CLASSLESS INPATIENT SERVICE FOR UNDERPRIVILEGED COMMUNITY AT LOCAL PUBLIC HOSPITAL OF WATES
Regional General Hospital Wates, Kulon Progo Regency, Special Region of Yogyakarta

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Since the start of the implementation of Universal Health Coverage in 2011, the hospital service for underprivileged people has no longer been problems. However, the massive increase of the patients from underprivileged families has caused minor obstacles in the terms of the available beds for patients based on the class of their health coverage. In order to keep providing the health services with superior quality, the Local Public Hospital of (RSUD) Wates must find a visible solution for such matter. Thus, the institution decided to apply the innovation of Classless Inpatient Service for Underprivileged Community. The innovation is mainly aimed for the availability of qualified health services for underprivileged families without having to ignore the applied Universal Health Coverage from the government.

B. Strategic Approach

 2. What was the solution?
This innovation starts from the problem of over-population of inpatients service users from underprivileged families at RSUD Wates. The management was trying to find a way out by approaching the several parties involved in the service provision including the paramedics committee, nursing committees, and other support personnel (the officers involved in the accommodation of hospitalization, guaranteeing institutions, basic health services and policy makers). The strategy adopted is the persuasive approach and coordination with the parties. The main objective of this strategy is avoid any turmoil upon the innovation implementation. The rights of the parties involved are not reduced as well as the obligations are not about to be increased. The persuasive approach and the coordination activities have been done not only by the paramedics but also by medical committee as well as guaranteeing institutions, basic health services and policy makers simultaneously in order to provide the best service at the hospital. In 2012 some regulations were issued in accordance with the conditions of service in RSUD Wates including The Decree of Director of RSUD Wates on the procedural administration for services for underprivileged families at RSUD Wates. In addition to persuasion and coordination, hospital management also needs to work carefully, thoroughly, effectively and efficiently, especially to meet the needs of service superiority.

 3. How did the initiative solve the problem and improve people’s lives?
• The initiative is able to solve the problem of rising number of hospitalized patients especially those from the underprivileged families by providing extra ward at the hospital should the regular ward is full, without any additional charge; • The initiative is different since it allows the underprivileged families to experience the same services as the other experience; • The patients are guaranteed by the Local Health Coverage (JAMKESDA) so they do not need to worry about the charges they will face when the treatment is done.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
RSUD Wates has been coordinating with guaranteeing institutions to fully implement the innovation without having to violate the medical ethics maintained by the Medical Committee. The hospital management also ensures that the whole process of the implementation is in accordance with the existing local as well as national regulations. Technically, RSUD Wates also established special unit called TPPRI (Inpatients Registration Unit) to monitor the availability of the ward for the patients from underprivileged families. The officers at TPPRI are all experience medical-support staff, ensuring that all patients are served professionally. To support the medical operational activities, the hospital provides the skilled and experienced doctors and specialist to handle all treatments needed. To accelerate all registration process at TPPRI, the hospital management also equipped the unit with the latest telecommunication tools and IT infrastructure. Administration officers to handle the linking of the whole process to the BPJS reimbursement scheme are also well prepared, making it easy for high rank officials to monitor and evaluate the development of the innovation implementation and also allowing the whole process to be effortless should it come to any claims handling management.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
a. The government; both central and local government with the provision of funds and regional budgets channeled through existing collateral that JAMKESNAS (National Health Coverage), JAMKESOS (Social Welfare Coverage) and JAMKESDA (Local Health Coverage); b. Regent; for giving easy access to hospital services for underprivileged families to take advantage of a variety of collateral, especially for residents of Kulon Progo by utilizing card-based and non-card-based JAMKESDA; c. The Hospital Management: the party who determined the policy to accept all inpatient users regardless the full ward occupancies; d. Professional organization (Medical Committee); medical committee will determine the type of drug policy and other services related to inpatients.
 6. How was the strategy implemented and what resources were mobilized?
Sources of financing for the innovation came from guarantee institution and regional budgets. The system used is a cross-subsidy between the guarantees. The hospital management conducted the thorough calculating and financing the system of cross-subsidies in choosing between the underwriting of this innovation, so that the balance between expenditure by financing can always be maintained.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
a. Patients from underprivileged families are not going to be ignored. Should the designated ward is fully-occupied, the underprivileged patients will be treated in higher class ward without any extra fees or charges; b. The innovation supports the bureaucracy reform in Indonesia, in the form of improving services excellence in public hospital regardless the economic status of the patients; c. The increase number of patients basically will also improve the income of the hospital. Financing aspects of assurance can largely replace the entire expenditure incurred for inpatient services for underprivileged patients. Replacement of guarantee is executed by the INA CBG's system, in accordance with Local Regulation No. 3 Year 2012 on Class III Health Service Tariff at RSUD Wates.

 8. What were the most successful outputs and why was the initiative effective?
The monitoring and evaluation process are done by comparing the fund used in the process to the factual documents prepared by the officials at the hospital. The comparing process is utilizing the standardized forms provided by the management. Besides, weekly evaluation is also done in order to monitor the improvement of the innovation’s implementation.

 9. What were the main obstacles encountered and how were they overcome?
The main constraints mainly set on the wards occupation management and financing matter. Wards occupation management needs precision and accuracy of observation from the field officers. Ward arrangements also need to be supported by telecommunications networks and information technology to accelerate the process. Means of telecommunication and information technology have all been set and prepared as well as been available widely in in the present moments. The financing matters have not been problems anymore due to the enactment of the guarantee by BPJS. Replacement funding calculation from BPJS are based on the diagnosis so that almost all the costs related to the treatments will always be able to claim.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a. All underprivileged patients have been able to be accommodated and well served. Based on the results of customer satisfaction surveys hospitalization in 2013, the satisfaction rate on the hospital service showed the rate of 72.94%. Based on the Minimum Service Standards/SPM regulated in the Regent Decree No. 32 of 2009, customer satisfaction rate of hospitalization was set at 70%. As for the subsequent years, the innovation is still going to be sustained. The most important thing to note is the priority service to customers regardless their economic strata. b. The visit ratio from underprivileged families has reached 66.52% in 2013, indicating the trust gained by the communities about the hospital service excellence.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Sustainability of the innovation is seen from the determination of the regulatory, planning, and allocation of resources both financial resources, institutional and human resources which surely can continue to be implemented. The health coverage reimbursement calculation using INA BPJS CBG's method has benefited the hospital due to the greater values offered by the scheme. The innovation is surely sustainable due to the provided means of telecommunication and information technology to support the acceleration of the whole process at the hospital. Besides, RSUD Wates added 24-capacity inpatients ward to support the continuation of the program. The innovation can easily replicated in other regions or provinces since the financial resources used for the program are taken from the National Health Coverage. Besides, in many cities, the means of telecommunication and information technology have been widely available.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
In public service delivery, especially in health service field, the most required aspects are integrity and dedication of the parties not to discriminate the service users based on their economic strata, in this case, a hospital shall never compromise the service based on the economic condition of the patients.

Contact Information

Institution Name:   Regional General Hospital Wates, Kulon Progo Regency, Special Region of Yogyakarta
Institution Type:   Government Agency  
Contact Person:   Lies Indriyati
Title:   Direktur RSUD Wates  
Telephone/ Fax:   +62 0274 773169, Fax: +62 0274 773092
Institution's / Project's Website:  
E-mail:   richo_jf@yahoo.com  
Address:   Jl. Tentara Pelajar Km 01 Wates Kulon Progo
Postal Code:   55611
City:   Wates
State/Province:   Special Region of Yogyakarta
Country:  

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