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Transformasi Kebijakan Pembiayaan Pelayanan Onkologi Dalam Program Jaminan Kesehatan Nasional: Implikasi Bagi Manajemen Rumah Sakit
Abstract
Pendahuluan: Transformasi kebijakan pembiayaan dalam Program Jaminan Kesehatan Nasional (JKN) terus berkembang seiring kebutuhan menjaga akses, efisiensi, mutu, dan keberlanjutan pelayanan kesehatan. Pelayanan onkologi menjadi perhatian karena memiliki kompleksitas klinis, kebutuhan teknologi, dan penggunaan sumber daya yang relatif tinggi. Penelitian ini bertujuan menganalisis transformasi kebijakan pembiayaan pelayanan onkologi dalam JKN berdasarkan regulasi di Indonesia serta implikasinya terhadap manajemen rumah sakit. Metode: Penelitian menggunakan pendekatan kualitatif dengan desain deskriptif-analitis melalui studi kepustakaan dan analisis regulasi. Data diperoleh dari peraturan perundang-undangan serta literatur ilmiah yang relevan dengan pembiayaan JKN dan pelayanan onkologi. Hasil Penelitian: Transformasi pembiayaan berlangsung bertahap melalui konsolidasi JKN, penerapan INA-CBG, penyesuaian standar tarif, penerapan Kelas Rawat Inap Standar (KRIS), serta uji coba Indonesian Diagnosis Related Groups (I-DRG) dan rujukan berbasis kemampuan pelayanan. Heterogenitas kebutuhan klinis dan biaya pelayanan onkologi menunjukkan bahwa biaya aktual tidak selalu sejalan dengan tarif berbasis kelompok kasus. Perubahan tersebut berimplikasi terhadap pengendalian biaya, clinical pathway, dokumentasi klinis dan pengodean, manajemen klaim, pengelolaan obat, sistem informasi, kapasitas pelayanan, dan kompetensi sumber daya manusia. Kesimpulan: Transformasi kebijakan pembiayaan onkologi dalam JKN menuntut integrasi tata kelola klinis dan finansial agar rumah sakit mampu menjaga efisiensi, kecukupan pembiayaan, mutu, akses, dan keberlanjutan pelayanan. INA-CBG masih menjadi dasar pembayaran FKRTL, sedangkan uji coba I-DRG menunjukkan arah transisi sistem pembayaran berikutnya.
Kata Kunci: Jaminan Kesehatan Nasional, Onkologi, INA-CBG, I-DRG, Manajemen Rumah Sakit
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DOI: https://doi.org/10.52643/marsi.v10i3.9493
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