2018
i
MALAYSIAN JOURNAL OF
e-ISSN: 2590-3829
ISSN: 1675-0306
(Supplement 3) 2018
Official Publication of the
MALAYSIAN PUBLIC HEALTH PHYSICIANS’ ASSOCIATION
ii
MJPHM
Official Journal of Malaysian
Public Health Physicians’ Association
EDITORIAL BOARD
Chief Editor
Prof. Dato’ Dr. Syed Mohamed Aljunid
International Centre for Casemix and Clinical Coding,
Faculty of Medicine, Universiti Kebangsaan Malaysia
Deputy Chief Editor
Prof. Dr. Sharifa Ezat Wan Puteh
Universiti Kebangsaan Malaysia
Members
:
Dato’ Prof. Dr Lokman Hakim Sulaiman
International Medical University (IMU)
Assoc. Prof. Dr Retneswari Masilamani
Universiti Tunku Abdul Rahman (UTAR)
Assoc Prof. Dr. Mohamed Rusli Abdullah
University Sains Malaysia
Assoc. Prof. Saperi Sulong
Universiti Kebangsaan Malaysia
Prof. Dr. Maznah Dahlui
University Malaya
Dr. Roslan Johari
Ministry of Health Malaysia
Dr. Othman Warijo
Dr. Amin Sah bin Ahmad
Ministry of Health Malaysia
Ministry of Health Malaysia
Dr. Ghazali bin Chik
Ministry of Health Malaysia
Dr. Sabrina binti Che Abd Rahman
Ministry of Health Malaysia
Dr. Mariam binti Mohamad
Universiti Teknologi MARA (UiTM)
Dr. Amrizal Muhd Nur
Universiti Kebangsaan Malaysia
Chief Editor
Malaysian JournalofPublicHealthMedicine(MJPHM)
International Centre for Casemix and Clinical Coding
Hospital Canselor Tuanku Muhriz
Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur
Malaysia
ISSN:1675–0306
e-ISSN: 2590-3829
TheMalaysian JournalofPublic HealthMedicineispublishedtwiceayear
Copyright reserved @ 2001
Malaysian Public HealthPhysicians’ Association
SecretariateAddress:
The Secretariate
International Centre for Casemix and Clinical Coding
Hospital Canselor Tuanku Muhriz
Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur
Malaysia
iii
Official Journal of Malaysian
Public Health Physicians’ Association
MJPHM
POSTGRADUATE FORUM ON HEALTH SYSTEMS AND POLICIES:
USING BIG DATA FOR HEALTH POLICY AND MANAGEMENT
2 - 3 JULY 2018
FACULTY OF MEDICINE, UNIVERISTI KEBANGSAAN MALAYSIA
HOSPITAL CANSELOR TUANKU MUHRIZ, CHERAS
KUALA LUMPUR
EDITORIAL BOARD
Members
:
Prof. Dato‘ Dr. Syed Mohamed Aljunid
Professor and Founder
Health Economics
International Center for Casemix and Clinical Coding
Universiti Kebangsaan Malaysia
Prof. Dr. Sharifa Ezat Wan Puteh
Head,
International Center for Casemix and Clinical Coding
Universiti Kebangsaan Malaysia
Assoc. Prof. Dr. Amrizal Muhammad Nur
Deputy Head,
International Center for Casemix and Clinical Coding
Universiti Kebangsaan Malaysia
Assoc. Prof. Dr. Azimatun Noor Aizuddin
Senior Lecturer
Deparment of Community Medicine
Universiti Kebangsaan Malaysia
Assoc. Prof. Dr. Aznida Firzah Abdul Aziz
Senior Lecturer
Deparment of Family Medicine
iv
Assoc. Prof. Nor Azlin Mohd Nordin
Senior Lecturer
Centre for Rehabilitation and Special Needs
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
Assoc. Prof. Dr. Tuti Ningseh Mohd Dom
Dean
Faculty of Dentistry
Universiti Kebangsaan Malaysia
Dr. Aidalina Mahmud
Univeristi Putra Malaysia
Dr. Yin New Aung
UCSI University, Kuala Lumpur
Dr. Irwan Saputra
v
ORAL PRESENTATION
KEY NOTE ADDRESS
USING OF BIG DATA FOR HEALTH POLICY AND MANAGEMENT
Professor Dr Syed Mohamed Aljunid
PLENARY
RESEARCH AND DEVELOPMENT OF BIG DATA IN HEALTHCARE SYSTEM
Lutfan Lazuardi
CHALLENGES IN MANAGING BIG DATA IN HEALTHCARE SETTING ASSOCIATE
Professor Ts. Dr. Nurhizam Safie
MANAGING BIG DATA FOR SOCIAL HEALTH INSURANCE
Professor.Virasakdi Chongsuvivatwong
ORAL PRESENTATION
Oral A01 IMPACT OF CASEMIX IMPLEMENTATION IN REDUCING COST OF BILLING OF SOCIAL
INSURANCE SCHEME IN A TEACHING HOSPITAL IN INDONESIA 1
Eka Yoshida Syukri S, Syed Mohamed Aljunid, Amrizal Muhd Nur
Oral A02 CAN NATIONAL HEALTH INSURANCE POLICY INCREASE EQUITY OF SKILL BIRTH ATTENDANT UTILIZATION IN INDONESIA?
A SECONDARY ANALYSIS OF 2012, 2013, 2014, 2015, 2016 NATIONAL SOCIO-ECONOMIC SURVEY DATA
2
Siti Khadijah Nasution, Laksono Trisnantoro, Yodi Mahendradata
Oral A03 CONTRIBUTION OF LOCAL GOVERNMENT IN ACHIEVING UNIVERSAL HEALTH COVERAGE (UHC): CASE STUDY OF UNIVERSE HEALTH JKN-KIS IN REGENCY / CITY
EAST KALIMANTAN PROVINCE 3
Erwin Purwaningsih, Happy R Pangaribuan
Oral A04 DETERMINANTS OF LENGTH OF STAY AT INTENSIVE CARE UNITS OF A TEACHING
HOSPITAL IN MALAYSIA 4
Yin Nwe Aung, Syed Mohamed Aljunid, Amrizal M Nur, Aniza Ismail
Oral A05 HOSPITAL ACCREDITATION IN INDONESIA: THE PROGRESS AND DETERMINANT
FACTORS 5
Viera Wardhani, Sutoto, Tjahjono Kuntjoro, Adi Utarini
Oral A06 PROGRESS AND CHALLENGES IN IMPROVING MATERNAL HEALTH IN TIBET
AUTONOMOUS REGION, P. R. CHINA IN 2000-2015 6
Labasangzhu, Virasakdi Chongsuvivatwong
Oral A07 MANAGEMENT COMPETENCY OF DOCTORS IN DISADVANTAGED AREAS IN INDONESIA: NEEDS AND RESPONSIBILITY OF FACULTY OF MEDICINE 7
Fury Maulina, Mubasysyir Hasanbasri, Riris Andono Ahmad
Oral B01 IMPACT OF MISCODING OF DIAGNOSIS AND PROCEDURES IN CASEMIX INA-CBG
REIMBURSEMENT ON HOSPITAL REVENUE IN INDONESIA 8
Syafrawati, Rizanda Machmud, Syed Mohamed Aljunid, Rima Semiarty
vi
Oral B03 PARENTS’ AND CAREGIVERS’ COSTS OF COMMUNITY-BASED REHABILITATION (CBR) PROGRAMME FOR DISABLED CHILDREN IN EAST COAST REGION OF PENINSULAR
MALAYSIA 10
Haliza Hasan, Syed Mohamed Aljunid, Sharifa Ezat WP, Aznida Firzah Abdul Aziz, Amrizal Muhd Nur, Nor Azlin Mohd Nordin and Nurul Anisah Jaafar
Oral B04 LONGITUDINAL DATA ANALYSIS OF TYPE 2 DIABETES MELLITUS AND ITS COMPLICATIONS AMONG THAI CITIZEN COVERED BY THE UNIVERSAL COVERAGE
SCHEME 11
Tanapat Laowahutanon, Virasakdi Chongsuvivatwong, Tippawan Liabsuetrakul, Apiradee Lim, Netnapis Suchonwanich, Tachimori Hisateru, Shuhei Nomura, Hiroaki Miyata
Oral B05 THE ROLE OF NUSANTARA SEHAT: DEPLOYMENT HEALTH WORKER UNDER SYSTEM
CONTRACT IN REMOTE PUSKESMAS INDONESIA 12
Happy R Pangaribuan, Erwin Purwaningsih
Oral B06 DETERMINANTS OF PATIENT SATISFACTION LEVEL ON INTERIOR DESIGN QUALITY OF
PUBLIC HOSPITALS IN MALAYSIA 13
Shariffah Syafiqah Aljunid, Nurul Nabilah Huda Mohamad Shukri, Syed Mohamed Aljunid, Mohd Zafrullah Mohd Taib, Zanariah Abu Samah
Oral B07 THE COMPLETENESS OF DISCHARGE SUMMARY AT TUGU KOJA HOSPITAL 14
Dience Meidiana MD, Anis Fuad, Lutfan Lazuardi
Oral C01 THE EFFECT OF INA-CBG CASEMIX IMPLEMENTATION ON COMPLETENESS OF MEDICAL RECORDS AND COMPLICATION RATES IN NATIONAL STROKE CENTER HOSPITAL IN
WEST SUMATERA PROVINCE, INDONESIA 15
Kamal Kasra, Syed Mohamed Aljunid, Amrizal Muhd Nur
Oral C02 ASSESSING THE VALIDITY OF GOOGLE TRENDS FOR DIGITAL EPIDEMIOLOGY OF
DENGUE IN INDONESIA 16
Atina Husnayain, Anis Fuad, Lutfan Lazuardi
Oral C03 EVALUATION OF SELECTED OUTCOMES OF COMBINATION ANTIRETROVIRAL THERAPY:
YEMEN COHORT STUDIES 17
Mayada Faisal Nabih, Sharifa Ezat WP, Amrizal Muhd Nur
Oral C04 AGE, PERIOD AND COHORT ANALYSIS OF AGE-SPECIFIC MATERNAL MORTALITY
TREND IN ETHIOPIA 18
Biniam Getachew, Tippawan Liabsuetrakul, Shama Vira
Oral C05 EFFECTIVENESS OF THE USE OF FOUR METHODS THAT HAS BEEN USED FOR RUNNING CRM-SYSTEM AT PUSKESMAS KOWILUT KEDIRI INDONESIA 19
Gerardin Ranind Kirana, Reny Nugraheni
Oral C06 COST EFFECTIVENESS OF COMMUNITY – BASED REHABILITATION (CBR) FOR CHILDREN
WITH DISABILITY 20
Nurul Anisah Jaafar, Haliza,Hasan, Nor Azlin,Mohd Nordin, Syed Mohamed Aljunid
Oral D01 FACTORS INFLUENCING QUALITY OF CLINICAL CODING IN THE IMPLEMENTATION OF MY-DRG® CASEMIX SYSTEM IN A TERTIARY HOSPITAL IN MALAYSIA 21 S A Zafirah, Amrizal Muhd Nur, Sharifa Ezat WP, Syed Mohamed Aljunid
vii
Relmbuss Biljers Fanda, Shita Listyadewi, Likke P Prawidya1, Laksono Trisnantoro
Oral D03 EXPECTED YEARS OF LIFE LOST DUE TO ALCOHOL CONSUMPTION IN THAILAND USING DATA FROM NATIONAL HEALTH EXAMINATION SURVEY 2003-2004 23
Jiraluck Nontarak, Alan Frederick Geater, Sawitri Assanangkornchai
Oral D04 POLICY AND PROGRAMMES ON INFANT AND YOUNG CHILD FEEDING IN EMERGENCY
(IYCF-E) IN INDONESIA 24
Nurlienda Hasanah, Hadfidhotun Nabawiyah
Oral D05 ELECTRONIC CIGARETTE AND NICOTINE DEPENDENCE AMONG MALAYSIAN
UNIVERSITY STUDENTS 25
Sharifa Ezat WP, Izzah Syazwani Ahmad, Roslina AM, Idayu BI, Hazli Zakaria, Tidi Maharani Hassan, Fariza Md Sham, Amer Siddiq AN, Andrea YL Ban, Soo CI, Rashidi Mohamed PM, Lee Jing, Ahmad Irdha Mokhtar, Suthahar Ariaratnam, Mohd Zaliman Mohd Yusoff
Oral D06 STUDY OF THE RESULT BASIC HEALTH RESEARCH AND POSBINDU ACTIVITIES FOR
PREVENTION AND CONTROL OF NON-COMMUNICABLE DISEASES ON CAMPUS 26
Krispinus Duma, Rahmat Bahktiar1, Evi Fitriany1
Oral D07 EFFECT OF ANTENATAL VISIT ON EXCLUSIVE BREASTFEEDING PRACTICE IN URBAN
POPULATION INDONESIA 27
Monica Dara Delia Suja, Mubasysysir Hasanbasri, Mohammad Hakimi
POSTER PRESENTATION
Poster A01
COST CONTAINMENT EFFORTS IN THE PUBLIC HOSPITAL PHARMACIES IN RESOURCE
CONSTRAINTS AREA OF GAZA - PALESTINE 31
Ahmed Alkhodary, Syed Mohamed Aljunid
Poster A02
IMPROVING PROCEDURE OF HOSPITAL INSURANCE CLAIM: A CASE STUDY AT
CEMPAKA PUTIH HOSPITAL JAKARTA, INDONESIA 32
Elmita Br Ginting, Dewi R Anggraini, Julita Hendrartini, Andreasta Meliala, Lutfan Lazuardi
Poster A03
DEMAND FOR HEALTHCARE AND DETERMINANTS OF DEMAND 33
Zamzaireen Zainal Abidin, Muhamad Hanafiah Juni, Rosliza Abdul Manaf, Lim Poh Ying
Poster
A04 THE CHALLENGES OF PUBLIC HEALTH CENTER (PHC) IN TIDORE KEPULAUAN, INDONESIA TO IMPLEMENT NATIONAL HEALTH INSURANCE SYSTEM 34
Nopryan Ekadinata, Budi Eko Siswoyo, Moh. Faozi Kurniawan, Faisal Mansur, Deni Harbianto
Poster
A05 IMPACT OF MANAGERS’ COMPETENCY ON THE QUALITY OF SERVICE IN ARMY HOSPITALS IN MALAYSIA AND ITS ASOCIATION WITH NATIONAL BLUE OCEAN
STRATEGY (NBOS): A PROPOSAL 35
Kamarruddin Junaidah, Mohd Nor Yahya, Adlina S, Syed Mohamed Aljunid
Poster A06
MENTAL HEALTH AND ITS ASSOCIATED FACTORS IN A SELECTED RURAL COMMUNITY
IN MALAYSIA 36
Sharifah Ezat WP, Ellyana Mohamad Selamat, Muhamad Arif Ahamed Siddeekh, Ahmad Soffian Mohd Noor, Izzah Syazwani Ahmad, Rokiah Haji Omar
viii
Poster B01
SOCIAL SUPPORT AND ADHERENCE TO THE HEMODIALYSIS THERAPY
IN PATIENTS WITH CHRONIC KIDNEY DISEASE 38
Windri Lesmana Rubai, Bernike Sofia Zega
Poster B02
WOULD KNOWING YOUR RISK FOR GETTING STROKE MAKE YOU CHANGE YOUR LIFESTYLE? A PROPOSAL FOR A PILOT RANDOMIZED CONTROLLED TRIAL AMONG
MALAYSIAN URBAN-DWELLING STROKE CAREGIVERS 39
Radhiyah Hussin, Ezura Madiana Md Monoto , Mohd Fairuz Ali, Aznida Firzah Abdul Aziz
Poster B03
EVALUATION OF CHRONIC DISEASE MANAGEMENT PROGRAM AT FIRST LEVEL HEALTH FACILITIES IN SLEMAN DISTRICT OF DI YOGYAKARTA AND EAST FLORES DISTRICT OF
EAST NUSA TENGGARA 40
Ahmad Muhammad Kasim, Laksono Trisnantoro, Yodi Mahendradhata
Poster B04
IMPROVEMENT OF HEALTH SYSTEM PERFORMANCE AFTER IMPLEMENTING THE
ASTHMA CARE PROGRAM IN THAILAND 41
Phatthanawilai Inmai, Tippawan Liabsuetrakul, Virasakdi Chongsuvivatwong, Hiroyuki Yamamoto, Nao Ichihara3, Hiroaki Miyata
Poster B05
EFFECT OF RESOURCES OF INFORMATION ON KNOWLEDGE OF HIV/AIDS: AN
ANALYSIS ON INDONESIAN YOUNG ADULT REPRODUCTIVE HEALTH SURVEY IN 2012 42
Nuraliah, Fika Daulian
Poster B06
TREND OF CESAREAN SECTION RATES AND ITS ASSOCIATION WITH OTHER COMMON MATERNAL AND PERINATAL COMPLICATIONS UNDER THE UNIVERSAL COVERAGE
SCHEME IN THAILAND DURING 2009-2017: A SECONDARY DATA ANALYSIS 43
Tippawan Liabsuetrakul, Jarawee Sukmanee, Pisake Lumbiganon, Jutatip Thungthong
Poster B07
COUNSELLING IN ANTENATAL CARE (ANC) INCREASES ADAPTIVE COPING AMONG
PRIMIGRAVIDA PREGNANT WOMEN DURING DELIVERY OF THEIR BABIES 44
Elvaria Mantao, Sumarni, Abdul Wahab
Poster B08
HOW DOES THE ROLE OF DECISION MAKERS AFFECT THE DELAY OF MATERNAL REFERRAL? (A QUALITATIVE STUDY AT WANUKAKA SUB-DISTRICT, WEST SUMBA
DISTRICT) 45
Verayanti Albertina Bata, Ova Emilia, Mohammad Hakim
Poster C01
CAN A GENERAL PRACTITIONER (GP) BE AN EFFECTIVE GATEKEEPER IN A NATIONAL
HEALTH INSURANCE (NHI) SYSTEM? A REVIEW OF CURRENT LITERATURES 46
Mohammad Husni Jamal,Syed Mohamed Aljunid,Aznida Firzah Abdul Aziz
Poster C02
FRAGMENTATION OF TB FINANCING AFTER NATIONAL HEALTH INSURANCE (JKN)
IMPLEMENTATION IN INDONESIA 47
Muhammad Asrullah, Deni Harbianto, Dedik Sulistiawan, Nopryan Ekadinata, Laksono Trisnantoro
Poster
C03 COSTS AND OUTCOME OF IN-VITRO FERTILIZATION SERVICES: A CASE STUDY IN A PRIVATE HOSPITAL IN KINGDOM OF SAUDI ARABIA 48
Faisal Almaslami,Syed Aljunid
Poster
C04 USING NATIONAL HEALTH INSURANCE DATA TO INVESTIGATE PROBLEMS OF TUBERCULOSIS PROGRAM IMPLEMENTATION IN INDONESIA:
A PRELIMINARY STUDY AMONG 4 DISTRICTS IN INDONESIA 49
ix
Poster C05
COSTS OF MEDICAL CARE AMONG STROKE PATIENTS LIVING IN THE COMMUNITY: A
LITERATURE REVIEW 50
Azera Hasra Ismail, Aznida Firzah Abdul Aziz, Sharifa Ezat WP
Poster C06
SOCIAL EXCLUSION OF BPJS PARTICIPANTS IN IMPLEMENTION OF THE NATIONAL
HEALTH INSURANCE (JKN) IN INDONESIA 51
Mahyuddin, Dedi Arisjulyanto
Poster C07
POTENTIAL ADAPTATION OF QUALITY PERFORMANCE AS EFFECTIVE SERVICE COVERAGE INDICATORS FOR MONITORING THE PROGRESS OF UNIVERSAL HEALTH
COVERAGE OF NON-COMMUNICABLE DISEASES 52
Aidalina Mahmud,Syed Mohamed Aljunid
Poster
C08 POLICY FOR THE HEALTH EMERGENCY AND DISASTER RISK MANAGEMENT (HEALTH-EDRM) WITHIN THE SENDAI FRAMEWORK 53
Surianto, Laksono Trisnantoro, Syahirul Alim
Poster D01
CAPACITY BUILDING FOR HEALTH VOLUNTEERS DURING DISASTER RISK REDUCTION 54
Ridlwan Kamaluddin, Laksono Trisnantoro, Syahirul Alim
Poster D02
WHY DOES THE DOCTOR WILLING TO SERVE FOR REMOTE AREA? STORIES FROM
PAPUA, INDONESIA 55
Faisal Mansur, Mubasysyir Hasanbasri
Poster
D03 THE IMPACT OF ELECTRONIC MEDICAL RECORDS ON EFFICIENCY AT OUTPATIENT SERVICE: A CASE STUDY OF CILANDAK COMMUNITY HEALTH CENTER, JAKARTA 56
Luigi, Anis FuaD, Lutfan Lazuardi
Poster D04
IMPLEMENTATION OF SURVEILLANCE SYSTEM OF NON-COMMUNICABLE DISEASES AT
THE FIRST-LEVEL HEALTH FACILITY OF SLEMAN 57
Ade Kartikasari Sebba, Baning Rahayujati, Isa DharmawidjajA
Poster D05
PROJECTED CANCER CASES ATTRIBUTABLE TO ALCOHOL CONSUMPTION IN THAILAND
2021 58
Shama Virani, Athip Tanaree, Polathep Vichitkunakorn, Hutcha Sriplung, Sawitri AssanangkornchaI
Poster D06
ANALYSIS OF REHABILITATION SERVICES IN KEDIRI LEPROSY HOSPITAL 59
Reny Nugraheni
Poster D07
A TELEDENTISTRY MODEL FOR PERIODONTAL DISEASE EARLY DETECTION AND
TIMELY INTERVENTIONS IN PRIVATE DENTAL SETTINGS 60
1
KEYNOTE ADDRESS
USING OF BIG DATA FOR HEALTH POLICY AND MANAGEMENT
Syed Mohamed Aljunid Professor and Chair
Health Policy and Management Faculty of Public Health Kuwait University
2
PLENARY
RESEARCH AND DEVELOPMENT OF BIG DATA IN HEALTHCARE
SYSTEM
Lutfan Lazuardi
Universitas Gadjah Mada
3
PLENARY
CHALLENGES IN MANAGING BIG DATA IN HEALTHCARE SETTING
Nurhizam Safie
Universiti Kebangsaan Malaysia
4
PLENARY
HEALTH SERVICE BIG DATA
Virasakdi Chongsuvivatwong
Professor and Curriculum Chairman, International Programme for Graduate Study in Epidemiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
5
Oral A01
Impact of Casemix Implementation in Reducing Cost of Billing of
Social Insurance Scheme in A Teaching Hospital in Indonesia
Eka Yoshida Syukri S 1, Syed Mohamed Aljunid 2,3 Amrizal Muhd Nur 2
1 United Nation University-International Institute for Global Health,
2 International Center for Casemix and Clinical Coding, Faculty of Medicine, UKM
3 Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait.
Fee-for-Service and casemix system are two provider payment methods used by social insurance schemes in Indonesia. Both methods require different the billing processes. This study is to determine the cost of billing process under casemix system and compared to FFS method in a teaching hospital. The study was conducted in the 1,001 beds national referral hospital in Indonesia. Universal sampling method was used to collect data from the 2011 Financial Report that contains the cost of human resources, stationary and billing delivery cost for billing process under FFS and casemix method. The cost of one patient’s bill for one year was calculated and analysed. There were 102,439 cases under FFS and 45,066 cases reimbursed using casemix. The median billing cost of patients under FFS (IDR 19,450.6 min-max IDR 13,758.0–27,073.0, IQR= 8,283.1) was significantly higher than casemix (IDR 15,788.6 min-max IDR 12,887.3-19,333.7; IQR=2,100.5) (p=0.033). One patient’s bill reimbursed using casemix was 23.2% lower than FFS. With type of payment as a dependent variable and 3 components of total cost (human resources, stationary and billing delivery) as independent variables, multiple logistic regression model showed that cost of billing process using casemix as compared to FFS were more likely to have lower cost of human resources (OR=2.531, p=0.032), stationary (OR=1.563, p=0.017), and billing delivery (OR = 1.269 p= 0.041). The casemix implementation has lower cost of billing process and decrease the hospital operational cost compared to FFS.
6
Oral A02
Can National Health Insurance Policy Increase Equity of Skill Birth
Attendant Utilization in Indonesia? A Secondary Analysis Of 2012,
2013, 2014, 2015, 2016 National Socio-Economic Survey Data
Siti Khadijah Nasution1,2, Laksono Trisnantoro3, Yodi Mahendradata 3
1 Doctoral student in faculty of medicine, Gadjah Mada University, Indonesia
2 Department of administration and health policy, Sumatera Utara University, Indonesia 3 Faculty of Medicine, Gadjah Mada University, Indonesia
The Indonesian government has been implementing National Health Insurance Program (JKN) since 2014. Utilization of skilled birth attendant (SBA) is one of the programs to decrease maternal mortality. This study aimed to evaluate the National Health Insurance based on equity indicator, especially in delivery service. Data were obtained from the National Socio-Economic Survey 2012-2016, a nationwide cross-sectional household survey. Chi-square and logistic regression were utilised to analyze the data in the second and third stage. Respondents were delivery mothers who had baby (<12 months) and married. In general, delivery by physician increased (especially in urban areas, in the West of Indonesia areas, in the non-subsidized health insurance) after JKN while delivery by midwife and non-SBA decreased. Delivery by SBA increased at the national level but this masked significant variation according to geographical location. Until 2016, the coverage of delivery by SBA and delivery at health facilities in the East of Indonesia areas were still left behind than in the West of Indonesia areas. The ownership of insurance was positively associated with SBA use (OR: 1.1-1.3; 95% CI) at the national level but bivariate analysis based on data in 2016 showed only 8 of 34 provinces with significant result (p<0.05). The geography factor (urban and rural areas), education and household economic were positively associated with SBA use (p<0.05). The gap of SBA utilization that were related to geographical factor, education and household economic must be reduced by supply-side improvements, re-examining the pro-poor insurance schemes (PBI), generate of household income and level of education.
7
Oral A03
Contribution Of Local Government in Achieving Universal Health
Coverage (Uhc): Case Study of Universe Health Jkn-Kis In Regency
/ City East Kalimantan Province
Erwin Purwaningsih1, Happy R Pangaribuan1
1 Faculty of Medicine, Universitas Gadjah Mada
Local government support for the sustainability National Health Insurance-Indonesia Health Card known as JKN-KIS (Jaminan Kesehatan Nasional-Kartu Indonesia Sehat) and achieving UHC was very strategic. One of them was by integrating the Regional Health Insurance called Jamkesda (Jaminan Kesehatan Daerah) into the JKN-KIS managed by National Social Health Insurance Administrator or BPJS Kesehatan (Badan Penyelenggara Jaminan Sosial Kesehatan). The objective of this study was to describe the contribution of local government to the achievement of UHC on JKN-KIS membership coverage. This study was a descriptive study in which information and data obtained from BPJS Kesehatan’s bulletin, web-based information and literature review. Support and commitment of East Kalimantan were evidenced by the signing of a joint agreement between the deputy region Eastsouthcentralnorth Kalimantan BPJS Kesehatan with all districts/cities in East Kalimantan. Total membership in East Kalimantan until 2018 reached 78% of the total population of 3.5 million, leaving the remaining 17% or less as many as 600.000 people who have to become JKN-KIS participants in order to meet UHC targets. While in the roadmap that 2018 must meet UHC target in each region. This means that at least 95% of the people in each region in East Kalimantan are participants of JKN-KIS. In conclusion, the Districts/Cities governments in East Kalimantan have contributed to integrating Jamkesda into the JKN-KIS program but have not yet achieved the targets. It requires better commitment and coordination from BPJS Kesehatan and local government to pursue the target in achieving UHC.
Keywords: Local Government, Universal Health Coverage, Membership BPJS, JKN-KIS
8
Oral A04
Determinants of Length of Stay at Intensive Care Units of a
Teaching Hospital in Malaysia
Yin Nwe Aung1,3, Syed Mohamed Aljunid1,2, Amrizal M Nur1, Aniza Ismail1,4 1 International Centre for Casemix and Clinical Coding, Faculty of Medicine UKM
2 Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait
3 Department of Laboratory Diagnostic Services and Community Medicine & BSCSPPD, UCS I University, Kuala
Lumpur, Malaysia
4 Department of Community Health, Faculty of Medicine, UKM Medical Centre, Hospital Canselor Taunku Muhriz,
Malaysia
When the cost of health care escalates, length of stay (LOS) at hospital becomes pivotal as it is a cost consuming activity. Amongst all hospital services, intensive care unit (ICU) is the most cost salvaging unit. Monitoring the LOS at ICU is vital for health services efficiency. A cross sectional study was conducted to explore the factors associating with LOS at ICUs in a teaching hospital in Malaysia. The data were collected from casemix database and ICU census from January 2013 to December 2015. Univariate analysis and multivariate regression analysis were conducted to identify the factors associated with the LOS at ICU. Due to skewness in LOS at ICU, log
transformation was used for the regression analysis. A total of 3,220 cases were included in this
study. The mean length of ICU stay is 5.6 days; with the geometric mean of 4. Male and very young children required higher ICU days. PICU requires longer LOS (5 days) whereas GICU, CICU and CCU needs 4, 3, 3 days respectively (p<0.001). The obstetric cases have 2.3 days of LOS at ICU; neonate 6.4 days; surgery 4.1 days; medicine 4.0 days; p<0.001). After regression analysis, age and sex have no significant contribution on ICU LOS and were excluded from the model. Approximately 1.5 additional days are required as the disease severity by MY-DRG classification progressed. Severity level-I cases require 2.95 days, level-II 3.5 days and level-III 5.1 days
(p<0.001). After adjusting the other variables, medical conditions need 0.26 days less (p<0.001)
and obstetrics reasons require 1.16 days less (p<0.001) compared to surgical cases. Less 0.91 day is required for obstetric problems than medical causes (p=0.001). Compared to PICU, less LOS required at GICU (1.36 days), CICU (1.6 days) and CCU (1.4 days) (p<0.001).Hospital systems are under pressure for quality outcomes and reduced costs. Compared to critical care practice in hospitals in more developed nations, Malaysian teaching hospital requires a longer average length of ICU stay. Exploring the possibilities of early mobilization from ICU and reducing the medical complication are potentials to reduce LOS, and hospital costs without sacrificing the health care quality.
9
Oral A05
Hospital Accreditation in Indonesia: The Progress and Determinant
Factors
Viera Wardhani1, Sutoto2, Tjahjono Kuntjoro3, Adi Utarini3
1Faculty of Medicine, Universitas Brawijaya Indonesia 2National Hospital Accreditation Committee Indonesia
3Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Indonesia
The implementation of hospital accreditation policy as an external quality assurance mechanism in Indonesia is a challenging task owing to its wide socioeconomic and geographic disparities. This paper aimed to describe the progress of hospital accreditation standard adoption in Indonesia related to the role of organizational and geographic factors. We evaluated the trend of hospitals accreditation status for the last six years (2012-2017) based on the accreditation status, hospital characteristic (size, ownership, service), and geographic location. Two national databases (national hospital registry and hospital accreditation report) were compared and merged to obtain all the measured variables. A descriptive analysis was performed to describe the accreditation status figure and trend related to hospital characteristics, i.e. class, service, owner, geographic area. Furthermore, a logistic regression was carried out to investigate the determinants of hospitals accreditation status. The trend shows a huge decrease (95%) of the new accredited hospitals in the year 2013 when compared to the year 2012. The number was start to increase after the year 2014 with the highest proportion (55%) reached in the year 2017. Two important policies might explain this figure which were: 1) the adaption of Joint Commission International standard in the year 2013, 2) the implementation of national health insurance scheme that require hospitals to be accredited. By the end of year 2017, there were 1183 hospitals with valid accreditation status of the total 2779 hospitals. Logistic regression analysis confirmed that higher hospitals capability, general and government owned hospitals, and being located in Java-Bali are the significant predictor for higher accreditation status. Our finding suggests that hospital capabilities (resource, government support) are the important determinants for hospital accreditation standards adoption in Indonesia. Cautious staging and support are needed for hospitals outside Java-Bali to accelerate their capacity in adopting the standards.
10
Oral A06
Progress and Challenges in Improving Maternal Health in Tibet
Autonomous Region, P. R. China In 2000-2015
Labasangzhu1,2, Virasakdi Chongsuvivatwong2
1 Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, P. R. China 2 Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songklha, Thailand
By 2030, China aims to achieve Sustainable Development Goal (SDG) 3. However, maternal health problems are still a major concern in certain areas of the country such as Tibet. Tibet’s Maternal Mortality Ratio (MMR) is still five times higher than national average. Yet, the progress of maternal and child health (MCH) and challenges in the health system that might have related to the high mortality are not been researched. We applied an impact model and the World Health Organization (WHO) health system building blocks for review of the health system, focusing on human resource for health and health infrastructure. Sources of information included government policies and regulations, health statistical yearbooks, and MCH Routine Reporting System. Online research articles (English and Chinese, 2000-2017) related to Tibetan maternal health issues were also reviewed. The hospital delivery rate increased from 20.1% in 2000 to 90.5% in 2015 due to the fee exemption, the MMR dropped from 466.9 to 100.1 per 100,000 live births. A maternal health service package was introduced. Service system has been developed. However, the number of health workers, qualified doctors and registered nurses per 1000 people were 4.4, 1.4 and 1.0 respectively, lower than national average (5.8, 1.8, and 2.4). Totally Tibet has 80 basic and 16 comprehensive emergency obstetrics care (EOC) centers, but merely 12 basic and 2.5 comprehensive EOC centers per 500,000 populations. Despite remarkable progress in maternal survival in Tibet, the shortage of health professionals and EOC centers in the predominant rural and scattered population remote areas still needs attention.
11
Oral A07
Management Competency of Doctors in Disadvantaged Areas in
Indonesia: Needs and Responsibility of Faculty of Medicine
Fury Maulina1, Mubasysyir Hasanbasri2, Riris Andono Ahmad2
1 Faculty of Medicine, Universitas Malikussaleh, Universitas Malikussaleh, Aceh, Indonesia 2 Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
Responsibility to work in underdeveloped areas and people expectations for quality of care require doctors with public health program management competencies. This study aimed to identify the doctors’ perception to the needs and responsibility of faculty of medicine to fulfil the management competency of doctors. A mixed method study was conducted among doctors working in disadvantaged areas in Indonesia. In-depth interview was used to collect data for qualitative method, while quantitative method was conducted through questionnaire for 8 provinces in Indonesia, namely Province of West Sumatera, Banten, East Java, West Kalimantan, South East Sulawesi, West Nusa Tenggara, West Papua and Papua. Communication skills and respect for the rights of others were the two most competencies needed, and competency to become a chairman/leader was the least needed. Furthermore, financial management skills have yet to be met by faculty of medicine, on the other hand, updating medical knowledge actively has been met. In addition, there were gaps between perception to the needs and responsibility of faculty of medicine to fulfil the management competency for doctors such managing program with limited resources, managing programs at limited cost, managing the organization's finances, lobbying and leadership skills. Doctors have the perception that management competency was needed when they serve in underdeveloped areas in Indonesia. However, the faculty of medicine has not fully fulfilled its responsibilities to provide management competency-related curriculum required for doctors working in disadvantaged areas in Indonesia.
Keywords: management, competency, doctor, disadvantaged areas, perception, needs, responsibility, faculty of medicine.
12
Oral B01
Impact of Miscoding of Diagnosis and Procedures in Casemix
Ina-CBG Reimbursement on Hospital Revenue in Indonesia
Syafrawati1, Rizanda Machmud2, Syed Mohamed Aljunid3,4, Rima Semiarty2
1 Faculty of Medicine, Andalas University, Padang, Indonesia 2 Faculty of Medicine, Andalas University, Padang, West Sumatera
3International Centre for Casemix and Clinical Coding, Faculty of Medicine, University Kebangsaan Malaysia 4 Department of Health Policy and Management, Faculty of Public Health, Kuwait University
The accuracy of diagnosis codes and procedures codes is crucial in implementation of casemix system. Reimbursement for services provided by hospitals under Jaminan Kesehatan Nasional (National Health Insurance) in Indonesia is based on diagnosis codes and procedure codes that grouped using Indonesia Case-Based Group (INA-CBG) casemix grouper. The aim of this study was to evaluate the impact of miscoding in casemix system reimbursement in hospital income. One hundred and eighty (180) medical records from three type C government hospitals in West Sumatera were chosen as samples in this research. Diagnoses and Procedures recorded in these medical records were re-examined and re-recoded by an independent senior coder (ISC). ISC coding results were compared with the codes done by coders in the hospitals. All cases were then re-grouped using INA-CBG casemix grouper to determine the casemix groups and the hospital tariffs. Miscoding is defined any changes in the INA-CBG casemix groups as the results of differences in the diagnosis and procedure codes of ISC and the hospital coders. The tariffs from the original casemix groups were then compared with the tariff of the new casemix groups. Miscoding were found in 22.2 % (40/180) of medical records. From this result, 18 (10%) were upcoding that elevate hospital reimbursement by a total of 38,872,699 IDR or 5.1% of the total hospital revenue. On the other hand, 22 medical records (12,2%) were wrongly coded and produce INA-CBG groups with lower hospital tariff. The total of value of down-coding was 33,842,800 IDR or 4.5% of all hospital income. The total of revenue lost due to miscoding is 72,715,499 IDR or 9.6% of the total hospital revenue. Accuracy of clinical coding is an important requirement for proper hospital reimbursement. Hospital management should take serious action to enhance skills of coders by engaging them on regular training on clinical coding. Intensive training and regular monitoring could decrease cases of miscoding in hospitals and reduce the loss of revenue.
13
Oral B02
Monitoring and Concept Development of the Compensation
Program Under the JKN Scheme
Budi Eko Siswoyo1, M. Faozi Kurniawan1, Wan Aisyah2, Welly Gadistina2, Dwi Martiningsih2
1 Center for Health Policy and Management, Faculty of Medicine, University of Gadjah Mada, 2 Research and Development Group, Social Security Agency of Health (BPJS Kesehatan)
The compensation program under the National Health Insurance (JKN) scheme in Indonesia is a regulatory mandate since 2014. The concept of compensation is for areas with no eligible health facilities to meet the medical needs of JKN members (or so-called DBTFMS area). Remote area (DTPK) are not the same as DBTFMS, but on the other hand there is no operational definition and technical guidance explaining about DBTFMS and compensation in JKN scheme.The objective of this study was to analyze the criteria, indicators, types of compensation, challenges, and roles among stakeholders in the compensation program under the JKN scheme, using case study with quantitative and qualitative descriptive approach. A total of 154 samples in 6 regions were selected using convenience sampling. The mapping of the study area considered districts that were not or have not been a DTPK area and were compared with DTPK areas. This study data were collected through focused-group discussions (FGDs) and secondary data tools on health facilities, BPJS Kesehatan, district stakeholders, health worker associations, and JKN members. Qualitative data were analyzed by thematic analysis and quantitative data were analyzed descriptively. Generally, three types of compensation (reimbursement, service support of the healthcare team, and additional services of specific health facilities) face major constraints related to physician and drug availability, geographic conditions and availability of health infrastructure. There are still no regulations and guidelines that can explain the criteria and technical mechanisms of compensation in the JKN scheme. This study shows that the development of criteria can include 2 indicators of availability of health facilities, 3 indicators of access to health facilities, 7 indicators of geographical factor, and 3 indicators of transportation access. Mapping DBTFMS or target areas of compensation should be determined by the DHO and verified by BPJS Kesehatan and Local Government. In conclusion, technical guidance should not only accommodate compensation mechanisms within the JKN scheme, but should clarify the roles between BPJS Kesehatan, the central government and district governments and also explain the methods and indicators of monitoring and evaluation. The effective and efficient compensation financing system should also consider the capacity of each district and the financial capabilities of BPJS Kesehatan.
14
Oral B03
Parents’ and Caregivers’ Costs of Community-Based Rehabilitation
(CBR) Programme For Disabled Children in East Coast Region of
Peninsular Malaysia
Haliza Hasan1,2,6, Syed Mohamed Aljunid 1,3, Sharifa Ezat WP, Aznida Firzah Abdul Aziz4, Amrizal Muhd
Nur1, Nor Azlin Mohd Nordin5 and Nurul Anisah Jaafar5
1 International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti
Kebangsaan Malaysia.
2 Kulliyyah of Nursing, International Islamic University Malaysia.
3 Department of Health Policy and Management, Faculty of Public Health. Kuwait
University.
4 Department of Family Medicine. Faculty of Medicine. Universiti Kebangsaan Malaysia. 5 Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti
Kebangsaan Malaysia
6 United Nations University – International Institute for Global Health (UNU-IIGH)/
University Kebangsaan Malaysia, Cheras, Kuala Lumpur
Rehabilitation for disabled children requires long-term programmes which are expensive to the family. This study aimed to estimate the cost incurred by parents and caregivers of disabled children participating in the Centre-Based and Home-Based Community-Based Rehabilitation (CBR) and cost of seeking alternative care. Activity-Based Costing (ABC) method was the cost analysis approach used to estimate twelve-months expenditure by 297 (160 in Centre-based and 137 in Home-based) parents and caregivers of disabled children aged 2 to 18 who attended CBR and seek alternative care. Costing was undertaken from societal perspective. Data were collected using a self-administered costing questionnaire and were presented in median (IQR) cost calculated for the 2014 institutional financial year. Results showed that the median total cost for CBR programme, including alternative care were significantly higher in Centre-Based compared to Home-Based group (RM 7,392 (6,849) vs. (RM 8,066 (36,939) (p value <0.001). The median direct and indirect costs, excluding medications and alternative care were nearly four times as high in Home-Based compared to Centre-Based (RM 2, 376 (11,228) vs. RM 608 (739) (p = <0.001). Parents and carers in Centre-Based spent RM 1,320 (1,978) on medication and supplements compared to only RM 450 (877) for those in Home-Based group. Both groups of parents and carers spent significant amount of resources on alternative care. Although, the cost of alternative care is 90.9% of the total cost for Centre-Based group compared to 55.8% in the Home-Based group, difference is not significant (p-value = 0.543). The high costs incurred for alternative care is a major economic burden to the family. Thus, further studies evaluating the cost effectiveness of alternative care for rehabilitation of disabled children are warranted.
15
Oral B04
Longitudinal Data Analysis of Type 2 Diabetes Mellitus and Its
Complications Among Thai Citizen Covered by The Universal
Coverage Scheme
Tanapat Laowahutanon1, Virasakdi Chongsuvivatwong2, Tippawan Liabsuetrakul2, Apiradee Lim3, Netnapis
Suchonwanich4, Tachimori Hisateru5, Shuhei Nomura6, Hiroaki Miyataf
1National Health Security Office, Thailand
2Epidemiology unit, Faculty of Medicine, Prince of Songkla University, Thailand
3Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla
University Pattani Campus, Thailand
4The Health Intervention and Technology Assessment Program (HITAP), Thailand
5Department of Mental Health Policy and Evaluation, National Institute of Mental Health, Japan 6Institute for Global Health Policy Research (iGHP), Japan
Type 2 Diabetes mellitus (T2DM) is a global concern and treatment of T2DM and its complications are covered by the health insurances in Thailand. However, patients’ long-term effects under the Universal Coverage Scheme (UCS) have not been evaluated. This study aimed to measure the admission per 1,000 populations and all-cause mortality rates of T2DM patients and its complications including chronic kidney disease (CKD), coronary heart disease (CHD), diabetic retinopathy (DR), stroke and diabetic foot during 2009-2016. In-patient database of UCS including 4,297,474 admissions of T2DM and its complication were retrieved for an analysis. Disease coding was referenced from International Classification of Diseases 10th Revision (ICD10). Admission rates were estimated from number of admitted patient divided by number of Thai universal health coverage scheme population and multiplied by 1,000 population. Mortality rates were estimated from number of death patients by T2DM and its complication in each year divided by number of admitted patient by T2DM and its complication. Admission rate of T2DM were increased from 4.05 to 6.53 per 1,000 populations. Admission due to CKD were dramatically increased from 0.65 to 1.9. Mortality rate of T2DM admitted in the hospitals were increased from 19.5% to 28.6%. Mortality rate of T2DM with myocardial infarction were increased from 29.4% to 48.5%. In conclusion, trends of admission of T2DM patients and its complication as well as mortality rate were increased dramatically. These findings could be used to alarm the quality of T2DM care and management to the policy makers.
Keywords: type 2 diabetes mellitus, universal coverage scheme, admission, mortality
16
ORAL B05
The Role of Nusantara Sehat: Deployment Health Worker Under
System Contract in Remote Puskesmas Indonesia
Happy R Pangaribuan1, Erwin Purwaningsih1
1Faculty of Medicine, Universitas Gadjah Mada
Primary health care known as Puskesmas in Indonesia, since 2012 has increased from 9,510 units to 9,767 units by 2016. The accessibility of the indigenous people to Puskesmas was still troublesome. Health care service in remote Puskesmas were relatively passive due to limited health facilities and human resources in managing the program. Ministry of Health declared “Nusantara Sehat” Project to strengthen the function of Puskesmas service in remote areas. This program deployed team based and individual health workers in remote Puskesmas with a 2-year work contract system. This research explored the role of Team Nusantara Sehat in strengthening the function of remote Puskesmas services. This research used quantitative research approach. Data were collected by filling out questionnaires through Google® forms by 109 personnel of Team Nusantara Sehat who were deployed in remote Puskesmas. About 78% participants stated that they were working to run programs that already existed in Puskesmas. Some local health workers considered their team as outsiders so they were less open to share information. Team Nusantara Sehat was oriented for preventive care, but in other case only 46% of the respondents were assigned to live in areas where it was hard to access Puskesmas. In conclusion, team Nusantara Sehat has an important role in remote Puskesmas. They need to have skill in management competency to give sustainable health care based in remote community. Then government should improve their system management organization to make them retain workers in remote Puskesmas.
17
Oral B06
Determinants of Patient Satisfaction Level on Interior Design
Quality of Public Hospitals in Malaysia
Shariffah Syafiqah Aljunid1, Nurul Nabilah Huda Mohamad Shukri2, Syed Mohamed Aljunid3,4, Mohd
Zafrullah Mohd Taib5, Zanariah Abu Samah6
1 Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia 2 Faculty of Agriculture, Universiti Putra Malaysia
3 International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia 4 Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait
Being in a hospital can be a stressful experience especially to the patients. The importance of design quality as a trigger to patients' satisfaction is becoming a topic of significant relevance as it also impacts the building operation. This study aims to determine the factors influencing the patients' satisfaction towards the interior design quality of inpatient units at public hospitals in Malaysia. Self-administered questionnaires were distributed among 483 inpatients from 5 Obstetrics and Gynaecology wards at public hospitals in Klang Valley region. CFA was constructed to remove items that did not meet the requirement of the model fit and only 8 latent variables were found. All latent variables were then included to test the measurement model validity. The SEM technique is used to examine the causal relationship and to test the hypothesis that patients' satisfaction towards the interior design quality can be predicted by furniture, space planning, accessibility, wayfinding, lighting, safety, color and air quality. The SEM results revealed that furniture ( = .243, p-value < .05), space planning ( = .265, p-value < .05), lighting ( = .263, p-value < .05), and color ( = .138, p-value < .05) has significant positive effect on patients' satisfaction towards interior design quality. Whereas wayfinding, safety, and air quality have statistically insignificant effect (but positive) on the patients' satisfaction, while accessibility has an insignificant negative effect. This study concludes that space planning plays the most important role on determining the patients' satisfaction while the aspect of accessibility does not affect how the patients feel towards the interior environment of the inpatient units. This study may provide input to help hospital planners to evaluate their priorities in planning and designing better hospitals in the future.
18
Oral B07
The Completeness of Discharge Summary at Tugu Koja Hospital
Dience Meidiana MD1, Anis Fuad, Lutfan Lazuardi 2
1 Hospital Tugu Koja, Jakarta
2 Master Programme of Hospital Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta,
Indonesia
In 2016 the discharge summary documents were incomplete, around 50% and 90% for outpatient and hospitalized patient respectively. The incompleteness could be caused by many factors like human, management and technology. This study aimed to examine those factors in the completeness of discharge summary fulfillment. This research used qualitative and quantitative methods with case study. Data were gathered through observation, in-depth interview and focused group discussion (FGD). The analysis unit was RSUD Tugu Koja. Informants were six doctors, a manager and three medical record officers. The checklist technique was used to analyze 352 documents of hospitalized patient in January – December 2016 period. Of all discharge summarys, 46% were complete and 53% remained incomplete. Based on the observation through checklist as secondary data, the most unfilled components by doctor in charge of the patient (DPJP) were discharge summary date (23.9%), physical examination (16.4%), doctor’s signature (12.8%) and doctor’s clear name (11.4%) compared to other components in those discharge summaries. Human factors which were observed through knowledge, motivation and attitude showed that the knowledge was not used maximally. Athough it was being understood that filling the discharge summary was a responsibility, but DPJP still needed reward and punishment. Therefore, the attitude of DPJP in fulfilling the discharge summary did not match to the hospital expectation. Organizational factor was seen from supervision and standard operating procedure (SOP). There was lack of supervision and discharge summary SOP caused DPJP to perceive that there was no problem in discharge summary fulfillment. In technological factor, there was a form that needed to be changed to improve the completeness of discharge summary. The time efficiency became an obstacle in fulfilling the discharge summary because it was done manually. The low completeness of medical resume fulfilment was caused by human, organization and technology factors that were related to each other. A comprehensive strategy involving human, organization and technology factor is thus necessary to improve the completeness.
19
Oral C01
The Effect of INA-CBG Casemix Implementation on Completeness
of Medical Records and Complication Rates in National Stroke
Center Hospital in West Sumatera Province, Indonesia
Kamal Kasra1,3, Syed Mohamed Aljunid 1,2, Amrizal Muhd Nur 1
1International Centre for Casemix and Clinical Coding, Faculty of Medicine Universiti Kebangsaan Malaysia 2Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait 3United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
The Indonesian government has implemented a casemix system known as INA-CBG in the last 10 years ago as the provider payment method for the National Health Insurance programme. The aim of this study was to compare the completeness of inpatient medical records and the patients’ complication rates before and after the implementation of INA-CBG casemix system. We hypothesised that the inpatient medical records will be more complete and the complication rates will be lower after the implementation of casemix system. The study was conducted at the National Stroke Centre Hospital (NSCH) in Bukit Tinggi, West Sumatera Province of Indonesia. Fourteen variables consisting of demographic and clinical characteristics of patients admitted to the hospital in 2008 and in 20012, before and after the implementation of INA-CBG casemix system was collected and compared. Stratified sampling method was used in selecting the cases. There were 244 cases in year 2008 and 559 cases in year 2012 included in the study. The results showed that the completeness of medical record increased from 59.4% in 2008 to 73.9% in 2012 (X2 = 16.067, P = 0.0001). The complication rates decreased from 18.4% in 2008 to 14.8% in 2012
(X2 = 12.953, P=0.002). In conclusion implementation of casemix system has helped to improve
the completeness of medical records and reduced the rate of complications. Medical practitioners were more like to ensure that their medical records are filled properly in order to obtain full reimbursement. The lower complication rates might reflect the enhancement in the quality of care following the implementation of casemix system due to better quality monitoring by the health financing authority.
20
Oral C02
Assessing the Validity of Google Trends for Digital Epidemiology of
Dengue in Indonesia
Atina Husnayain1, Anis Fuad2, Lutfan Lazuardi3
1Graduate Program of Public Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah
Mada
2Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and
Nursing, Universitas Gadjah Mada
3Department of Health Policy Management, Faculty of Medicine, Public Health, and Nursing, Universitas
Gadjah Mada
Digital traces are rapidly used for health monitoring purposes in recent years. This approach is growing as the consequence of increased use of mobile phone, internet, and machine learning. Many studies reported the use of Google Trends data as potential data source to assist traditional surveillance system. The raising of internet penetration (51.8%) and the huge utilization of Google (98%) indicate the potential use of Google Trends in Indonesia. Since no previous study on validating official dengue report and Google Trends data in Indonesia and compare it over the years, thus this study aimed to cover this gap. This was a quantitative study using time series data (2012-2016). Two sets of data were validated using Moving Average analysis in Microsoft Excel. Pearson correlation and time lag correlation were also used to measure the correlation between those data. Moving Average analysis showed that Google Trends data have a linear time series pattern with official dengue report. Pearson correlation indicated high correlation for 3 defined search terms with R-value range from 0.9210 to 0.937(p≤0.05) which seemed to be increased in epidemic period (2015-2016). Time lag correlation also indicated that Google Trends data could potentially be used for early warning system and novel tool to monitor public reaction before the increase of dengue cases and during the outbreak. In conclusion, Google Trends data have a linear time series pattern and statistically correlated with official dengue report. Identification of information seeking behavior is needed to support the use of Google Trends for disease surveillance in Indonesia.
21
Oral C03
Evaluation of Selected Outcomes of Combination Antiretroviral
Therapy: Yemen Cohort Studies
Mayada Faisal Nabih1. Sharifa Ezat WP2, Amrizal Muhd Nur2
1National AIDS Control Program – Ministry of Public Health and Population, Yemen
2International Centre for Casemix and Clinical Coding (ITCC) - Faculty of Medicine Universiti Kebangsaan
Malaysia (UKM)
HIV treatment and care program were established in 2007 in five main governorates out of 22 governorates of Yemen. There were different barriers that prevent people living with HIV (PLHIV) in Yemen from accessing HIV treatment services including limited resources, access and sociocultural factors. Although cohort studies were found to analyse the treatment outcomes and the effectiveness of combination antiretroviral therapy (cART), this study evaluated the selected outcomes of cohort of PLHIV who were being treated between the period of 2007 and 2014 and analyse selected treatment outcomes of cART. A retrospective descriptive study of 1,703 PLHIV who initiated cART between 2007 and 2014 was carried out. This Yemen Cohort analysis has been following PLHIV receiving cART at 5 public health care facilities, using routine clinical care data. The main outcomes of interest were retention in care; clinical presentations; clinical failures;
changes in the cART; lost to follow-up and mortality. The cohort analysis of each year between
2007 and 2014 showed retention rate of less than 80%. Patient profiles were characterized by a predominance of men (male: female ratio 1039/664 (1.6∶1)), with a mean age of 35 years; and 1448/1703 (85%) had been infected with HIV via heterosexual contact. The majority of patients 1107/1703 (65%) presented late with clinical stages 3 and 4, and most of them 886/1703 (52%) initiated cART with a CD4 T-cell count ≤200 cells/mm. The most regimens included Tenofovir and Efavirenz cART 1039/1703 (61%) and TB treatment started for 85/1703 (5%) of them. Anout one fifth or 375/1703 (22%) of the patients presented HIV-related clinical manifestations after starting cART, while more than half of PLHIV 1141/1703 (67%) experienced cART substitution, and the mean AIDS mortality rate was 15% per year. Although, cART use showed effectiveness in public health services, different barriers still play a role in preventing access to HIV treatment. Mobilization of resources and formulation of better health policies for the needs of PLHIV are important steps towards improving access to cART and patient's retention in care.
22
Oral C04
Age, Period and Cohort Analysis of Age-Specific Maternal Mortality
Trend in Ethiopia
Biniam Getachew1, Tippawan Liabsuetrakul1, Shama Vira
1Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Maternal Mortality was persistently high for over decades in Ethiopia though it has declined in recent years. The roles of time-varying elements in this decrease are unknown. Analyzing maternal mortality with age-period-cohort analysis will provide evidence to policymakers to re-direct resources towards vulnerable age groups. The aim of this analysis was to determine the role of age effect, period effect and birth cohort effect on trend of age-specific maternal mortality in Ethiopia. Age-period-cohort (APC) analysis was applied to examine the effect of age, period and birth cohort on MM in Ethiopia using data from the Ethiopian Demographic and Health Survey (EDHS) from years 2000, 2005, 2011 and 2016. Age specific maternal mortality rates were calculated using standardized maternal death compared to women-years of exposure per 100,000 mothers and the trend was analyzed. In most age groups, the maternal mortality rate decreased in 2015 compared with the previous years except for older women. According to the APC analysis, the age-cohort effect explains the maternal mortality rate better than age-period effect. The period effect shows the risk ratio of maternal mortality after 2005 decreased compared with before. The cohort effect illustrates women born after 1980 has lower risk ratio compared with the older one. Maternal mortality in Ethiopia declined in recent years. However, certain age group still face high maternal mortality rate. Because of this, the Ministry of Health (Ethiopia) should consider maternal mortality reduction interventions with respect to high-risk age groups.
23
Oral C05
Effectiveness of The Use of Four Methods That Has Been Used for
Running CRM-System at Puskesmas Kowilut Kediri Indonesia
Gerardin Ranind Kirana1, Reny Nugraheni1
1Public Health Department, Institut Ilmu Kesehtan Bhakti Wiyata Kediri
Customer Relationship Management (CRM) System has long been used as a way to improve patient satisfaction by identifying patient needs and providing quality health services. The purpose of this study was to compare the effectiveness of the use of four methods that has been used for running CRM-system at Puskesmas Kowilut, Kediri, Indonesia. This study was a descriptive research evaluation. The subjects were the four methods used by Kowilut Health Center Kediri to run CRM-system. Coordinator and the members of Customer Satisfaction Surveyor (CSS) Team were the respondents. Collecting information was done through interviews and observation. The use of short messaging system (SMS) to convey complaints directly to CSS Team was the most effective method for running CRM-system. Patient complaints were well documented, CSS Team could follow them up quickly, and patient complaints could also be resolved promptly with effective solutions. These can be done because the person in charge of the health services’ quality in Puskesmas, in this case was the head of Puskesmas, received very quickly the report of complaints that have been documented by CSS Team, resulting in improvement recommendations be submitted to internal meetings and with immediate follow-up action. The follow-up actions were then documented and displayed on Puskesmas wall magazine, readable by all patients. Focus on the use of SMS to convey complaints directly to CSS team is the most effective method for running the CRM-system at Puskesmas Kowilut Kediri, and it will be able to save cost compared to running four methods at once. In the future, it is necessary to develop this method, by using some other media such as email and other social media, to submit a complaint directly to the CSS team.
24
Oral C06
Cost Effectiveness of Community
–
Based Rehabilitation (CBR) For
Children with Disability
Nurul Anisah,Jaafar 1,2, Haliza,Hasan1, Nor Azlin,Mohd Nordin2, Syed Mohamed Aljunid1,3
1 International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre 2 Physiotherapy Program, Faculty of Health Science, Universiti Kebangsaan Malaysia
3 Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait
Children with disability require long-term and continuous rehabilitation. Community-based Rehabilitation (CBR) was developed to fulfil this need and has benefited children at various ages both in the rural and urban societies. CBR are divided into two types of program which are center and home-based program, both are well-utilised by the population. To date no research is available on cost of CBR for children attending the program in the country; the cost-effectiveness of the two types of program has not been assessed. The objective of this study was to compare the average cost-effectiveness ratio (ACER) of center and home-based program of CBR. A total of 220 children with disability aged 4 to 18 years from 29 CBR centres in Pahang, Terengganu and Kelantan were recruited. Patient’s and provider’s cost were estimated using activity-based costing approach, with the use of self-administered questionnaire. Outcome of rehabilitation was measured in term of changes in disability level, using Barthel Index. ACER was estimated by measuring cost per Barthel Index score gained following 6 months of attending the CBR. Results showed that mean difference in Barthel Index score in children completing center-based program was higher (Mean Rank= 112.8, n=172 than the home-based group (Mean Rank=102.3, n=48). The total patient’s cost was RM1439 (SD=1744) and RM266 (SD=RM445) for the center and home-based program, respectively. While the total provider’s cost was RM42,380 (SD=RM13,559) and RM29,575 (SD=RM9961) for the center and home-based program, respectively. The ACER from patient’s perspective were RM1332 for center-based and RM1267 for home-based program, while ACER from provider’s perspective were RM39,240 and RM140,831 respectively. Overall ACER for each program were RM40,573 for center-based and RM142,099 for home-based program. The result shown that that center-home-based program is more cost-effectiveness than home-based program. Children with disability should be encouraged to participate in center-based program of CBR rather than having the rehabilitation at home.
