The Caesarean Sections Claims of National Health Insurance in the East Java Region Hospital

Tika Rahhmatillah Mustofa; Andreasta Meliala

doi:10.53756/jjkn.v4i1.188

Authors

Tika Rahhmatillah Mustofa a:1:{s:5:"en_US";s:23:"Universitas Gadjah Mada";}
Andreasta Meliala Gajdah Mada University

DOI:

https://doi.org/10.53756/jjkn.v4i1.188

Keywords:

Cesarean section delivery, National Health Insurance, Quality Control, Cost Control, Robson Classification

Abstract

WHO (2015) sets the standard for sectio caesarea at 10-15%. The proportion of SC deliveries in East Java was 22.4% in 2018, higher than the national average of 17.6%. The burden of JKN financing on childbirth is increasing and is among the top 10 most CBGs cases nationally. As an effort to control quality and control costs, BPJS Health in coordination with the Quality Control Cost Control Team (TKMKB) issued guidelines and self-assessment instruments for cesarean section (SC) in 2020. This study was conducted to explore the picture of SC before and during the implementation of the SC Self-Assessment Instrument in National Health Insurance patients in East Java. Of the 837,809 study subjects, 247,508 (60.5%) had SC delivery. Sectio Caesarea delivery of National Health Insurance patients at FKRTL in East Java is associated with individual factors, namely age and type of JKN membership and service factors, namely SC Self-Assessment Instrument, class of care, severity level, and hospital type. Implementation of the SC Self-Assessment Instrument has not been optimal in reducing the SC rate. A comprehensive strategy is needed to reduce the rate of sectio caesarean delivery, including interventions for pregnant women and families; health workers, health facilities, and professional organizations.

References

Abdullah, M. R. T. (2022). Analisis Efektivitas Biaya Pelayanan Sectio Caesarea: Studi Kasus pada Masa Sebelum dan Saat Pandemi COVID-19 di Rumah Sakit X Tahun 2019-2020. Jurnal Ilmiah Kesehatan, 21(03). https://doi.org/10.33221/jikes.v21i03.2221

Andayasari, L., Muljati, S., Sihombing, M., Dona, ;, Cicih, A. ;, Danny, O. ;, Mogsa, F., Widianto, ;, Teknologi, P., Kesehatan, T., Klinik, E., & Percetakan, J. (2015). Proporsi Seksio Sesarea dan Faktor yang Berhubungan dengan Seksio Sesarea di Jakarta THE PROPORTION OF CAESAREAN SECTION AND ASSOCIATED FACTORS IN HOSPITAL OF JAKARTA.

Anwar, I., Nababan, H. Y., Mostari, S., Rahman, A., & Khan, J. A. M. (2015). Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011. PLoS ONE, 10(3). https://doi.org/10.1371/journal.pone.0120309

Ashar, H., & Kusrini, I. (2020). Determinant of the Increased Sectio Caesarea Labor Rates of Indonesia in 2017.

Cunningham F. G., Leveno K. J., Bloom S. L., Dashe J. S., Hoffman B. L., Casey B. M., Spong C.Y. (2018a). Williams Obstetrics 25th Edition. Chapter 30: Cesarean Delivery and Peripartum Hysterectomy.

Dinas Kesehatan Provinsi Jawa Timur. (2022). Profil Kesehatan Jawa Timur 2021.

DJSN. (2021). Statistik JKN 2015-2019. Fakta dan Data Capaian Program Jaminan Kesehatan Nasional.

Hoxha, I., Fejza, A., Aliu, M., Jüni, P., & Goodman, D. C. (2019). Health system factors and caesarean sections in Kosovo: A cross-sectional study. BMJ Open, 9(4). https://doi.org/10.1136/bmjopen-2018-026702

Idris, H., & Anggraini, R. (2022). Highest economic status increases risk of cesarean section in women of childbearing age. Universa Medicina, 41(2), 129–138. https://doi.org/10.18051/univmed.2022.v41.129-138

Kementerian Kesehatan RI. (2018). Laporan Nasional RISKESDAS 2018.

Kementerian Kesehatan RI. (2021). Disease Accounts pada Skema JKN Tahun 2018.

Khunpradit, S., Tavender, E., Lumbiganon, P., Laopaiboon, M., Wasiak, J., & Gruen, R. L. (2018). Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005528.pub2

Lee, J. T., McPake, B., Putri, L. P., Anindya, K., Puspandari, D. A., & Marthias, T. (2023). The effect of health insurance and socioeconomic status on women’s choice in birth attendant and place of delivery across regions in Indonesia: a multinomial logit analysis. BMJ Global Health, 8(1), e007758. https://doi.org/10.1136/bmjgh-2021-007758

Majid, E., Kulsoom, S., Fatima, S., & Zuberi, B. F. (2022). To evaluate rising caesarean section rate and factors contributing to it by using modified robson’s criteria at a tertiary care hospital. Pakistan Journal of Medical Sciences, 38(7). https://doi.org/10.12669/pjms.38.7.5983

Marthias, T., McPake, B., Carvalho, N., Millett, C., Anindya, K., Saputri, N. S., Trisnantoro, L., & Lee, J. T. (2022). Associations between Indonesia’s national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000–2017. Journal of Epidemiology and Community Health, jech-2021-217213. https://doi.org/10.1136/jech-2021-217213

Monari, F., Menichini, D., Bertucci, E., Neri, I., Perrone, E., & Facchinetti, F. (2022). Implementation of guidelines about women with previous cesarean section through educational/motivational interventions. International Journal of Gynecology and Obstetrics, 159(3), 810–816. https://doi.org/10.1002/ijgo.14212

Mylonas, I., & Friese, K. (2015). The indications for and risks of elective cesarean section. In Deutsches Arzteblatt International (Vol. 112, Issues 29–30, pp. 489–495). Deutscher Arzte-Verlag GmbH. https://doi.org/10.3238/arztebl.2015.0489

Nastiti, A. A., Triharini, M., Santika, N. K. A., Dewi, Y. S., Barnawi, N. A., & Arifin, H. (2022). Determinants of caesarean section delivery: A nationwide study in Indonesia. British Journal of Midwifery, 30(5), 282-289. https://doi.org/10.12968/bjom.2022.30.5.282

Nugraheni, W. P., Mubasyiroh, R., & Hartono, R. K. (2020). The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery services in Indonesia. PLoS ONE, 15(7). https://doi.org/10.1371/journal.pone.0235176

Permenkes. (2021). PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 26 TAHUN 2021 TENTANG PEDOMAN INDONESIAN CASE BASE GROUPS (INA-CBG) DALAM PELAKSANAAN JAMINAN KESEHATAN.

Permenkes. (2023). PERMENKES NO 3 TAHUN 2023 TENTANG STANDAR TARIF PELAYANAN KESEHATAN DALAM PENYELENGGARAAN PROGRAM JAMINAN KESEHATAN.

Satriawan, D., Pitoyo, A. J., & Giyarsih, S. R. (2021). Faktor-faktor yang Memengaruhi Kepemilikan Jaminan Kesehatan Pekerja Sektor Informal di Indonesia. TATALOKA, 23(2), 263–280. https://doi.org/10.14710/tataloka.23.2.263-280

Sihombing, N., Saptarini, I., Sisca Kumala Putri, D., Penelitian dan Pengembangan Upaya Kesehatan Masyarakat, P., & Litbang Kesehatan, B. (2017). DETERMINAN PERSALINAN SECTIO CAESAREA DI INDONESIA (ANALISIS LANJUT DATA RISKESDAS 2013). Jurnal Kesehatan Reproduksi, 8(1), 63–75. https://doi.org/10.22435/kespro.v8i1.6641.63-75

Surat Edaran Direktorat Jenderal Pelayanan Kesehatan nomor HK.02.02/III/2878/2020 tentang Kesiapsiagaan Rumah Sakit Rujukan dalam Penanganan Rujukan Maternal dan Neonatal Dengan COVID-19

TKMKB. (2020). Pedoman & Instrument Asesmen Diri Seksio Cesarea (SC) di Rumah Sakit.

WHO. (2015). WHO Statement on Caesarean Section Rates.

Widjayanti, T. B. (2020). Karakteristik Ibu Melahirkan Sectio Caesaria Peserta Jaminan Kesehatan Nasional di Rumah Sakit Profit X di Sekitar Jakarta Pendahuluan.

Wyatt, S., Silitonga, P. I. I., Febriani, E., & Long, Q. (2021). Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: A cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017. In BMJ Open (Vol. 11, Issue 5). BMJ Publishing Group. https://doi.org/10.1136/bmjopen-2020-045592