Perspektif Layanan Sekunder
3/24/2016
3/24/2016
3/24/2016
2012
2013
2014
2015
2016
2017
2018
2019
Konsensus
manfaat
Penyesuaian
Perpres
Jamkes
Manfaat bervariasi
belum komprehensif
sesuai kebutuhan
medis
- Manfaat standar
-
Komprehensif
sesuai keb medis
-
Berbeda non
medis
Iuran :
Masih
berbeda PBI
dan Non PBI
Manfaat
sama untuk
semua
penduduk
KEGIATAN-KEGIATAN
Iuran bervariasi
Penetapan
manfaat dlm
Perpes JK,
termasuk
koordinasi
manfaat
Kajian berkala tahunan tentang upah, iuran, efektifitas manfaat,
dan pembayaran antar wilayah
Telaah utilisasi kontinyu untuk menjamin efisiensi, menurunkan
moral hazard, dan kepuasan peserta dan tenaga / fasilitas kesehatan
Penyesuaian
Perpres
Jamkes
3/24/2016
Perkembangan Healthcare di Indonesia
3/24/2016
Perbandingan di ASEAN
3/24/2016
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Non Kelas
D
C
B
A
Populasi RS di Indonesia (Berdasarkan Kelas)
3/24/2016
Plus VS Minus JKN –
RS Rujukan
•
Kenaikan biaya kesehatan dapat
ditekan.
•
Biaya dan mutu pelayanan
kesehatan dapat ditingkatkan.
•
Kepesertaan bersifat wajib bagi
seluruh penduduk.
•
Pembayaran bersifat prospektif.
•
Adanya kepastian pelayanan
kesehatan yang berkelanjutan.
•
Manfaat pelayanan kesehatan
komprehensif (promotive,
preventive, curative dan
rehabilitative)
•
Pembiayaan di Swasta berbeda
dengan di Pemerintah.
•
Sistem regionalisasi belum
berjalan baik.
•
Penyebaran dokter/rumah sakit
belum merata di Indonesia.
•
Terbatasnya tempat tidur di
rumah sakit rujukan tingkat
lanjut.
•
Seringkali dianggap kecurangan
(fraud).
•
Lamanya proses administrasi
pembayaran > verifikasi.
3/24/2016
Sistem Rujukan Berjenjang
JENJANG
RUJUKAN
PENGERTIAN
FASILITAS PELAYANAN
KESEHATAN
MONITORING DAN
EVALUASI
Tingkat I
Mampu memberikan
pelayanan kesehatan
dasar
•
Puskesmas
•
Puskesmas perawatan
•
Balai pengobatan
•
Praktek perorangan
•
Dokter Keluarga
•
Klinik pratama
•
Rumah bersalin
•
Klinik umum
•
RS Pratama
Kadinkes Kab/Kota dan
organisasi profesi
cabang Kab/kota
Tingkat II
Mampu memberikan
pelayanan kesehatan
spesialistik
•
RS kelas C
•
RS kelas D
(baik milik pemerintah,
TNI/Polri, BUMN maupun
swasta)
Kadinkes Propinsi dan
organisasi profesi
cabang Kab/kota
Tingkat III
Mampu memberikan
pelayanan kesehatan
sub spesialistik
•
RS kelas A
•
RS kelas B
(baik milik pemerintah,
TNI/POLRI, BUMN maupun
swasta)
3/24/2016
11
PNPK
NASIONAL
organisasi
profesi
LEGALISASI
KEMENKES
PPK/
SPO
pimpinan
fasilitas
yankes
PEMBUAT
FASYANKES
SIFAT
CAKUPAN
PANDUAN
PRAKTIK KLINIS
ALUR KLINIS
=
clinical pathway
Sesuai standar profesi
ALGORITME
PROTOKOL
PROSEDUR
STANDING ORDER
Akreditasi Nasional
3/24/2016
Coordination of Benefit
•
Kerjasama dengan Asuransi/TPA lainnya?
3/24/2016
Reach
Scale
International
Quality
SILOAM HOSPITALS GROUP
Affordable and Accessible Healthcare
to all socio economic segments
Godly
Compassion
By 2017..
•
Beds
4,800 to 10,000
•
Patients per annum
2 million to 15 million
•
Hospitals
21 to 40 hospitals
15 to over 25 cities
3/24/2016
Misi SHG
(The trusted destination of choice for holistic world class
healthcare, health education and research)
Pilihan Terpercaya Untuk Mendapatkan
Pelayanan Kesehatan Bertaraf Internasional,
Pendidikan Kesehatan,
3/24/2016
Values
1. Cinta Kasih
2. Belas kasihan
3. Integritas
4. Kejujuran
5. Kepedulian
6. Empati
3/24/2016
Mature and Developing Hospitals
79.45% Ownership
EAST KALIMANTAN
SILOAM HOSPITALS BALIKPAPAN
228 Bed Capacity 92 GP and Specialists 180 Nurses
Centre of Excellence : Emergency & Trauma and Orthopedics
EAST SUMATERA
SILOAM HOSPITALS JAMBI
100 Bed Capacity 65 GP and Specialists 127 Nurses
Centre of Excellence : Emergency & Trauma
83.0% Ownership
SOUTH JAKARTA
MRCCC SILOAM SEMANGGI
331 Bed Capacity 172 GP and Specialists 220 Nurses
Centre of Excellence : Cancer Centre
TANGERANG (West of Jakarta)
SILOAM HOSPITALS LIPPO VILLAGE
308 Bed Capacity 234 GP and Specialists 455 Nurses
Centre of Excellence : Neurosience & Heart Centre
WEST JAKARTA
SILOAM HOSPITALS KEBON JERUK
279 Bed Capacity 198 GP and Specialists 342 Nurses
Centre of Excellence : Urology & Orthopaedic
EAST JAVA
SILOAM HOSPITALS SURABAYA
162 Bed Capacity 144 GP and Specialists 265 Nurses
Centre of Excellence : Fertility Centre
BEKASI (East of Jakarta)
SILOAM HOSPITALS CIKARANG
118 Bed Capacity 91 GP and Specialists 161 Nurses
3/24/2016
New Hospitals in 2012
TANGERANG (West of Jakarta)
SILOAM GENERAL HOSPITAL (RSUS)
664 Bed Capacity 49 GP and Specialists 214 Nurses
SOUTH SUMATERA
SILOAM HOSPITALS PALEMBANG
347 Bed Capacity 119 GP and Specialists 161 Nurses
Centre of Excellence : Emergency & Trauma
NORTH SULAWESI
SILOAM HOSPITALS MANADO
230 Bed Capacity 98 GP and Specialists 126 Nurses
Centre of Excellence : Emergency & Trauma
SOUTH SULAWESI
SILOAM HOSPITALS MAKASSAR
360 Bed Capacity 97 GP and Specialists 247 Nurses
Centre of Excellence : Cardiology and Emergency & Trauma
DEPOK (South of Jakarta)
SILOAM HOSPITALS CINERE
37 Bed Capacity 19 GP and Specialists 51 Nurses
Centre of Excellence: Cardiology
80.0% Ownership
3/24/2016
New Hospitals in 2013
BALI
SILOAM HOSPITALS BALI
281 Bed Capacity 97 GP and Specialists 179 Nurses
Centre of Excellence : Emergency & Trauma, Medical Tourism,
Orthopaedics and Cardiology
BALI
BIMC KUTA
19 Bed Capacity 51 GP and Specialists 65 Nurses
Centre of Excellence : Emergency & Trauma
BALI
BIMC NUSA DUA
31 Bed Capacity 57 GP and Specialists 74 Nurses
Centre of Excellence : Emergency & Cosmetic Surgery
80.0% Ownership
80.0% Ownership
New Hospitals in 2014
SOUTH JAKARTA
SILOAM HOSPITALS TB SIMATUPANG
269 Bed Capacity 110 GP and Specialists 136 Nurses
Centre of Excellence : Emergency & Trauma.
Cardiology, Oncology and Neuroscience
WEST JAVA
SILOAM HOSPITALS PURWAKARTA
203 Bed Capacity
34 GP and Specialists
105 Nurses
Centre of Excellence : Emergency & Trauma
SILOAM HOSPITALS ASRI
42 Bed Capacity
104 GP and Specialists
76 Nurses
3/24/2016
Hospitals newly opened
NORTH SUMATERA
SILOAM HOSPITALS MEDAN
EAST NUSA TENGGARA
SILOAM HOSPITALS KUPANG
There are currently 29 sites under
various stages of development
NUSA TENGGARA TIMUR
3/24/2016
JKN
–
Siloam Hospitals Group
Sumatra Population : 50.6 mio
Kalimantan Population : 13.8 mio
Java Population : 136.6 mio
Sulawesi Population : 17.4 mio
Papua Population : 3.6 mio
Bali Population : 3.9 mio
Nusa Tenggara Population : 9.2 mio
Maluku Population : 2.6 mio
Jakarta Population : 10 mio
Greater Jakarta Population : 28 mio
•
Tidak semua RS di SHG
memiliki kemampuan yang
sama.
•
Tidak semua daerah memiliki
sistem distribusi yang baik.
•
Policy yang berbeda untuk
masing-masing regional.
•
Lamanya proses verifikasi.
3/24/2016
Kesimpulan
Human Resources
Facilities
expenditure
•
Kurangnya Dokter
Spesialis
•
Fee for Service VS
Fixed Service
•
Sistem Pendidikan
•
Verifikator
•
Mixed Facilities:
Beds, ICU, OT, HD
•
100 % Private
•
E-Catalog
–
tidak
ada barang
•
Type B
–
Rujukan
kurang
•
No Subsidies
•
Cash Flow
•
Obat-Obat
Catastrophic
•
Operational Cost
•
COB
Network
3/24/2016
