Today, the demand for health service which is consistent, high qualified with the most effective way, affordable, and accountable is getting stronger. For public hospitals, health care cost control often becomes a problem that is quite burdening in the midst of intense competition with private hospitals and clinics. In the long run, this problem is feared to burden the state hospital’s budget heavily.
"Frequently, the public hospital management complains about the total cost of handling a specific diagnosis that is often different for each doctor, and often greater than the Askes (Health Insurance Agency) stipulation, thus potentially harming public hospital when submitting a claim to Askes,” dr. F.L. Parluhutan Sitorus, M. Kes., said in an open examination of Doctoral Program of Medicine and Health, UGM Graduate School, Thursday (27/10), at Faculty of Medicine.
The Health Office Head of Toba Regency in Samosir delivered that there are many cases of patients with varied services on doctor's behavioral differences in giving prescription and medical investigations that led to the payment amount for each case tending to be high. In addition, the length of stay (LOS), the slow process of administration, and the slow handling of patients are the issues most raised by the patients.
Sitorus said, citing Muller et al (2008), the implementation of clinical pathways is an approach that can be used in the rationalization of costs without reducing quality. This method is a model of health service management which has been widely applied by hospitals in various regions in the world. In 2003 it was reported that as many as 80% of hospitals in the United States have implemented clinical pathways.
From the research results presented in the dissertation entitled "The Effect of Implementation of Clinical Pathways to Service Efficiency in Dr. Djasamen Saragih Hospital of Pematang Siantar, a decrease in costs due to the decline of hospital length of stay (LOS) is seen, but the supporting medical cost increases significantly after the implementation of clinical pathways. The increase occurs in all components of medical support. The increase is more due to adherence to clinical pathways than excessive symptoms.
Before the implementation of clinical pathways, Sitorus continued, that routine blood/ urine check-up which is a must for patients with suspected infections has become a policy in Dr. Djasamen Saragih Hospital of Pematang Siantar. For reasons that are less known, there are still many doctors being reluctant to order this type of laboratory examination.
"After the implementation of clinical pathways, in addition to other diagnostic supports that have been listed mandatory in clinical pathways algorithm, routine blood/ urine check-up becomes more mandatory. This explains the increase in the use of routine blood/ urine medical supports," he explained.