Analisis Risiko Pelaksanaan Program Pengelolaan Penyakit Kronis (Prolanis) Bpjs Kesehatan Di Klinik Pratama Bina Husada Bakti

Wulandari, Dani (2019) Analisis Risiko Pelaksanaan Program Pengelolaan Penyakit Kronis (Prolanis) Bpjs Kesehatan Di Klinik Pratama Bina Husada Bakti. S2 thesis, Universitas Kristen Indonesia.

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Abstract

Dalam Peraturan BPJS Kesehatan Nomor 2 Tahun 2015 Pasal 36 ayat (1) hasil pencapaian target indikator komitmen pelayanan FKTP menjadi dasar pembayaran kapitasi berbasis pemenuhan komitmen pelayanan. Berdasarkan penilaian terhadap FKTP melalui KBK, indikator pelaksanaan Angka Kontak dan Rasio Rujukan Rawat Jalan Non Spesialistik pada Klinik Pratama Bina Husada Bakti sudah mencapai target, namun pelaksanaan Rasio Peserta Prolanis (Program Pengelolaan Penyakit Kronis) Rutin berkunjung ke FKTP masih di bawah dari 50%. Hal tersebut terjadi pada klinik yang terjadi di Jakarta Timur termasuk pula pada Klinik Pratama Bina Husada Bakti. Hasil penelitian memperlihatkan bahwa identifikasi proses bisnis program Prolanis di Klinik Pratama Bina Husada Bakti adalah sejak Januari 2017 target indikator peserta Prolanis yang rutin berkunjung ke Klinik BHB masih dibawah 50%. Target Indikator Prolanis BPJS seharusnya ≥ dari 50%. Hal tersebut dikarenakan peserta Prolanis yang dirujuk ke rumah sakit, tidak dilakukan PRB oleh rumah sakit setelah 3 (tiga) bulan. Selain daripada itu, kebutuhan obat apotek untuk peserta Prolanis juga ditanggung oleh Klinik, sehingga dana kapitasi JKN di FKTP dimanfaatkan seluruhnya untuk jasa pelayanan dan dukungan biaya operasional pelayanan kesehatan. Peluang dan dampak program Prolanis BPJS di Klinik Pratama Bina Husada Bakti terdiri dari 6 jenis yang meliputi 30 risiko dari unit yang ada di Klinik Pratama Bina Husada Bakti, yaitu risiko proses internal akibat kegagalan proses atau prosedur (procedure risk) ada sekitar 15 (lima belas) risiko. risiko manusia (human error) ada sekitar 10 (sepuluh) risiko. risiko kepuasan pelanggan/pasien (customer satisfaction risk), ada sekitar 2 (dua) risiko. risiko sistem akibat penggunaan teknologi dan sistem (technology and system risk) ada sekitar 3 (tiga) risiko. Oleh karena itu, mitigasi dampaknya, yaitu menghimbau untuk meninjau ulang peraturan BPJS Kesehatan agar lebih fleksibel terutama dalam pelaporan semua kegiatan Prolanis dan menghimbau terkait dengan kebijakan BPJS Kesehatan agar men-support dana kembali kegiatan Prolanis. Kata Kunci: Risiko Operasional, BPJS Kesehatan, Prolanis. /In Health BPJS Regulation Number 2 Year 2015 Article 36 paragraph (1) the achievement of the FKTP service commitment target target is the basis for capitation payments based on fulfilling service commitments. Based on the assessment of FKTP through the KBK, the indicators for the implementation of the Contact Number and Non-Specialty Outpatient Referral Ratios at the Primary Bina Husada Bakti Clinic have reached the target, but the implementation of the Prolanis Participant Ratio (Chronic Disease Management Program) Regular visits to FKTP are still below 50%. This happened to clinics that occurred in East Jakarta, including the Primary Bina Husada Bakti Clinic. The results showed that the identification of Prolanis program business processes at the Pratama Bina Husada Bakti Clinic was that since January 2017 the target indicator for Prolanis participants who regularly visited the BHB Clinic was still below 50%. BPJS Prolanis Indicator Targets should be ≥ of 50%. That is because Prolanis participants who are referred to hospitals, do not do DRR by the hospital after 3 (three) months. Besides that, the need for pharmacy drugs for Prolanis participants is also borne by the Clinic, so that JKN capitation funds in FKTP are used entirely for services and support for operational costs of health services. Opportunities and impacts of the BPJS Prolanis program at the Pratama Bina Husada Bakti Clinic consist of 6 types which include 30 risks from units in the Pratama Bina Husada Bakti Clinic, namely the risk of internal processes due to failure of a process or procedure (procedure risk) there are around 15 (fifteen) ) risk. human risk (human error) there are about 10 (ten) risks. customer / patient satisfaction risk (customer satisfaction risk), there are about 2 (two) risks. system risk due to technology and system risk there are around 3 (three) risks. Therefore, mitigating its impact, namely urging to review BPJS Health regulations to be more flexible, especially in reporting all Prolanis activities and appealing related to BPJS Health policies in order to support the funds back Prolanis activities. Keyword: Operational Risk, Health BPJS, Prolanis.

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