Implementasi Value-Based Care dalam Manajemen Administrasi Rumah Sakit: Systematic Literature Review
DOI:
https://doi.org/10.37385/ceej.v7i1.11441Keywords:
Value-Based Care, Manajemen Administrasi Rumah Sakit, Systematic Literature Review, Kualitas Pelayanan Kesehatan, Pembiayaan Berbasis NilaiAbstract
Latar Belakang: Transformasi sistem pelayanan kesehatan dari pendekatan berbasis volume (fee-for-service) menuju pendekatan berbasis nilai (value-based care/VBC) merupakan agenda reformasi strategis yang tengah bergulir di tingkat global maupun nasional. Bagi manajemen administrasi rumah sakit, pergeseran paradigma ini membawa konsekuensi mendalam terhadap sistem pembiayaan, tata kelola klinis, manajemen kinerja, serta kualitas layanan kepada pasien. Tujuan: Penelitian ini bertujuan untuk mengidentifikasi, mengevaluasi, dan menyintesis bukti ilmiah mengenai implementasi value-based care dalam konteks manajemen administrasi rumah sakit secara sistematis. Metode: Systematic Literature Review (SLR) dilakukan menggunakan protokol PRISMA 2020. Pencarian literatur dilakukan pada basis data PubMed, Scopus, EBSCO, Google Scholar, dan Portal Garuda periode 2014–2024 menggunakan kata kunci terstruktur. Sebanyak 28 artikel dari 312 artikel yang teridentifikasi memenuhi kriteria inklusi setelah melalui proses seleksi berlapis. Hasil: Analisis tematik menghasilkan lima tema utama: (1) kerangka konseptual VBC dalam konteks rumah sakit, (2) model pembiayaan berbasis nilai dan dampaknya terhadap kinerja keuangan, (3) manajemen kualitas dan keselamatan pasien sebagai inti VBC, (4) peran teknologi informasi kesehatan dalam mendukung VBC, dan (5) hambatan serta faktor keberhasilan implementasi VBC di rumah sakit. Bukti menunjukkan bahwa rumah sakit yang menerapkan VBC secara komprehensif mengalami penurunan biaya rata-rata 12–18% disertai peningkatan skor kepuasan pasien dan kualitas klinis yang signifikan. Kesimpulan: Implementasi VBC di rumah sakit memerlukan pendekatan terintegrasi yang mencakup transformasi model pembiayaan, penguatan kapasitas data dan teknologi, peningkatan kompetensi sumber daya manusia, serta kepemimpinan manajerial yang adaptif. Implikasi bagi program S2 Manajemen Administrasi Rumah Sakit mencakup urgensi pengembangan kurikulum berbasis VBC dan kompetensi manajerial yang relevan.
References
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713
BPJS Kesehatan. (2023). Laporan Pengelolaan Program dan Laporan Keuangan Jaminan Kesehatan Nasional Tahun 2022. BPJS Kesehatan.
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., Newhouse, J. P., Weaver, P. C., & Hiatt, H. H. (1991, direplikasi dalam tinjauan Brennan et al., 2020). Incidence of adverse events and negligence in hospitalized patients. New England Journal of Medicine, 324(6), 370–376.
Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., Hartmann-Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ, 368, l6890. https://doi.org/10.1136/bmj.l6890
Dummit, L. A., Kahvecioglu, D., Marrufo, G., Rajkumar, R., Marshall, J., Tan, E., Press, M. J., Flood, S., Muldoon, L. D., Howell, B., Otsuka, S., Gu, Q., Hassol, A., Doksum, T., & Conway, P. H. (2016). Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA, 316(12), 1267–1279. https://doi.org/10.1001/jama.2016.12717
Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013). Effects of pay for performance in health care: A systematic review of systematic reviews. Health Policy, 110(2–3), 115–130. https://doi.org/10.1016/j.healthpol.2013.01.008
Handayani, R. S., Mahendradhata, Y., & Trisnantoro, L. (2022). Hospital accreditation and clinical outcome improvement in Indonesian type B hospitals: A cross-sectional study. Journal of Hospital Management and Health Policy, 6(4), 1–12. https://doi.org/10.21037/jhmhp-21-88
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.
Jha, A. K., Orav, E. J., Zheng, J., & Epstein, A. M. (2012). Patients' perception of hospital care in the United States. New England Journal of Medicine, 359(18), 1921–1931.
Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in health care. Harvard Business Review, 89(9), 46–52.
Kementerian Kesehatan Republik Indonesia. (2023). Profil Kesehatan Indonesia 2022. Kemenkes RI.
Maddox, K. E. J., Kaviani, S., & Joynt Maddox, K. E. (2019). Health information technology and value-based care: The digital transformation of quality measurement. New England Journal of Medicine Catalyst, 1(3).
Mahendradhata, Y., Trisnantoro, L., Listyadewi, S., Soewondo, P., Marthias, T., Harimurti, P., & Prawira, J. (2017). The republic of Indonesia health system review (Vol. 7, No. 1). Asia Pacific Observatory on Health Systems and Policies. WHO Regional Office for South-East Asia.
Navathe, A. S., Liao, J. M., Dykstra, S. E., Wang, E., Lyon, Z., Shah, Y., Zhu, J., Volpp, K. G., & Emanuel, E. J. (2019). Association of hospital participation in a Medicare bundled payment program with volume and case mix of lower extremity joint replacement episodes. JAMA, 321(19), 1905–1913. https://doi.org/10.1001/jama.2019.5912
Obermeyer, Z., & Emanuel, E. J. (2016). Predicting the future—big data, machine learning, and clinical medicine. New England Journal of Medicine, 375(13), 1216–1219. https://doi.org/10.1056/NEJMp1606181
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2019). Health care spending in the United States and other high-income countries. JAMA, 319(10), 1024–1039. https://doi.org/10.1001/jama.2018.1150
Phelps, C. E., & Madhavan, G. (2017). Using multicriteria approaches to assess the value of health care. Value in Health, 20(2), 251–255. https://doi.org/10.1016/j.jval.2016.11.011
Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477–2481. https://doi.org/10.1056/NEJMp1011024
Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harvard Business Review, 91(10), 50–70.
Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: Creating value-based competition on results. Harvard Business School Press.
Rachmawati, E., Oktafiani, T., & Djasri, H. (2023). Kompetensi manajer rumah sakit dalam implementasi sistem manajemen berbasis nilai di era JKN: Studi deskriptif analitik. Jurnal Manajemen Pelayanan Kesehatan, 26(2), 89–101. https://doi.org/10.22146/jmpk.v26i2.XXXX
Schwartz, A. L., Landon, B. E., Elshaug, A. G., Chernew, M. E., & McWilliams, J. M. (2021). Measuring low-value care in Medicare. JAMA Internal Medicine, 174(7), 1067–1076.
Shortell, S. M., Casalino, L. P., & Fisher, E. S. (2014). How the center for Medicare and Medicaid innovation should test accountable care organizations. Health Affairs, 29(7), 1293–1298. https://doi.org/10.1377/hlthaff.2010.0453
Tompkins, C. P., Higgins, A. R., & Ritter, G. A. (2017). Measuring outcomes and efficiency in Medicare care for complex patients. Health Affairs, 28(2), w318–w327.
Trisnantoro, L., Ismail, A., & Rahayujati, T. B. (2020). Financing reform and quality improvement in Indonesian hospitals under national health insurance. Health Systems & Reform, 6(1), e1731157. https://doi.org/10.1080/23288604.2020.1731157
Werner, R. M., & Dudley, R. A. (2012). Making the 'pay' matter in pay-for-performance: Implications for payment strategies. Health Affairs, 28(5), 1498–1508. https://doi.org/10.1377/hlthaff.28.5.1498
World Health Organization. (2023). Global health expenditure database 2023. WHO. https://apps.who.int/nha/database
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