INA CBGs
Process 3. Sum the unit costs to calculate the total cost 3. Allocate costs to departments
per service/patient proportionally according to their
4. Construct the average cost for a particular consumption of resources
service or patient group 4. Divide department costs by its service
volume to estimate unit costs
Unit cost estimates are built from the Unit cost estimates are averaged from the
Cost Flow individual service or patient level upwards facility and department level downwards
Top-down results are best for relative cost comparisons and bottom-up
results are best for absolute cost estimates.
Top-down Costing Results Bottom-up Costing Results
Unit Cost of Hospital Discharge Unit Cost of Complicated Delivery
$140 $140 $5
$8 $36 Other
$12 $29 Opera ng
$80 $80
Diagnos c
$140
$20
$60 $60
$110 Drug/Medical
Supply
$40 $80 $40 $75 Labor
$68
$56
$20 $20
$0 $0
Medicine Surgery Maternity Pa ent 1 Pa ent 2 Pa ent 3
Selected Hospital Departments Sample of Pa ents
The average cost of a Medicine discharge is $80, compared to On average, a complicated delivery costs $122, ranging
$140 for Surgery and $110 for Maternity. Assuming the from $100 to $140 across patients. Staff time and
average hospital discharge costs $100, the cost weights are drugs/medical supplies account for the majority of the cost,
0.80, 1.40, and 1.10 respectively. at 55% and 23%.
Bottom up designs within a top down costing exercise typically include bottom up
measurement of:
Priority services, treatment episodes, activities, or cost items
Services that are heterogeneous in their resource use (vary widely in their complexity and cost
e.g., ICU services, laboratory tests, surgical procedures
Services where precision and accuracy of cost measurement is considered important
Services where there is heavy personnel time or overheads that go into a technology
Services or technologies where there is extensive sharing of personnel, buildings, or equipment
Cost items that are anticipated to have the highest impact on total cost
Data that are missing or not routinely captured
Data for allocation statistics (e.g., personnel time worked)
ANALISA EKSPLORING
CBGs COST
COST WEIGHT
CMI
HBR
PRELEMINARY TARIF
AF
TARIF
Struktur tarif stabil (should be as stable as possible)
Struktur tarif sederhana (should be as simple as
possible)
Struktur tarif berbasis pada pelayanan, bukan organisasi
(should be based on services not organisations)
Seluruh pemangku kepentingan harus dilibatkan dalam
proses penyusunan tarif
Tarif memiliki rujukan berbasis acuan biaya (should
continuous to be based on referrence cost)
Aim of Tariff Development
To ensure that providers are fairly reimbursed for
their work
To ensure that the price reflects the actual cost of
providing services which will promote system
sustainability
To ensure that the price structure support
appropriate medical and reward those providing
good outcomes
Sumber : UNU-IIGH
Providers may charge informal payment to
compensate for inadequate formal payment.
Providers may avoid treating sicker patients.
Inappropriate referrals may occur.
Providers provide suboptimal care.
Services may be over or under utilize.
Sumber UNU-IIGH
TARIF INA CBGs
Cost Adjustment
TARIF = HBR
HospitalBa X Weight X factor
Cost Casemix
CBG Cost
Weights Index
Adjustment Tariff
Base Rate
Factor
5 Steps Cost Acounting Proces
1. Menentukan pusat biaya
2. Mengelompokkan unit kerja ke dalam
administrative/overhead cost center
Supporting /Intermediate cost center
Clinical departments/ final cost center
3. Menempatkan direct cost ke cost center
4. Menetapkan dng spesifik alocation factor dan proporsi
5. Mengalokasikan indirect cost ke cost center,
Mengalokasikan overhead cost ( direct, indirect ) ke
intermediate cost dan final cost,
Mengalokasikan intermediate cost ke final cost
Statistic alocation factor/alocation bases
A. Overhead Cost Centre Allocation Statistics
1. Administration No. of staff
2. Maintenance Floor area
3. Utilities Floor area
4. Consumables No. of staff
5. Dietetic Patient days
6. Laundry & Linen Patient days
Outpatient Department
13. Medical Specialist Clinic Visit
14. Surgical Specialist Clinic Visit
Total
Proporsi IPD OPD
Inpatient fraction Outpatient fraction
Theathre 100% 0%
Step-down Cost Allocation
The step-down method yields total cost per Clinical department after
allocating Administrative and Ancillary department costs.
Department Cost Administration Step-Down Allocation Ancillary Step-Down Allocation Total Clinical
Hospital
Department
Department Direct Indirect Total Admin Transport Maint Hygiene Kitchen Pharm Lab X-Ray Echo Blood Theater Cost
Tarif nasional
Perkelompok RS
Review tiap 2 thn (Perpres no 12 thn 2013 ttg JKN
Average Cost for Specific DRG
CW =
Aggregate Average Cost
RP 4.600.000
33
A Hospitals Case-Mix Index is a Value Which Relates one Hospitals
Production to Another Hospitals Production.
Sumber UNU-IIGH
Overall cost of treating a patient in the hospital by taking into account the
complexities of cases managed in the hospital
Total Cost
HBR = Total # of equivalent cases x CMI
Dihitung masing2 RS
Dikelompokkan berdasar kelas dan jenis RS
Perkelompok RS diambil Mean HBR
Menggambarkan total biaya RS ((inpatient,outpatient) dibagi
jmlh output (inpatient/outpatient)
Meliputi HBR ranap dan rajal
Perbedaan wilayah
Inflasi
Perbedaan biaya transportasi
Adjusment factor dipengaruhi oleh :
Location Geographic
Local wage rates
Direct and indirect health professions
education
Hospital role in healthcare delivery
Metode Adjustment
Formula
Pass throught of actual cost
Hospital spesific rates
Peer grouping
AF INA CBGs 2013
Kelas RS
RS Pendidikan non pendidikan
Jenis RS : Umum, Khusus
Regionalisasi
Ketersediaan anggaran agar terlaksana
kontinuitas pelayanan.
AF INA CBGs 2014
Kelas RS
Jenis RS : Umum, Khusus
Regionalisasi
Ketersediaan anggaran agar terlaksana
kontinuitas pelayanan.
CBGs ttt utk RS kelas C dan D
CBGs ttt utk kelas A-B
CBGS ttt vs tarif RS (cost to charge ratio )
Special CMG
REVIEW TARIF
HOSPITAL LEVEL
Hospital Casemix Team
Clinical Specialists
Hospital Directors
Langkah pengumpulan data
Sosialisasi
Pengiriman template ke RS
Workshop
Pengisian template ke NCC
Verifikasi dan Validasi
Perbaikan pengisian template
Bimtek ke RS
Pengiriman ulang ke NCC
Rekap variabel cost oleh tim NCC
Kendala pengumpulan dan pengolahan
data
Respon RS kurang, merasa sbg beban tambahan
Data kurang lengkap, kurang akurat
RS hanya memiliki data agregat
Tidak tahu cara mengisi
Klasifikasi RS blm sesuai standar
Sistem laporan keuangan RS yg mengelompokkan
biaya berdasar kelas perawatan bkn berdasar jenis
layanan
Kelemahan : belum tersedia laporan keuangan
audited sbg dasar utk kroscek
Fasilitas IT kurang memadai
Solutions for Data Availability and Quality Challenges