ANALISIS BIAYA OBAT PASIEN RAWAT JALAN MELALUI SUBSTITUSI GENERIK DI RSU PKU MUHAMMADIYAH YOGYAKARTA (ANALYSIS OF OUTPATIENT\u27S DRUG COST

Abstract

ABSTRACT Background: Drug is the biggest component of health service cost in Indonesia. Thus, drug cost control through generic prescribing would increase efficiency of health service. In an effort to increase generic prescribing, PKU Muhammadiyah hospital in Yogyakarta published Administration Decision Letter No.13291E-IV/SK.3.2/11/1999 and No. 1330/E-IV/SK.3.2/11/1999, which allow the Pharmacy Instalation substitutes branded-generic to generic on patients\u27 request. Decrease of hospital revenue could be avoided by a financing scheme, which provides a financial incentive to the hospital. This study aimed to analyze drug cost of PKU Muhammadiyah hospital out patient department and design a financing scheme, which support generic substitution implementation in that hospital. This study also analyzed effectiveness of implementation of generic substitution policy in PKU Muhammadiyah hospital. Method: This study was designed as a quasi-experimental case study, analytical and explorative. Data was gathered through observing documentation and interviewing officers related to policy implementation, and also a simple survey to outpatient of PKU Muhammadiyah hospital. The reduction of drug cost caused by generic substitution was statistically analyzed using a t-test. The effectiveness of implementation of generic substitution was evaluated by assessing influence of policy on generic prescription and drug cost. Result: Result of the study showed that through generic substitution, drug cost decreased very significantly (p=0,000) from Rp 35.042,- to Rp 26.218,- and the potential saving is Rp 4.687.923,- for 531 prescription or Rp 8.824,- per prescription. The package rate based on patient\u27s ability to pay is Rp 28.800,-. The differences between drug cost and package rate could have been used as financial incentive to the hospital. Implementation of generic substitution policy at PKU Muhammadiyah hospital increased insignificantly (p=0,297) percentage of brand name substituted from 2,56% to 3,52%. But, there is no increase in percentage of using generic medicine, which even decrease insignificantly (p=0,062) from 36,22% to 31,55%. There is a significant increase (p=0,022) in prescription cost from Rp22.990,- in 1998 to Rp28.403,- in 2000. Keywords: analysis, generic substitution, hospita