PENGEMBANGAN PRA-MODEL MANAJEMEN DOKTER YANG MENDUKUNG EFISIENSI BIAYA PELAYANAN PASIEN PADA ERA ASURANSI KESEHATAN DI RS. PANTIWILASA "CITARUM" SEMARANG PHYSICIAN MANAGEMENT'S PRE-MODEL DEVELOPMENT SUPPORTING PATIENT'S COST OF CARE EFFICIENCY IN THE HEALTH INSURANCE ERA AT PANTIWILASA "CITARUM" HOSPITAL, SEMARANG

Abstract

Increasing patients paid by third party payer, draws hospital's management to do efficiency. Physicians have a strategic position at hospital. Hospital should have a physician's management model that can drive cost efficiency. The objective of this study is to develop physician management's pre-model at Pantiwilasa "Citarum" Hospital which could drive patient's cost of care efficiency. This study was participated by 50 physicians working at Pantiwilasa "Citarum" Hospital in Semarang as respondents. This research is observational study, using cross sectional approach, to search correlation between independent and dependent variables, and also to develop pre-model. More than 52 % respondents can accept if they have to follow the standardization of patient's care procedure, to prescribe appropriately fitted with formularium, to shorten the hospitalized time, to receive relatively lower medical fees for patient participated in health insurance, to accept empowering the medical committee, to accept Pantiwilasa's medical equipments and to accept policy of Pantiwilasa "Citarum" related to physician. Most of respondents (94 %) also accept liabilities for supporting patient's cost of care efficiency management. Based on chi-square test, there are significant differences (p<0.05) between the answer of full time physicians and visiting physicians participated in this study. The differences are in the acceptance to follow standard procedure for patient's care, and to prescribe appropriately fitted with formularium. There is no significance difference (p<0.05) in the answer for other study variables that are shorten hospitalized time, lower medical fees for insuranced patients, empowering the medical committee, provided medical equipments, policy related to physician, and liabilities for patient's cost of care efficiency management. Based on logistic regression, there is no significant influence in respondent's acceptance on variables of cost efficiency studied, and in respondent's acceptance on hospital's equipments and policy, as well as in the respondent's acceptance on the liabilities to support patient's cost of care efficiency in common Qualitatively, concludes that accepted physician management pre-model that support patient's cost of care efficiency includes good relationship between hospital's administrator and physicians, empowering medical staff committee, "Hospital Bylaws" implementation, appropriate medical fee, and physician chosen implementation by hospital's administrator. Meningkatnya pasien yang dibayar pihak ketiga di Indonesia, mendorong manajemen rumah sakit untuk melakukan efisiensi biaya. Dokter mempunyai posisi strategis dalam rumah sakit. Untuk itu rumah sakit memerlukan model manajemen dokter yang mendukung efisiensi biaya. Penelitian ini bertujuan mengembangkan pra-model manajemen dokter di RS. Pantiwilasa "Citarum" yang dapat mendorong secara bermakna efisiensi biaya pelayanan pasien. Penelitian ini melibatkan 50 dokter yang bekerj a di RS Pantiwilasa "Citarum", Semarang sebagai responden penelitian. Penelitian ini bersifat observasional dengan menggunakan pendekatan "cross sectional" untuk mencari hubungan antara variabel independen dan dependen dan pengembangan pra-model . Penelitian ini menemukan secara deskriptif bahwa lebih dari 52 % responden dapat menerima bila diharuskan untuk mentaati prosedur standar pengelolaan pasien, menulis resep sesuai formularium, memperpendek waktu rawat inap, menerima jasa medis relatif lebih rendah untuk pasien peserta asuransi, pemberdayaan komite medik, peralatan kerj a yang ada dan kebijakan umum RS. Pantiwilasa "Citarum" yang menyangkut dokter. Sebagian besar responden (94 %) juga bisa menerima kewajiban untuk mendukung efisiensi biaya pengelolaan pasien. Dengan uji chi square, terdapat perbedaan jawaban yang signifikan (p<0,05) antara responden dokter tetap dan dokter mitra dalam hal penerimaan pada keharusan mengikuti prosedur standar pengelolaan pasien dan keharusan mentaati formularium. Tidak ada perbedaan jawaban yang signifikan pada variabel penelitian lain (p<0,05). Dengan analisis regresi logistik ditemukan tidak ada pengaruh antara penerimaan dokter pada variabel upaya-upaya efisiensi biaya, dan penerimaan dokter pada kebijakan dan fasilitas rumah sakit, terhadap variabel penerimaan pada kewajiban mendukung efisiensi biaya pengelolaan pasien secara umum. Secara kualitatif dapat disimpulkan pra-model manajemen dokter yang dapat diterima dan mendukung efisiensi biaya pengelolaan pasien meliputi hubungan yang harmonis antara administrator rumah sakit dengan dokter, pemberdayaan komite medik, adanya "Hospital Bylaws", jasa medis yang layak, serta administrator rumah sakit harus memilih dokter.