BAB 7. SIMPULAN DAN SARAN
7.2 Saran
1. Diperlukan penelitian lanjutan yang mengevaluasi program JKN saat telah terimplentasi dalam jangka waktu yang lebih panjang, untuk menyingkirkan kemungkinan adanya era transisi non JKN ke JKN yang dapat merancukan hasil penelitian.
2. Ada keterkaitan erat antara biaya dan kualitas layanan kesehatan sehingga disarankan untuk penelitian selanjutnya yang berbasis kesehatan baik segi etiologi, diagnostik, terapi dan prognostik sebaiknya menyertakan analisis ekonomi kesehatan.
3. Diperlukan suatu evaluasi berkala terhadap pelaksanaan P3G, untuk memastikan terpeliharanya kualitas layanan sesuai yang dimaksudkan, yang tidak terpengaruh oleh sistem pembiayaan dan faktor eksternal lain.
Populasi geriatri makin berkembang seiring waktu. Geriatri memiliki karakteristik yang khas sehingga memerlukan pendekatan khusus dalam penatalaksanaan masalah kesehatannya, yang dikenal dengan Pendekatan Paripurna Pasien Geriatri (P3G). P3G telah menjadi standar pelayanan di RSCM dan terbukti menghasilkan luaran perawatan yang lebih baik, dari segi mortalitas, rehospitalisasi, lama masa rawat, perbauikan kualitas hidup dan lebih efektif biaya. Semenjak awal tahun 2014, di Indonesia mulai diberlakukan sistem pembiayaan Jaminan Kesehatan Nasional, menggantikan sistem jaminan kesehatan sebelumnya yang masih sangat bervariasi.
Yang menjadi pertanyaan adalah apakah terdapat perbedaan kesintasan dan efektifitas biaya pasien geriatri yang dirawat di RSCM pada era JKN dibanding era non JKN.
Tujuan dari penelitian ini adalah untuk mengetahui perbandingan kesintasan dan efektifitas biaya pasien geriatri yang dirawat di RSCM antara era JKN dan non JKN.
Penelitian ini menggunakan metode kohort retrospektif dengan kontrol historis. Sampel dikumpulkan dari pasien geriatri yang dirawat di RSCM selama periode Juli 2013-Juni 2014 yang kemudian dibagi menjadi kelompok JKN dan kelompok non JKN sebagai kontrol. Akan dinilai perbedaan angka mortalitas, kurva kesintasan dan efektivitas biaya perawatan dengan menghitung incremental cost effectivitveness ratio (ICER).
Dari total 225 subjek, 100 subjek berada di era non JKN dan 125 subjek di era JKN dengan karakteristik demografis dan klinis yang relatif sama. Sebagian besar subjek pada kedua kelompok berjenis kelamin perempuan, berada pada kelompok usia 60-79 tahun, bersuku Jawa, dan tidak bersekolah. Terdapat kesetaraan karakteristik demografis pada kedua kelompok. Subjek pada kelompok JKN memiliki proporsi penyakit pneumonia, sepsis dan sindrom delirium akut yang lebih tinggi, serta nilai albumin dan status gizi yang lebih rendah dibandingkan kelompok non JKN, namun tidak bermakna secara statistik. Tidak ada perbedaan mortalitas selama perawatan( 31,2% vs 28%, p = 0,602) dan kesintasan 30 hari antara kelompok JKN
dan non JKN ( 66,4% vs 65,2 %, p = 0.086). Kurva kesintasan 30 hari antara kedua kelompok tidak menunjukkan perbedaan bermakna (log rank = 0,831). Hasil perhitungan ICER menunjukkan dengan investasi biaya sebesar 1,4 juta diperoleh penurunan kesintasan sebesar 1,2%.
Dari penelitian ini disimpulkan tidak ada perbedaan kesintasan antara pasien geriatri yang dirawat di RSCM pada kelompok JKN dan non JKN. Perhitungan ICER menunjukkan dibutuhkan investasi biaya untuk memperoleh penurunan kesintasan pada penerapan JKN, namun interpretasi hasil ini perlu mempertimbangkan implentasi JKN yang masih dalam tahap awal. Diperlukan penelitian lanjutan saat implementasi JKN telah berlangsung dalam kurun waktu lebih panjang.
Geriatrics is a growing population with special characteristics and medical problems. Comprehensive Geriatrics Assesment (CGA) has been proven to improve the overall outcome of inpatient geriatric patients, including mortality, rehospitalization, quality of life, length of stay dan more cost effective. CGA has been implemented in RSCM as the standard geriatric medical care. Since January 2014, a new insurance system called National Health Insurance Program (NHIP) was implemented in Indonesia. It is unclear how NHI will affect the mortality rate and cost effectiveness of geriatric inpatients receiving CGA.
The objectives of this study is to determine the difference between cost effectiveness and survival of geriatric patients between NHIP and non NHIP era in RSCM acute geriatric ward inpatients.
This is a retrospective cohort study with hystorical control. The subject were geriatric inpatients ≥60 years old with one or more geriatrics giants between Juli to Desember 2013 (non NHIP) and Januari to Juni 2014 (NHIP). A survival analysis and determination of incremental cost effectivitveness ratio (ICER) was used to compare the survival and cost effectiveness between the two group.
The result are as follows. A total of 225 subject was recruited, 100 in NHIP era dan 125 in non NHIP era. Most of the subjects in both groups are women, in the 61-80 group of age, and didn’t attend school. The clinical and demographics characteristics were relatively similar between the NHIP and non NHIP group. The subject in NHIP group had higher proportion of pneumonia, sepsis, acute confusional state and lower albumin and nutritional level compared with non NHIP group, though not statistically significant. No difference in 30 day mortaliy rate and inhospital mortality were found between NHIP and non NHIP group (31,2% vs 29%, p = 0,721 and 31,2% vs 28%, p=0,602, respectively). No significant difference was found when comparing the survival curve between the two group (log rank = 0,831). Calculation of ICER shows that NHIP is associated with an increased cost of 1,4 million rupiah and 1,2 % survival lost.
Based on this study, we can conclude that NHIP had no impact on survival in geriatric inpatients. ICER calculation shows NHIP implementation is associated with higher investment cost to yield lower survival rate. Further research is needed to evaluate this result when NHIP had been implemented for a longer duration.
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dr. Hari Sutanto/ dr. Ika Fitriana/ dr. Paskalis
1. Nama : Tn/ Ny. ______________ No RM :______________________
2. Tanggal lahir : _____________________ Usia : ______________________
3. Alamat : _______________________________________________________
4. Suku : _____________________ No telp : ______________________
5. Agama : _____________________ Status : ______________________
6. Pekerjaan : PNS/ Swasta/ Pensiun/ Tidak bekerja
7. Pendidikan :Tidak Sekolah / SD / SMP / SMU / S1 / S2 / S3