Health care Provider Claim Data (HPCD) Repository

Transcription

1 Health care Provider Claim Data (HPCD) Repository Center for Health Financing and Health Security National Casemix Center Ministry of Health Indonesia

2 Indonesia in brief An archipelago between Asia and Australia, islands with 5 big islands: Java, Sumatra, Kalimantan, Sulawesi and Papua Population (2010) : people Life Expentancy (2014) : Male 68,87 & Female 72,59 Government: 34 provinces, 514 districts/municipalities (since 2000 : decentralization process to district level including health) source: Badan Pusat Stastistik

3 Universal Health Coverage (UHC) in Indonesia Indonesian health financing reform replacing fee for service payment with prospective payment system (PPS). Universal Health Coverage (UHC) in Indonesia has started since 1 January 2014 called Jaminan Kesehatan National (JKN) BPJS is a government agency that pays claims from hospitals UHC Coverage about 180 million people (okt 2017) Hospital payment system in this program has adopted DRG payment called INA-CBG system Primary Health care payment system base on Capitation hospitals and Specialist Clinic have been implemented INA- CBG system (September 2017) both Private (voluntary) and Public

4 Overview of The Health Provider In Indonesia Health care facilities Primary health care : 9,799 public primary health centres, > 3,000 private clinics, > 40,000 general practitioners Secondary and Tertiary health care : 926 public hospitals, 1,744 private hospitals

5 JKN Contracted Health Care Providers No Primary health care providers Total 1. Gov Health center 9, Private Clinic 5, Private practice 4, Specific health center (RS Pratama) 6. Dentist private practice 13 1,160 No Secondary & tertiary health care providers Total 1. Hospital 2, Specialist Clinics 193 Total 2,218 TotTotal 21,053 Source: BPJS Kesehatan, Sept 2017

6 HPCD Repository (Hospitals and Specialist Clinic Provider)

7 Background Needs of National Database for monitoring and evaluation on implementation Universal Health Coverage (UHC) Needs of Dashboard system for policy maker Data for DRG Development New Classificaton, tarif setting, etc. Limited access for Hospital data claim Geographical challenge Still Many Hospital don t have Hospital Information System (HIS)

8 E-Klaim & HPCD Repository Schema

9 E-Klaim Software Already Installed in Hospital Contracted JKN MoH Develop Standalone webbase application Act as a server inside hospital for managing claim data Integration with existing HIS is supported using web service Distribute to all Hospital and Specialize Clinic Contracted by JKN User friendly Secure for Data Transfer to others software Integrated with HIS and Payor (BPJS) Aplication

10 E-Klaim Data flow Mandatory for sending the individual claim to HPCD Repository before claim process to BPJS (Payor)

11 E-Klaim Software

12 E-Klaim Security Application is encrypted Data transfer over HTTPS Data is encrypted prior transfer (.txt format) Encryption schema: Public Key Encryption + AES 256 CBC Encryption key is generated, never stored Server ID locking for each Hospital (anti spoofing mechanism) Encrypted data is signed with Hospital ID and Server ID Offline data exchange is also encrypted Decrypt can only be done by Ministry of Health or BPJS (Payor)

13 Data Variable Describe (Individual record) 1. Hospital Code 2. Hospital Class 3. Ward Class 4. Patient Type Discharge 5. Admission Date 6. Discharge Date 7. Sex 8. Discharge Status 9. Age 10. Birth Weight (for neonates) 11. Diagnosis List ( until 29 diagnosis) 12. Procedures List (until 29 procedures) 13. Spesial CMG (Top Up payment) 14. INA-CBG Code 15. INA-CBG Tarif 16. Hospital Charge 17. LOS 18. ICU Marker 19. Ventilator Marker 20. Patient ID Card

14 HPCD Repository This system start on oktober 2016 Currently keep more than 62 million claims consist of inpatient and outpatint individual record data since October 2016 and continuing increase realtime direct from hopsitals Our Data Center is sharded into 4096 databases across 5 servers for easily manage Average individual data record/day Hospitals have access to their own data and dashboard

15 HPCD Repository Use for Monitoring and Evaluation for Policy Maker to analize performance of JKN Program (dashboard) : Equity Quality Access Data source for INA-CBG Development Tariff Setting Built new classification (Grouper) Research statistic

16 Dashboard 1

17 Dashboard 2

18 THANK YOU JAMINAN KESEHATAN NASIONAL For healthier Indonesia 18