Analysis of the Casemix Team Performance on the Quality of Health Services and Outpatient Patient Satisfaction at Grandmed Hospital in 2025
DOI:
https://doi.org/10.35451/6mxgnr55Keywords:
Casemix, INA-CBG’s, human resources, Service Quality, Outpatient Services, Hospital PerformanceAbstract
The The implementation of the Casemix system through INA-CBG’s as part of the National Health Insurance (JKN) program requires hospitals to improve efficiency while maintaining service quality. The performance of the Casemix team plays a crucial role in ensuring coding accuracy, claim timeliness, and cost control. This study aimed to analyze the factors influencing the performance of the Casemix team and its relationship with service quality in the Outpatient Unit of RS Grandmed Lubuk Pakam in 2025.This research used a mixed methods approach with a sequential explanatory design. Quantitative data were collected from 93 JKN outpatient respondents selected using the Slovin formula and accidental sampling technique. Data were analyzed using univariate, bivariate (Chi-Square test), and multivariate (multiple logistic regression) analyses. Qualitative data were obtained through in-depth interviews with five key informants selected purposively and analyzed using thematic analysis.The results showed that most respondents rated human resources (62.4%), SIMRS-based Casemix system (65.6%), facilities and infrastructure (59.1%), financing (67.7%), service quality (64.5%), and Casemix team performance (63.4%) in the good category. Bivariate analysis indicated that all independent variables had a significant effect on Casemix team performance (p < 0.05). Multivariate analysis revealed that service quality was the most dominant factor influencing Casemix team performance (OR = 6.46; p = 0.000), followed by human resources (OR = 4.10; p = 0.002) and financing (OR = 3.44; p = 0.006). In conclusion, the success of Casemix implementation in the outpatient unit is influenced by a combination of human resources, information systems, financing mechanisms, and service quality. Strengthening human resource competence and improving service quality are key strategies to optimize Casemix team performance and enhance hospital service efficiency
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References
[1] Kementerian Kesehatan Republik Indonesia, Kebijakan Obat Nasional. Jakarta, Indonesia: Kementerian Kesehatan RI, 2021.
[2] A. Smith, B. Johnson, and C. Davis, “Factors influencing healthcare costs and quality: A multi-level analysis,” Health Services Research, vol. 57, no. S1, pp. 123–135, 2022.
[3] L. Chen, Y. Zhang, and H. Li, “Health data analytics for cost control and quality improvement in hospital services,” International Journal of Health Planning and Management, vol. 40, no. 1, pp. 112–120, 2025.
[4] A. Wijayanti, I. Setiawan, and E. Putri, “Casemix implementation and its impact on hospital efficiency: A case study in outpatient units,” Health Economics Journal, vol. 5, no. 3, pp. 178–190, 2021.
[5] S. Amalia, R. Fitriani, and A. Nugroho, “The impact of continuous training and development on Casemix team performance in hospitals,” Jurnal Pendidikan dan Pelatihan Kesehatan, vol. 8, no. 2, pp. 115–128, 2023.
[6] B. Pratama and H. Susilo, “The influence of information technology support on the efficiency of Casemix processes in healthcare facilities,” Jurnal Sistem Informasi Kesehatan, vol. 10, no. 3, pp. 187–200, 2022.
[7] A. Rahman, N. Susanti, and R. Pratama, “The role of Casemix team in achieving quality and cost-effective healthcare services: A systematic review,” Jurnal Manajemen Pelayanan Kesehatan, vol. 7, no. 1, pp. 45–58, 2024.
[8] Y. Wang, X. Liu, and M. Chen, “Impact of electronic health records on coding efficiency and claim accuracy in outpatient services,” BMC Health Services Research, vol. 23, art. no. 456, 2023.
[9] R. L. Mathis and J. H. Jackson, Human Resource Management, 14th ed. Boston, MA, USA: Cengage Learning, 2011.
[10] T. A. Widodo, “Pengaruh kompetensi coder terhadap akurasi klaim INA-CBG’s di rumah sakit,” Jurnal Manajemen Pelayanan Kesehatan, vol. 20, no. 3, pp. 145–152, 2017.
[11] S. N. Handayani and B. Prasetyo, “Pelatihan coding diagnosis dalam meningkatkan ketepatan klaim JKN,” Jurnal Administrasi Kesehatan Indonesia, vol. 6, no. 2, pp. 89–96, 2018.
[12] S. P. Robbins and T. A. Judge, Organizational Behavior, 17th ed. Harlow, UK: Pearson Education, 2017.
[13] W. H. DeLone and E. R. McLean, “The DeLone and McLean model of information systems success: A ten-year update,” Journal of Management Information Systems, vol. 19, no. 4, pp. 9–30, 2003.
[14] M. R. Saputra, “Implementasi SIMRS terintegrasi terhadap efektivitas klaim BPJS di rumah sakit,” Jurnal Sistem Informasi Kesehatan, vol. 5, no. 1, pp. 23–30, 2019.
[15] R. Indrayani, “Pengaruh kualitas sistem informasi rumah sakit terhadap kinerja petugas administrasi,” Jurnal Ilmu Kesehatan Masyarakat, vol. 9, no. 1, pp. 55–63, 2020.
[16] Kementerian Kesehatan Republik Indonesia, Pedoman Sistem Informasi Manajemen Rumah Sakit (SIMRS). Jakarta, Indonesia: Kemenkes RI, 2018.
[17] A. Donabedian, “The quality of care: How can it be assessed?” Journal of the American Medical Association, vol. 260, no. 12, pp. 1743–1748, 1988.
[18] H. Susanto, “Analisis sarana prasarana terhadap kinerja unit rekam medis rumah sakit,” Jurnal Rekam Medis dan Informasi Kesehatan, vol. 4, no. 2, pp. 101–108, 2021.
[19] D. Lestari, S. Wulandari, and L. Hakim, “The role of communication and feedback between Casemix teams and medical staff on the quality of medical records and claim accuracy,” Jurnal Komunikasi Kesehatan, vol. 6, no. 1, pp. 30–42, 2024.
[20] G. R. Terry and L. W. Rue, Principles of Management. Homewood, IL, USA: Richard D. Irwin, 2010.
[21] Kementerian Kesehatan Republik Indonesia, Pedoman Pelaksanaan INA-CBG’s dalam Program Jaminan Kesehatan Nasional. Jakarta, Indonesia: Kemenkes RI, 2020.
[22] M. Sari, B. Kurniawan, and D. Lestari, “The influence of coder competency on the accuracy of diagnosis codes and claim costs in the JKN era,” Jurnal Kebijakan Kesehatan Indonesia, vol. 11, no. 2, pp. 101–112, 2022.
[23] M. Armstrong, Armstrong’s Handbook of Human Resource Management Practice, 13th ed. London, UK: Kogan Page, 2014.
[24] S. P. Robbins and M. Coulter, Management, 13th ed. Boston, MA, USA: Pearson, 2016.
[25] F. Y. Rahmawati, “Faktor-faktor yang memengaruhi keberhasilan implementasi Casemix di rumah sakit,” Jurnal Kebijakan Kesehatan Indonesia, vol. 9, no. 2, pp. 67–75, 2020.
[26] I. K. Mahendra, “Evaluasi sistem Casemix terhadap mutu pelayanan rawat jalan,” Jurnal Administrasi dan Kebijakan Kesehatan, vol. 6, no. 4, pp. 210–218, 2019.
[27] World Health Organization, World Health Statistics 2022. Geneva, Switzerland: WHO, 2022.
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