• Document: Health care Provider Claim Data (HPCD) Repository
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  • Uploaded: 2019-03-14 02:34:36
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Health care Provider Claim Data (HPCD) Repository Center for Health Financing and Health Security National Casemix Center Ministry of Health Indonesia Indonesia in brief  An archipelago between Asia and Australia, 17504 islands with 5 big islands: Java, Sumatra, Kalimantan, Sulawesi and Papua  Population (2010) : 237.641.326 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 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 • 2.218 hospitals and Specialist Clinic have been implemented INA- CBG system (September 2017) both Private (voluntary) and Public 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 JKN Contracted Health Care Providers Primary health care Secondary & No Total No tertiary health care Total providers providers 1. Gov Health center 9,841 1. Hospital 2,025 2. Private Clinic 5,471 2. Specialist Clinics 193 4. Private practice 4,568 Total 2,218 5. Specific health center 13 (RS Pratama) 6. Dentist private practice 1,160 TotTotal 21,053 Source: BPJS Kesehatan, Sept 2017 HPCD Repository (Hospitals and Specialist Clinic Provider) 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) E-Klaim & HPCD Repository Schema E-Klaim Software • MoH Develop Standalone webbase Already Installed in application Hospital Contracted JKN • 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 E-Klaim Data flow Mandatory for sending the individual claim to HPCD Repository before claim process to BPJS (Payor) E-Klaim Software 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) Data Variable Describe (Individual record) 1. Hospital Code 11. Diagnosis List ( until 29 diagnosis) 2. Hospital Class 12. Procedures List (until 29 procedures) 3. Ward Class

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