHA(AN REPU#LIKINDONESIA NOMOR 2: (*'n 2014 (EN(ANGPEDOMAN PELAKSANAAN PROGRAM )AMINANKESEHA(AN NASIONAL
• Pel5nn &e!e*tn %lm p$+$m )KN%",e$"&n !e8$ ,e$6en6n e;e&t"; %n e<!"en%enn mene$p&n p$"n!"p &en%l" m't' %n&en%l" ,"59 S'm,e$ pen%nn %lm
pen5elen$n )KN ,e$!l %$" iuran ataucost sharing %$" pe!e$t pe!e$t P#I %n ,'&nP#I9
• I'$n me$'p&n !e6'ml* 'n 5n %",5$&n
!e8$ te$t'$ +le* Pe!e$t Pem,e$" Ke$6Dn=At' Peme$"nt* Unt'& P$+$m )m"nnKe!e*tn9 I'$n %"%!$&n t! p$"n!"p +t+n$+5+n %lm UU S)SN9
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PERA(URAN MEN(ERI KESEHA(AN REPU#LIK INDONESIA NOMOR 1> (AHUN 2014 (EN(ANG PENGGUNAAN DANA KAPI(ASI )AMINANKESEHA(AN NASIONAL UN(UK )ASA PELA?ANAN KESEHA(AN DANDUKUNGAN #IA?A OPERASIONAL PADA FASILI(AS KESEHA(AN (INGKA( PER(AMA MILIK PEMERIN(AH DAERAH
• S"!tem pem,5$n p% F!"l"t! Ke!e*tn ("n&tPe$tm .FK(P %l* %enn kapitasi9 Pent'$npen'nn %n &p"t!" )KN 'nt'& 6! pel5nn&e!e*tn %n %'&'nn ,"5 +pe$!"+nl %"t'6'&n ,"FK(P m"l"& peme$"nt* %e$* 5n ,el'm mene$p&np+l penel+ln &e'nn ,%n l5nn 'm'm %e$*9
• Pem,5$n Kp"t!" +le* #P)S Ke!e*tn %"%!$&n p% 6'ml* pe!e$t 5n te$%;t$ %" FK(P !e!'" %enn %t#P)S Ke!e*tn9 Pem,5$n &p"t!" &ep% FK(P%"l&'&n +le* #P)S Ke!e*tn !et"p ,'ln pl"n lm,ttnl 1 ,'ln ,e$6ln9
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Pemn;tn %n &p"t!" )KN %"F(KP %l*
.1 Dn Kp"t!" 5n %"te$"m +le* FK(P %$" #%n Pen5elen$ )m"nnS+!"l Ke!e*tn %"mn;t&n !el'$'*n5 'nt'& 9 pem,5$n 6!pel5nn &e!e*tn@ %n ,9 %'&'nn ,"5 +pe$!"+nl pel5nn&e!e*tn9
.2 Al+&!" 'nt'& pem,5$n 6! pel5nn &e!e*tn %"tetp&n!e&'$n-&'$nn5 0B %$" pene$"mn Dn Kp"t!"9
.3 Al+&!" 'nt'& pem,5$n %'&'nn ,"5 +pe$!"+nl pel5nn&e!e*tn %"tetp&n !e,e!$ !el"!"* %$" ,e!$ Dn Kp"t!" %"&'$n"%enn ,e!$ l+&!" 'nt'& pem,5$n 6! pel5nn &e!e*tn!e,"mn
.4 #e!$n l+&!" %"tetp&n !et"p t*'n %enn Kep't'!n KeplDe$* t! '!'ln Kepl SKPD D"n! Ke!e*tn K,'pten=K+t %enn
mempe$t"m,n&n 9 &e,'t'*n +,t lt &e!e*tn %n ,*n me%"!*,"! p&"@ ,9 &e"tn +pe$!"+nl pel5nn &e!e*tn %lm $n&men8p" t$et &"ne$6 %" ,"%n 'p5 &e!e*tn pe$+$nn@ %n 89,e!$ t'n6nn 5n tel* %"te$"m %$" Peme$"nt* De$*9
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PERA(URAN MEN(ERI KESEHA(AN REPU#LIKINDONESIA NOMOR 2 (AHUN 2014 (EN(ANGPE(UN)UK (EKNIS SIS(EM INDONESIN CSE BSE!"O#PS .INA-C#G!• P+l pem,5$n &ep% ;!"l"t! &e!e*tn t"n&t ln6'tn
.FK(L %l* %enn INA-CBGs !e!'" %enn Pe$t'$nP$e!"%en N+m+$ 12 (*'n 2013 tentn )m"nn Ke!e*tn!e,"mn tel* %"',* %enn Pe$t'$n P$e!"%en N+m+$ 111 (*'n 20139 Dlm met+%e pem,5$n INA-C#G! te$6%"
pe$',*n 8$ pn%n %n pe$"l&' %lm penel+ln $'m*!&"t !e$t pel5nn te$*%p p!"en9 R'm* !&"t *$'!mem'l" pe$',*n 8$ pn%n %$" p+l pem,5$n fee forservice ke pembayaran dari mulai tingkat manajemenrumah sakit, dokter dan seluruh karyaan rumah sakit.
• Pem,5$n pel5nn &e!e*tn %enn men'n&n !"!tem
INA C#G! te$*%p FKR(L ,e$%!$&n p% pen6'n &l"m %$"FKR(L ,"& 'nt'& pel5nn $7t 6ln m'p'n 'nt'& pel5nn$7t "np9 Kl"m FKR(L %",5$&n +le* #P)S Ke!e*tn palinglambat !" hari setelah berkas klaim diterima lengkap.
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#e,e$p 'p5 5n !e,"&n5 %"l&'&n $'m* !&"t %l*
19 Mem,n'n t"m $'m* !&"t
29 Men"n&t&n e<!"en!"
39 Mempe$,"&" m't' $e&m me%"!
49 Mempe$,"&" &e8eptn %n m't' &l"m
9 Mel&'&n !tn%$"!!"
9 Mem,ent'& ("m C!em"=("m INA-C#G $'m* !&"t
9 Memn;t&n %t &l"m9
:9 Mel&'&n $e"' $ost%&laim
>9 Pem,5$n 6! me%"!109D"*$p&n !el'$'* $'m* !&"t p$+"%e$ )KN ,"! ,e$&+nt$",'!"
'nt'& men"$"m&n %t &+%"n %n %t &osting !e*"n %pt%"*!"l&n t$"; 5n men8e$m"n&n a&tual &ost pel5nn %"$'m* !&"t9
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• Implement!" managed &are %lm )KN ,e$%!$&n pe$t'$n5n % tel* !e!'" %enn te+$" managed &are9 Ken%l" m't'%n ,"5 %lm )KN me$'p&n 8$ 'nt'& mem!t"&n p$+!e!pel5nn &e!e*tn ,e$6ln !e!'" !tn%$ 5n %"tetp&n!e$t pemnt'n te$*%p l'$n &e!e*tn Pe!e$t !'p5 %pt
te$l&!n %enn e;e&t"; %n e<!"en9
• )KN mene$p&n p$"n!"p !'$n!" !+!"l 5n mel"p't"
19 Ke+t+n-$+5+nn nt$ 5n &5 %n m"!&"n 5n !e*t%n !&"t 5n t' %n m'% %n 5n ,e$"!"&+ t"n" %n$en%*@
29 Kepe!e$tn 5n ,e$!";t 76", %n t"%& !ele&t";@
39 I'$n ,e$%!$&n pe$!ent!e 'p*=pen*!"ln@
49 #e$!";t n"$l,9