EVALUASI PELAKSANAAN UTILIZATION REVIEW BADAN PENGELOLA JAMINAN KESEHATAN SOSIAL PROVINSI DAERAH ISTIMEWA YOGYAKARTA

Abstract

Background: Badan Pengelola (Bapel) Jamkesos has made
efforts to control cost by implementing utilization review since
2006. Data obtained from the result of utilization review (UR)
have not been fully evaluated to assess the performance of
health service providers. This is essential because UR can be
used by Bapel to communicate with the contracted health
service providers.
Objective: To evaluation implementing utilization review at
Jamkesos of Yogyakarta with describe UR activities; identify
the performance of health service providers and average
amount of health service cost before and after the implementation
of UR by Bapel Jamkesos of Yogyakarta Special Territory.
Method: The study was a survey that used before and after
design and secondary data of claim records. Variables of the
study were average support examination, percentage of irrelevance
of support examination, percentage of non generic
drugs, average cost of support examination, average cost of
drugs, average cost of operation, average total cost. Data
analysis used descriptive analysis was made to get an overview
of average cost and t-test to find out the difference of
the performance of health service providers before and after
UR.
Result and Discussion: Utilization Review (UR) carried out
by Jamkesos had not evaluated and analyzed the data available.
There was no significant difference in average support
examination, percentage of irrelevance support examination,
percentage of non generic drugs, average cost of support
examination; and average total cost of DHF service before
and after UR.
Conclusion: UR activities at Jamkesos of Yogyakarta Special
Territory were not yet optimum. There was no difference
in the performance of health service providers before and
after UR and there was difference in average total cost of
DHF service before and after UR carried out by Jamkesos.
Keywords: utilization review, cost containment, cost of health
service