Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
4,
N
o
.
4
,
D
ecem
b
er 20
1
5
, pp
. 28
8~
29
3
I
S
SN
: 225
2-8
8
0
6
2
88
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Strok
e
T
r
eatm
ent Cost Analysis
f
o
r Consi
d
eration
on Heal
th
Cost Determination Using INA- CBGs
I
n
g
e
n
i
da
Ha
dn
in
g
1
, Z
u
llies Ika
w
ati
2
, Tri
Murti Anda
yani
2
1
School of Phar
macy
, Faculty
of
Medi
cine and
Health Sciences,
Muhammadi
y
a
h
Yog
y
ak
arta University
, Indonesia
2
Faculty
of Phar
macy
, Gad
j
ah
Mada Univ
ersity
, I
ndonesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Aug 16, 2015
Rev
i
sed
No
v
19
, 20
15
Accepted Nov 25, 2015
Indonesian Cas
e
Based Groups (INA-
CB
Gs)
implementation on hospital
financing for stroke patien
t
using
Jamin
an Kesehatan Masyarakat
(J
am
kes
m
as
) at 3
rd
class hospitalization
requir
e
s ther
ap
y
plan managemen
t
and cos
t
anal
ys
i
s
becaus
e
s
t
roke
is
a leading c
a
u
s
e of death worl
dwide and
need high
treatment cost. I
t
is
puIDR
osed to skim
p the hospita
l expend
itur
e
and avoid deficit suffering. Th
e stud
y
obje
c
ti
ves was to determ
ine the
s
u
itabil
i
t
y
cos
t
b
e
tween re
al s
t
ro
ke trea
tm
ent cos
t
and heal
th fina
ncing bas
e
d
on INA-CBGs,
and to determine th
e
highest cost component on stroke
trea
tm
ent at J
ogja hos
pital
.
Thi
s
cr
oss
sectional observation
a
l
stud
y
used
retrospective sampling method. The s
ubjects
were taken fro
m all stroke
patient popu
lation using Jamkesmas in
surance at Jogja Hospital, w
e
re
hospitalized between Januar
y
2
011
- April 2012 and met the inclusion
crit
eria
. Th
e s
ubjec
t was
then
clas
s
i
fi
ed bas
e
d
on INA-CBGs. P
a
ti
ent’s
length of stay
and costs (direct medical
and dir
ect non-medical costs) were
defined
as stud
y
variab
le. Data
was an
aly
s
ed us
ing descriptive
analy
s
is and
Mann Whitney
test. Throuh
this
stud
y
we
conclu
de the
aver
age r
a
te of r
e
al
stroke tre
a
tm
ent
cost at Jogj
a Hospital was high
er insignif
i
can
tl
y th
an INA-
CBGs based cost and the highest treat
ment
cost was on the medicine and
m
e
dical
equ
i
pm
ent.
Keyword:
Com
o
rbid fact
or
Co
st An
alysis
IN
A-CB
Gs
Length of
stay
Stroke
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
In
ge
ni
da Ha
dn
i
ng,
School of
Pharmacy,
Mu
h
a
mm
ad
iya
h
Yog
y
ak
arta Un
i
v
ersity,
Jalan
Lingk
ar
Selatan
Tam
a
n
tirto
Kasi
h
a
n B
a
n
t
u
l
,
In
don
esia.
Em
a
il:
i
ngeni
d
a
.ha
dni
ng
@
g
m
a
i
l
.
com
1.
INTRODUCTION
Stroke
was a
major
disease
cause
d of deat
h in the
worl
dwide a
nd t
h
e t
h
ird leading ca
use
of
death i
n
the United Sta
t
es after hea
r
t disease and all cancers
.
St
r
o
k
e
was o
ccu
red
i
n
m
o
re t
h
an
70
0,
0
00
pe
opl
e pe
r
year with
15
0,0
0
0
m
o
rtality
rate [1
]. Strok
e
was th
e "e
xp
en
siv
e
"
d
i
sease as th
e p
a
tien
t
o
f
ten
requ
ired
furth
e
r
treat
m
e
n
t
an
d lo
ng-term
reh
a
b
ilitatio
n
.
Th
is b
ecau
s
e a st
rok
e
co
u
l
d
cau
s
e ph
ysical and
men
t
al d
i
sab
ility d
u
e
t
o
ne
ur
ol
o
g
i
c
a
l
dam
a
ge as
a resul
t
o
f
ac
ut
e i
n
t
e
rr
u
p
t
i
o
n o
f
cere
b
ral
bl
o
od
fl
o
w
due t
o
occl
us
i
on
or
h
e
m
o
rrh
ag
e [2]-[4
]. In
200
0,
p
a
tien
t
s with
strok
e
in
th
e Un
ited
States were sp
en
t 3
0
b
illio
n
US do
llars
for
treatm
e
nt [5]. Stroke’s
pat
i
ent was ofte
n receive
d
polypha
rm
acy
because m
o
st of them
als
o
ha
d
com
p
lications or com
o
rbi
d
disease [2],
[6].
2.
Vari
ous st
r
o
ke
t
r
eatm
e
nt
gui
del
i
n
es we
re l
e
d t
o
t
h
e va
ri
o
u
s
cost
s t
o
be p
a
i
d
by
t
h
e st
ro
ke pat
i
e
nt
o
r
st
ro
ke pat
i
e
nt
'
s
fam
i
l
y
or t
h
e i
n
su
rance
.
I
f
t
h
e dr
ug
’s
han
d
l
i
ng
or sel
ect
i
o
n
was i
m
prope
r,
t
h
en i
t
wo
ul
d
l
ead
th
e p
a
tien
t
into
lon
g
e
r
ho
sp
italizatio
n
or go
t m
o
re co
m
p
licatio
n
s
d
i
sease then
wou
l
d m
a
k
e
h
i
gh
er
hos
pi
t
a
l
i
zat
i
o
n
expe
nses
. Th
e am
ount
of s
t
ro
ke t
r
eat
m
e
nt
cost
was i
n
f
l
uence
d
by
t
h
e t
y
pe of
use
d
d
r
u
g
thera
p
y, type of give
n m
e
dica
l proce
d
ure by medical st
aff, medical tea
m
c
a
pability in diagnose accurac
y
and
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
S
t
ro
ke Trea
tmen
t Co
st
Ana
l
ysis fo
r C
o
n
s
id
era
tio
n on
H
e
a
lth
C
o
st D
e
term
i
n
a
tion
.... (In
gen
i
da
H
adn
ing)
28
9
rapi
dity, as
we
ll as the a
d
here
nce
of m
e
dical staf t
o
t
h
e
cl
i
n
i
cal
pat
h
way
s
t
h
at
have
be
en
pre
v
i
o
usl
y
a
p
p
r
o
v
e
d
b
y
th
e
ho
sp
ital.
B
a
sed
on
Ke
p
u
t
u
sa
n M
e
nt
er
i
Kesehat
a
n
N
o
m
o
r 9
89/
M
e
nke
s/
SK/
I
X/
2
0
0
7
,
t
h
e
Fi
na
nc
i
ng
Sy
st
em
usi
n
g
IN
A
-
DR
Gs
(I
nd
o
n
esi
a
Di
ag
no
si
s R
e
l
a
t
e
d G
r
ou
ps
)
pa
ckage
sy
st
em
was a
p
pl
i
e
d
on
1st
J
u
l
y
2
0
0
8
fo
r t
h
e
m
e
m
b
er o
f
Ja
m
i
nan K
e
sehat
a
n M
a
sy
ara
k
at
(Jam
kesm
as) [7]
.
At
t
h
e
en
d
of
2
0
1
0
,
t
h
e
r
e
was a
re
pl
ace
m
e
nt
o
f
usi
n
g s
o
ft
war
e
gr
o
upe
r f
r
o
m
INA
-
DR
Gs
t
o
I
N
A
-
C
B
G
s (I
n
d
o
n
esi
a
C
a
se B
a
sed
Gr
ou
ps
) [
8
]
.
B
y
t
h
e
im
pl
em
ent
a
t
i
o
n o
f
I
N
A
-
C
B
G
s o
n
t
h
e h
o
s
pi
t
a
l
fi
nanci
n
g f
o
r
3r
d cl
ass pat
i
e
nt
s, t
h
e cost
anal
y
s
i
s
o
f
h
o
s
p
italized
treat
m
e
n
t
fo
r
p
a
t
i
en
ts with
strok
e
was n
e
ed
ed
in
treatm
e
n
t
p
l
an
thu
s
th
e ho
sp
ital co
u
l
d
m
a
k
e
cost
savi
n
g
s a
nd
di
dn
’t
get
a
n
y
fi
nanci
a
l
l
o
st
.
T
h
e co
st
anal
y
s
i
s
gav
e
a be
nefi
t
i
n
t
e
rm
of cl
aim
subm
i
ssi
on t
o
t
h
e
heal
t
h
i
n
su
ra
nc
e an
d
pr
o
v
i
d
e
d
p
r
oper treatm
e
nt for the
patie
nts
based on t
r
eatm
e
nt cost list.
Th
e stud
y objectiv
es was to d
e
term
in
e th
e su
itab
ility co
st b
e
tween
t
h
e
strok
e
’s
real co
st th
eraph
y
and
heal
t
h
fi
na
nci
n
g ba
sed
o
n
IN
A-C
B
Gs, a
nd t
o
det
e
rm
i
n
e t
h
e hi
g
h
est
c
o
st
com
p
o
n
ent
on st
ro
ke t
r
eat
m
e
nt
at Jog
j
a ho
sp
ital.
2.
R
E
SEARC
H M
ETHOD
Thi
s
c
r
os
s sect
i
onal
ob
ser
v
at
i
onal
st
u
d
y
use
d
r
e
t
r
o
s
pe
kt
i
f
sam
p
l
i
ng m
e
t
hod
w
h
i
c
h
t
h
e
s
u
b
j
ect
was
t
a
ken
fr
om
al
l st
ro
ke
pat
i
e
nt
po
p
u
l
a
t
i
on
w
ho
use
d
Jam
k
esm
a
s at
Jogja
Ho
spi
t
a
l
an
d
were
h
o
spi
t
a
l
i
zed o
n
Janu
ary 201
1-April 20
12
and
m
e
t with
th
e in
clu
s
ion
crite
ria. The i
n
clus
ion c
r
iteria of
the study were
acute
stroke
patient
with Jam
k
esmas m
e
m
b
ership and
with
dia
g
nosis
code
I619
for i
n
tracere
b
ral
hem
o
rrha
ge, I639
fo
r cere
b
ral inf
a
rction
,
a
nd
I
6
4 f
o
r n
o
t s
p
ecific stro
ke
be
t
w
een haem
orrha
g
i
c
st
r
oke an
d st
ro
ke
i
n
farct
i
o
n, i
n
m
a
l
e
or fem
a
l
e
, wi
t
h
cl
i
n
i
cal
di
ag
no
se st
r
o
k
e
cause
d ne
ur
o
l
ogi
c de
fi
ci
t
s
and cl
assi
fi
ed i
n
t
h
e sam
e
di
agnosi
s
.
The excl
usion criteria were referred ac
ute stroke patient
with
Ja
m
k
es
m
a
s
m
e
m
b
ersh
ip
or retu
rn
to
d
i
sch
a
rg
e
with decease
d
status
or discharg
e
with no
physician c
onse
n
t.
The subject then was classified
usi
n
g I
N
A
-
C
B
G
s. Pat
i
e
nt
’
s
l
e
ngt
h o
f
st
ay
and cost
s (di
r
ect
m
e
di
cal
cost
s an
d
di
rec
t
no
n-m
e
di
cal
cost
s)
were
de
fi
ne
d as st
udy varia
b
le. Medi
cal record
re
vi
ew at hospital aim
e
d
at de
m
ogra
p
hy characteristic data collection suc
h
as patie
nt
nam
e
,
m
e
di
cal recor
d
n
u
m
b
er, age, sex, length
of
st
ay
du
ri
n
g
h
o
s
pi
t
a
l
i
zat
i
on (
d
at
e and t
i
m
e of
adm
i
ssi
on an
d
di
scha
r
g
ed
),
d
a
t
e
and t
i
m
e of
st
ro
ke
on
set
,
s
t
ro
ke
risk
factors, previous m
e
dication,
n
u
rsi
n
g
r
ecor
d
,
an
d la
b
o
rat
o
rium
resu
lts. All data
w
e
re rec
o
rde
d
i
n
case
rep
o
rt
fo
rm
. St
ro
ke t
r
eat
m
e
nt
cost
t
r
aci
ng
was ba
sed
o
n
pat
i
e
nt
m
e
di
cal
recor
d
. C
o
st
of m
e
di
cat
i
ons
and
medical equipments were traced fr
om
hos
pital pharm
aceutical department
, while
m
e
dical procedure cost,
n
u
rsing
co
st, ad
d
ition
a
l ex
amin
atio
n
co
st
(l
ab
oratoriu
m
,
ph
ysio
th
erap
y,
an
d nu
trition
)
, ad
m
i
n
i
stratio
n
co
st,
and hos
p
italization c
o
st
were t
r
aced from
finance a
n
d adm
i
nistration depa
rtm
e
nt.
Data collected from
patient medical record and fr
om
pat
i
e
nt
t
r
eat
m
e
nt
cost
t
r
aci
n
g
wer
e
pr
ocesse
d
and
anal
y
s
e
d
a
ccor
d
i
n
g t
o
t
h
e
f
o
l
l
o
wi
ng
anal
y
s
i
s
m
e
t
hods:
Descri
pt
i
v
e a
n
al
y
s
i
s
was
do
n
e
t
o
det
e
rm
i
n
e t
h
e
hi
g
h
est
c
o
s
t
com
pone
nt
o
n
st
r
o
ke t
r
eat
m
e
nt
at
J
o
gja
h
o
s
p
ital.
Treatm
e
n
t
co
st su
itab
ility an
alysis o
f
INA-CBGs-
b
a
sed
strok
e
treatm
e
n
t
co
st was con
d
u
c
ted
by
com
p
aring a
n
a
l
ytical treatm
e
nt cost
with
INA-CBGs-base
d costs. Data an
alysis with
Man
n
Wh
it
n
e
y test was
d
o
n
e
fo
r con
tin
uou
s v
a
riab
le th
at h
a
s b
een
p
r
o
cessed
in
descrip
tiv
e an
al
ysis. Th
is an
alysis will
th
en
u
s
ed
to
seek t
h
e signifi
cant cost disc
repancy
betwe
e
n
real
st
r
oke
t
r
eatm
e
nt
and
I
N
A
-
C
B
G
s
-
ba
s
e
d.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Str
o
ke P
a
ti
ent
Ch
ar
acteri
s
t
i
c
a
t
Jo
gj
a
Ho
s
p
i
t
al
During
Janu
ary 2
011
–
April 20
12
t
h
ere
were 67
strok
e
p
a
tien
t
s at Jog
j
a
Ho
sp
ital who
fu
lfilled
the
inclusion c
r
iteria. The
r
e
were
6
patients
with c
ode
I6
19 (Intracere
b
ral
He
m
o
rrhage
), 15
patients wit
h
code
I6
3
9
(C
ere
b
ral
Infa
rct
i
o
n), a
n
d 4
6
pat
i
e
nt
s
wi
t
h
co
de I
64
(U
ns
peci
fi
ed S
t
ro
ke). St
ro
ke
pat
i
e
nt
charact
eri
s
t
i
c
can be
see
n
on the
Ta
ble
1.
Tab
l
e
1
.
Strok
e
Patien
t
Ch
aracteristic with
Jam
k
es
m
a
s
me
mb
ersh
ip at Jo
gja Ho
sp
ital
d
u
rin
g
Janu
ar
y 2
011
–
Ap
r
il 2
012
Characteristics
Intracerebral He
m
o
rrhag
e (I619)
Cerebral
Infarction (I
639)
Unspecified Strok
e
(I64)
(n
=6
) %
(n
=1
5
)
%
(n
=4
6
)
%
Sex:
M
a
le 6
100
5
33.
3
20
43.
5
Fem
a
le 0
0
10
66.
7
26
56.
5
Age :
≤
55 y
e
ar
s of age
3
50
5
33.
3
17
37
> 55 y
e
ar
s of age
3
50
10
66.
7
29
63
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
288 – 293
29
0
Most of stroke patient with diagnosis code of
I619 (Intracerebral
He
m
o
rrhage
)
, I639 (Cere
b
ral
In
farctio
n)
, a
n
d I
6
4 (
U
nspeci
fied St
ro
ke)
w
e
re age
d
5
5
. T
h
e ris
k
of st
roke might increa
s
e
2 tim
es after age
55
[9].
At the el
de
rly group, the
risk
of hype
rtension
i
n
creas
es because
the
bl
ood vessels be
com
e
m
o
re
rigid
and
less elastic
[10], whereas the
hype
rtensi
on is
the
m
o
st im
po
rtant risk fact
or
of st
r
oke
[1
1
]
,[1
2
]
.
Acco
r
d
i
ng t
o
the
res
u
lt of stroke patient’s
case
study
wit
h
ce
rebral
in
fa
rction
(
I
6
3
9
)
a
n
d
n
o
n
-s
pecifi
c stro
ke c
a
ses
(I
64
),
it
has b
een
k
n
o
w
n t
h
at
fem
a
le has hi
g
h
er st
ro
ke
pre
v
alenc
e
s than m
e
n (66.7% an
d 56.5%). T
h
e condition is
i
n
fl
ue
nce
d
by
t
h
e i
n
cream
ent
of
hy
pe
rt
en
si
on ri
s
k
i
n
wom
e
n greater
than m
e
n
by their inc
r
easing age.
Prem
enopa
use
wom
e
n tend
to ha
ve
hi
ghe
r blood
pres
su
re than m
e
n because t
h
ey are infl
uence
d
by the
red
u
ct
i
o
n
of e
s
t
r
o
g
en
l
e
vel
i
n
m
e
nopa
use
pe
r
i
od
[
10]
.
One
of t
h
e
factors
affecting t
h
e leng
t
h
of
stay in ac
ute isc
h
em
ic stroke
patients was
age of
65 years
or m
o
re [
1
3]
.
An
ot
he
r st
udy
st
at
ed an i
n
cre
a
se of
l
e
n
g
t
h
o
f
st
ay
i
n
di
a
b
et
i
c
pat
i
e
nt
s wi
t
h
t
h
e a
g
e
of
6
0
y
ears
o
r
m
o
re, and
a
d
ecrease of leng
th
of stay in
fe
m
a
le p
a
tien
t
s [14
]
.
3.
2.
Cos
t
s
An
aly
s
is Based
o
n
I
N
A-
CBGs
The am
ount of INA-CBGs c
o
sts decide
d
by the gove
rnm
e
nt varies fo
r each diagnosis coding and is
affect
ed
by
t
h
e
di
sease se
ve
ri
t
y
.
Whi
l
e
di
ag
n
o
si
s c
ode i
s
de
t
e
rm
i
n
ed
by
h
o
s
pi
t
a
l
’
s co
di
ng
of
fi
cer,
I
N
A
-
C
B
G
s
code
an
d t
h
e di
sease seve
ri
t
y
was cal
cul
a
t
e
d
by
I
N
A
-
C
B
G
s
ow
ne
d
by
Jam
k
esm
a
s cent
r
al
m
a
nagem
e
nt
. IN
A-
C
B
G
s co
de de
t
e
rm
i
n
at
i
on i
s
do
ne o
n
co
nc
or
da
nce wi
t
h
t
h
e p
r
i
m
ary
diagn
o
si
s co
de,
seco
nda
ry
di
a
g
n
o
si
s
code
, m
e
di
cal
pr
oce
d
u
r
es,
an
d l
e
n
g
t
h
o
f
st
a
y
. Th
ose
vari
a
b
l
e
s are
i
n
put
by
h
o
s
p
i
t
a
l
co
di
n
g
of
fi
cer al
on
g
wi
t
h
Jam
k
esm
a
s report
i
n
g i
n
eac
h
day
t
h
r
o
u
g
h
h
o
s
pi
t
a
l
-
o
w
ne
d I
NA C
B
G
s so
ft
ware
[1
5]
-[
1
7
]
.
The ave
r
a
g
e cost
o
f
patient care
ba
sed
on the
ave
r
age length
of st
ay can
be see
n
on Ta
ble 2.
Tabel
2. T
h
e
a
v
era
g
e c
o
st
of
pat
i
e
nt
care
ba
sed
o
n
t
h
e
ave
r
age length of st
ay with
J
a
mk
e
s
ma
s
m
e
mb
e
r
s
h
i
p
a
t
Jo
gj
a Ho
sp
ital d
u
r
i
ng
Janu
ar
y
20
11
–
Ap
r
il
20
12
Real Cost
Intracerebral He
m
o
rrhag
e (I619)
Cerebral
Infarction (I
639)
Unspecified Strok
e
(I64)
L
e
ngth of Stay
P
L
e
ngth of Stay
p
L
e
ngth of Stay
p
< 9.
5
Days
≥
9.
5
Days
< 8.
5 Day
s
≥
8.
5
Days
< 7.
5 Day
s
≥
7.
5
Days
Mean
(IDR)
2,
189,
89
1
6,
799,
94
8
0,
042
3,
271,
20
8
4,
921,
04
2
0,
014
2,
488,
25
6
4,
666,
39
3
0,
000
DS (I
DR)
214,
69
7
283,
79
7
598,
07
1
1,
443,
71
8
897,
98
6
2,
812,
38
4
The
relation be
tween t
h
e le
ngth of
stay and t
r
eat
m
e
nt cost was a
n
alysed using Spearm
a
n correlati
on
t
e
st
.
The
t
e
st
m
e
t
hods
we
re cho
o
se
n beca
u
s
e
t
h
e dat
a
we
re not
n
o
rm
al
ly
di
st
ri
b
u
t
e
d
.
B
a
sed on
S
p
e
a
rm
an
anal
y
s
i
s
st
roke
wi
t
h
di
ag
no
se
code I
6
19 (
I
nt
ercere
b
ral
He
m
o
rrhage
)
ha
d
p val
u
e o
f
0,
0
42 (
p
<
0
,
0
5),
di
agn
o
s
e
code
I
6
3
9
(C
e
r
ebral
I
n
farct
i
o
n)
wi
t
h
p val
u
e of
0,
0
14
(p<
0
,
0
5
)
, a
n
d di
a
g
nos
e co
de I
6
4
(U
ns
peci
fi
ed
S
t
ro
ke)
with
p
v
a
lu
e o
f
0
,
0
0
0
(p
<0
,0
5).
Tho
s
e d
i
agn
o
se
cod
e
s h
a
ve po
sitif co
rrelatio
n
co
efisien, and
i
t
can
b
e
concl
ude
d t
h
at there is a
posi
tive co
r
r
el
at
i
o
n
bet
w
ee
n t
h
e l
e
ngt
h
of st
ay
a
n
d
t
r
eat
m
e
nt
cost
w
h
i
c
h
m
e
ans t
h
e
l
o
n
g
er
t
h
e
pat
i
e
nt
st
ay
t
h
e
hi
g
h
er
t
r
eat
m
e
nt
cost
w
o
ul
d
be
[
13]
,
[
1
8
]
,
[
1
9]
.
Det
a
i
l
s
of
t
h
e a
v
era
g
e t
r
eat
m
e
nt
cost
of
st
r
oke
pat
i
e
nt
s c
onsi
s
t
e
d
of
di
re
ct
m
e
di
cal
and
no
n
-
m
e
di
cal
cost
s as seen i
n
Tabl
e 3
.
The g
r
eat
est
com
pone
nt
s of
st
ro
ke t
r
eat
m
e
nt
cost
fr
om
al
l
t
h
e
di
ag
no
st
i
c
co
d
e
s we
re m
e
di
ci
ne c
o
st
a
n
d
m
e
di
cal
eq
ui
pm
ent
c
o
st
(
I
D
R
1,
00
2,
9
9
1
t
o
I
D
R
3,
08
6,
9
4
8
or
3
5
-
48
%), O
2
se
rv
i
ce fee (
I
DR
20
7,
6
00 t
o
I
D
R
97
2,
0
00
o
r
7-
1
7
%)
, an
d
n
u
rsi
ng
cost
(I
DR
2
1
0
,
2
5
0
t
o
I
D
R
1
,
0
7
4
,
00
0
or
9-
15
%)
,
The c
o
st
s
o
f
m
e
di
ci
ne a
n
d m
e
di
cal
eq
ui
pm
ent
,
O
2
se
rvice
,
nursing we
re
a
ffected by
the
accuracy of
d
i
agn
o
sis, tr
eat
m
en
t selectio
n
,
and
strok
e
co
m
o
r
b
id
ities
f
acto
r
s [13
]
, [1
8
]-[2
0
]
. Tho
s
e f
actor
s t
h
en w
ill
d
i
rectly affect t
h
e
p
a
tien
t
’s leng
th
of stay
and treatm
e
nt cost as seen on
Table 2.
Oth
e
r st
u
d
i
es
h
a
v
e
con
c
lud
e
d
th
at th
e leng
th
o
f
stay for isch
em
ic stro
k
e
p
a
tien
t
in
Sardj
ito
Ho
sp
ital
was affe
cted b
y
stroke seve
ri
ty
[18]
. The di
ffe
rence in le
ngth of stay of gene
ral diseas
e was affecte
d
by the
disease se
verit
y
and c
o
m
o
rbi
d
fact
or s
u
c
h
as myocar
d
i
al in
farction
and
co
ng
estiv
e h
e
art
failu
re [1
9
]
,[21
]-
[2
3]
. S
o
m
e
fact
ors t
h
at
m
i
ght
l
e
ngt
he
n t
h
e ho
spi
t
a
l
i
zat
ion
o
f
acut
e
i
s
chem
i
c
st
roke
pat
i
e
nt
s we
re
di
abet
es
mell
itu
s, atrial
fib
r
illatio
n, type of strok
e
, st
ro
k
e
treatm
e
n
t
, an
d stro
k
e
relap
s
[13
]
.
The st
r
oke t
h
e
r
apy
cost
s f
o
r al
l
di
agno
se code
s at
Jo
gj
a Ho
sp
ital are no
t o
n
l
y affe
cted by the type
and
n
u
m
b
er o
f
d
r
ugs
use
d
b
u
t
al
so a
ffect
e
d
by
ot
he
r a
d
di
t
i
onal
m
e
di
cat
i
ons t
o
t
r
eat
t
h
e st
r
oke
co
m
o
rbi
d
fact
or
s. T
h
e m
o
re
t
y
pe
of
d
r
u
g
s
use
d
fo
r st
r
oke
t
r
eat
m
e
nt
the
hi
g
h
er
t
h
e t
r
eat
m
e
nt
cost
sho
u
l
d
be
. M
o
r
e
ov
e
r
,
the m
o
re com
o
rbi
d
fact
ors
the
highe
r
the
trea
t
m
en
t co
st shou
ld
b
e
as
well [1
3
]
,[18
]-[20
].
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
S
t
ro
ke Trea
tmen
t Co
st
Ana
l
ysis fo
r C
o
n
s
id
era
tio
n on
H
e
a
lth
C
o
st D
e
term
i
n
a
tion
.... (In
gen
i
da
H
adn
ing)
29
1
Table
3.
Details of
Direct Me
dical and
Non-Medi
cal
Cost Stroke Patient Treatm
e
nt
with
Jam
k
es
m
a
s
Me
m
b
er
sh
i
p
Cost Variable
Intracerebral He
m
o
rrhag
e (I619)
Cerebral
Infarction (I
639)
Unspecified Strok
e
(I64)
Real cost
Real cost (
I
DR.
)
Real cost (
I
DR.
)
< 9.
5 Day
s
≥
9.
5 Day
s
< 8.
5 Day
s
≥
8.
5 Day
s
< 7.
5 Day
s
≥
7.
5 Day
s
Mean
(IDR)
%
Mean
(IDR)
%
Mean
(IDR)
%
Mean
(IDR)
%
Mean
(IDR)
%
Mean
(IDR)
%
Direct Medical Co
st
Visit
fee
165,
00
0
7
455,
00
0
7 211,
42
9
6
418,
75
0
8
181,
73
6
7
431,
90
5
9
Electro
m
e
dic
Diagnostic
-
-
-
-
650,
00
0
19
385,
50
0
8
352,
50
0
13
22,
000
1
L
a
bor
ator
y
analysis
118,
62
5
5
138,
25
0
2 149,
50
0
4
190,
81
3
4
153,
40
0
6
183,
88
1
4
Rehabilitation
me
d
i
c
-
-
156,
50
0
2 61,
875
2
112,
75
0
2
59,
400
2
114,
78
1
2
O
2
Ser
v
ice
376,
65
0
17
972,
00
0
14
413,
49
0
12
707,
40
4
14
207,
60
0
7
470,
80
0
10
Nur
s
ing 210,
25
0
9
1,
074,
00
0
15
328,
00
0
9
574,
87
5
11
275,
63
2
10
520,
14
3
11
Radiology
53,
000
2
53,
000
0,
8
53,
000
2 53,
000
1
58,
600
2 64,
316
1
M
e
dicine,
m
e
dical eq
1,
002,
99
1
44
3,
086,
94
8
44
1,
239,
28
9
35
2,
055,
45
1
40
1,
165,
88
8
42
2,
302,
66
5
48
Nutr
ition
94,
875
4
328,
50
0
5 104,
42
9
3
183,
43
8
4
84,
560
3
178,
78
6
4
Direct Non Medical Cost
Roo
m
180,
00
0
8 640,
00
0
9 245,
71
4
7
415,
00
0
8
198,
40
0
7
396,
19
0
8
Am
bulance
60,
000
3 60,
000
1 60,
000
2
72,
000
1
60,
000
2
72,
000
2
T
o
tal 2,
261,
39
1
6,
964,
19
8
3,
516,
72
6
5,
168,
97
9
2,
797,
71
6
4,
757,
46
7
As seen
on Ta
ble 4, the m
o
st co
mm
on com
o
rbid fact
or
in
str
o
k
e
, in
d
i
ag
no
sis cod
e
of
I
619
, I63
9
,
and
I
6
4
was
h
y
p
ert
e
nsi
o
n
(
8
3.
3%,
9
3
.
3
%,
and
7
3
.
9
%
)
.
It
was c
o
nsi
s
t
e
nt
wi
t
h
t
h
e
t
h
e
o
ry
st
at
i
ng
hy
pe
rt
ensi
o
n
were the m
o
st com
m
on com
o
rbid
f
actors in ischem
ic stroke as well as in he
m
o
rrhagic st
roke
[
2
],[
1
8
]
,
[
22
],
[24
]
.
Tabl
e
4.
St
ro
ke
com
o
rbi
d
fact
ors
o
f
Jam
k
es
m
a
s
m
e
m
b
ersh
i
p
at
J
o
g
j
a
H
o
s
p
i
t
a
l
du
ri
n
g
J
a
nua
ry
20
1
1
–
Ap
ri
l
2
012
Co
m
o
rbid Fa
ctors
Intracerebral He
m
o
rrhag
e (I619)
Cerebral
Infarction (I
639)
Unspecified Strok
e
(I64)
(n
=6
) %
(n
=1
5
)
%
(n
=4
6
)
%
Hy
per
t
ension
5
83.
3
14
93.
3
34
73.
9
Diabetes M
e
llitus
4
26.7
10
21.7
Dyslipide
m
ia
6
13.0
Sepsis
2
4.
4
Ver
tigo/m
i
gr
ain
3
50.
0
9
19.
6
Car
d
iac pr
oblem
1
6.
7
1
2.
2
Depr
ession
2
13.
3
Seizur
e
2
13.
3
2
4.
4
Hyp
e
rten
sion
mig
h
t
cau
se in
tracran
ial v
e
ssel ru
p
t
u
r
e
o
r
b
eco
m
e
sten
otic. Th
e rup
t
ur v
e
ssel will
cause intrac
ranial hae
m
orrha
g
e, but
wh
en
the th
e v
e
ssel b
e
co
m
e
sten
o
tic
it
mig
h
t
d
i
stu
r
b
in
tracran
ial b
l
oo
d
fl
o
w
an
d, e
v
e
n
t
u
al
l
y
, b
r
ai
n
cel
l
u
l
a
r deat
h
.
M
o
re
ove
r, t
h
e ri
se i
n
bl
oo
d p
r
ess
u
re m
i
ght
fa
st
er t
h
e
pl
aq
ue
fo
rm
ati
on
pr
o
cess, e
n
d
o
t
h
el
i
a
l
l
a
y
e
r dam
a
ge, a
n
d fi
nal
l
y
pl
aq
ue w
o
ul
d b
e
p
r
o
n
e t
o
ru
pt
u
r
e a
n
d
causes
th
ro
m
b
u
s
. Thro
m
b
u
s
th
en
will o
cclu
d
e
b
l
oo
d
v
e
ssel lo
cally, o
r
b
e
co
m
e
e
m
b
o
l
y
i
n
b
l
ood
stream in
to
cerebrovasc
ula
r
system
[10].
M
a
nn
Whi
t
n
e
y
t
e
st resul
t
were u
s
ed t
o
fi
nd any
si
g
n
i
f
i
cant
di
sc
re
pancy
bet
w
ee
n real
st
ro
ke
treatm
e
nt coast and the amount of
INA-CBGs cost when t-test we
re
not
avai
l
a
bl
e due t
o
a
b
n
o
rm
al
ly
distributed
dat
a
. T
h
e a
n
alysis res
u
lts can be
seen i
n
Ta
ble
5.
Table
5.
C
o
rre
l
ation Betwee
n Real Cost a
n
d
IN
A-C
BG
s
C
o
st
Co
st
Intracere
b
ral He
m
o
rrha
g
e (I619)
Cereb
r
al In
farctio
n (I63
9
)
Unspe
c
ifi
e
d Stroke (I64)
Me
an
DS
p
Me
an
DS
p
Me
an
DS
p
Real Cost (I
DR)
3
.
726
.57
6
2
.
389
.79
7
0
.
305
4
.
151
.11
9
1
.
386
.11
3
0
.
108
3
.
482
.62
3
2
.
269
.06
6
0
.
404
INA-CB
Gs Cost
(
IDR
)
2
.
227
.48
4
0
4
.
599
.52
3
1
.
088
.48
2
2
.
936
.80
5
50
8
.
833
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
288 – 293
29
2
The am
ount
o
f
real
st
roke t
r
e
a
tm
ent
cost
at
Jog
j
a
Hos
p
i
t
a
l
fo
r di
ag
n
o
si
s code
of I
6
19 a
n
d I
64 (
I
D
R
3.
72
6.
5
76 a
n
d
IDR
2
.
3
8
9
.
7
9
7
)
were a
v
era
g
el
y
hi
g
h
er t
h
an t
h
e am
ount
of I
N
A-C
B
G
s cost
fo
r t
h
e
sam
e
di
ag
no
si
s co
de
(I
DR
2
.
2
2
7
.
4
84 a
n
d I
D
R
2.
93
6.
8
0
5
)
,
w
h
i
l
e
i
t
was l
o
w
e
r
fo
r
di
ag
nosi
s
code
o
f
I
6
39
f
o
r
real
stroke treatm
e
nt cost (IDR
4.151.119)
com
p
ared with
INA-CBGs’s (IDR
4.599.523
)
. Moreover
, Mann
Whi
t
n
ey
t
e
st
anal
y
s
i
s
for
di
a
g
n
o
se c
ode I
6
19
(
Intracerebral Hemorrhage
) wi
t
h
p val
u
e o
f
0.
3
05
(p
>0.
0
5
)
,
di
ag
no
se co
de I6
3
9
(
Cer
e
bral
Infarction
) wi
th p val
u
e of
0.
10
8 (
p
>0
.0
5
)
,
and
di
ag
no
se code I
6
4 (
Unspecified
Stroke
) with
p v
a
lu
e of 0
.
404
(p
>0.05
)
. That
m
ean
t th
er
e was an insi
gnificant discre
pancies betwee
n real
stroke treatm
e
nt cost at Jogja
Hos
p
ital and the
co
rr
es
p
ond
ing
IN
A-
CBG
’
s
co
st. Acco
rd
ing
to
th
e
aforem
en
tio
n
e
d
an
alysis it was con
c
lud
e
d th
at th
e
h
o
sp
ital was ad
eq
u
a
tel
y
cap
ab
le
o
f
do
ing
rate m
a
n
a
g
e
m
e
n
t
det
e
rm
i
n
ed by
IN
A-C
B
Gs. B
y
doi
ng
s
o
, t
h
e
hos
pi
t
a
l
di
d
no
t
have
t
o
bea
r
t
o
o
m
a
ny
cost
d
e
fi
ci
t
s
[9]
.
As see
n
o
n
t
a
b
l
e 6, t
h
ere
are
som
e
l
o
sses ne
ed t
o
be
co
ve
r
e
d
by
Jo
g
j
a
Ho
spi
t
a
l
d
u
ri
n
g
1
6
m
ont
hs
o
f
th
e stud
y (
J
an
uar
y
20
11
–
Ap
ril 2
0
12)
fo
r
all
str
o
k
e
d
i
ag
no
si
s cod
e
s and
sev
e
r
ity as m
u
ch
as I
D
R
2
7
.3
76.16
7.
Th
e co
st d
e
ficits
mig
h
t
actu
a
lly b
e
an
ticip
ated
if its cau
ses an
d
so
lu
tio
n
s
were
k
nown
b
e
fo
re. One o
f
its
p
o
s
sib
l
e cau
ses were
b
r
and
e
d
m
e
d
i
cin
e
p
r
escrib
ing
th
at mig
h
t
actu
a
lly be su
b
s
titu
ted
with
g
e
n
e
ric m
e
d
i
cin
e
event
h
ough s
o
me of t
h
e
presc
r
ibing
has
al
re
ady used ge
neric
m
e
dicine [9].
Tab
l
e
6
.
To
tal
Real Co
st and
INA-CB
Gs Rate for Jam
k
esmas Mem
b
ersh
ip with
Stro
k
e
at
Jo
gj
a Ho
sp
ital
d
u
r
i
ng
Janu
ar
y
20
11
-
A
p
r
il 20
12
Diagnosis Code
I
NA-
CB
Gs Code
Nu
m
b
e
r
of
Patient
Total Real Cost
(IDR.)
To
tal IN
A-CBGs
Rate (IDR.)
I
619
G-
4-
13-
I
6
22.
359.
4
6
0
13.
364.
8
9
8
I
639
G-
4-
14-
I
12
52.
492.
0
4
3
48.
884.
8
3
2
I
639
G-
4-
14-
I
I
3
9.
774.
74
6
20.
108.
0
1
0
I
64 G-
4-
15-
I
34
94.
252.
4
0
6
91.
719.
7
2
6
I
64 G-
4-
15-
I
I
10
48.
339.
5
0
9
33.
499.
9
2
0
I
64 G-
4-
15-
I
II
2
17.
608.
7
4
9
9.
873.
36
0
T
o
tal 244.
82
6.
913
217.
45
0.
746
L
o
ss 27.
376.
1
6
7
The g
ove
r
n
m
e
nt
-
d
et
erm
i
ned IN
A-C
B
Gs co
de very
de
pe
n
d
ed
wi
t
h
t
h
e d
i
agn
o
si
s co
de rep
o
rt
e
d
by
h
o
s
p
ital
cod
i
ng
o
f
ficers,
thu
s
d
i
agno
sis writing
accu
r
acy an
d m
e
d
i
c
a
l p
r
o
c
ed
ure
writing
co
m
p
l
e
ten
e
ss
becam
e
the prim
ary factors due to the
dis
c
repa
ncy of
INA-CBGs rat
e
for e
v
ery code and seve
rity level
det
e
rm
i
n
ed by
pri
m
ary
and seco
nda
ry
di
agn
o
si
s an
d t
h
e
m
e
di
cal
proc
edu
r
es [
1
5]
,[
1
7
]
,
[
18]
,
[
2
5
]
.
T
h
i
s
rat
e
di
ffe
re
nce bec
a
m
e
t
h
e
m
a
i
n
pr
o
b
l
e
m
i
n
co
di
n
g
p
r
ocess.
M
a
nagem
e
nt
o
f
Jo
g
j
a H
o
s
p
i
t
a
l
had t
o
soci
a
l
i
ze t
o
doct
o
rs
rega
rdi
ng t
h
e c
o
di
n
g
pr
ocess a
nd t
h
e im
port
a
nce o
f
cor
r
ect
an
d d
e
t
a
i
l
e
d di
agn
o
s
i
s wri
t
i
ng t
h
at
m
i
ght
cause i
n
accurat
e
rate
deciding. Thus, sol
v
ing
this
problem
might be
a step
t
o
pre
v
e
n
t hos
p
ital loss.
B
a
sed o
n
t
h
e
abo
v
e
di
scus
si
on
, t
h
e
r
e are
som
e
im
port
a
nt
fact
o
r
s t
o
b
e
conce
r
ned
f
o
r m
a
nagi
n
g
Jam
k
es
m
a
s rate effectively: the acc
uracy
of diagnosis,
tr
eat
m
en
t d
ecision
an
d nu
rsing
care for the
stroke
’s
treatm
e
nt and
also its com
o
rb
i
d
fact
o
r
s.
T
h
ey
are al
s
o
i
m
port
a
nt
i
ssue
s
t
o
a
voi
d
hos
pi
t
a
l
’
s fi
nanci
a
l
l
o
ss.
Ho
sp
ital m
a
n
a
g
e
m
e
n
t
is ex
p
e
cted
to
d
e
m
o
nstrate th
ose
important iss
u
es t
o
thei
r m
e
dical staf a
n
d pa
ra
medic
t
o
reac
h t
h
e sa
m
e
l
e
vel
of
u
n
d
erst
a
ndi
ng
an
d c
o
mmit
m
en
t in
th
e m
e
d
i
cal tea
m
at Jo
gj
a
Ho
sp
ital.
4.
CO
NCL
USI
O
N
The a
v
era
g
e ra
te of real stroke treatm
e
nt cos
t
at
Jo
gj
a Ho
spital was h
i
gh
er in
sign
ifican
tly th
an
INA-
C
B
G
s base
d cost
, wi
t
h
i
t
s
hi
ghe
st
t
r
eatm
e
nt
cost
com
pon
ent
on t
h
e m
e
di
ci
ne an
d m
e
di
cal
equi
pm
ent
cost
.
Th
us, t
h
e h
o
s
p
i
t
a
l
was ad
eq
uat
e
l
y
capabl
e
of m
a
nagi
n
g
st
ro
ke t
r
eat
m
e
nt
cost
base
d
on
I
N
A
-
C
B
G
s
eve
n
th
ou
gh
t
h
ey still h
a
d
t
o
cl
o
s
e t
h
e co
st
d
e
ficit.
ACKNOWLE
DGE
M
ENTS
T
h
is
r
e
s
e
ar
ch
w
a
s
su
ppo
r
t
ed b
y
Un
iv
er
s
ity o
f
M
uhamm
a
d
iyah Yogyakarta.
W
e
t
h
ank to Prof. Dr.
B
a
m
b
ang C
i
pt
o, M
A
, R
ect
or
of M
u
ham
m
adi
y
ah Y
ogy
a
k
art
a
Uni
v
ersi
t
y
for t
h
e f
u
n
d
i
ng s
u
pp
ort
.
W
e
al
so
th
ank
to Di
recto
r
of Jo
gj
a Ho
sp
ital for
facilit
atin
g
o
u
r
research.
REFERE
NC
ES
[1]
DiPiro, JT., Talbert, RL., Yee,
GC.,
Matzk
e
, GR., Well, BG., Posey
,
LM., “P
harmacotherap
y
:
A
Pathoph
y
s
iolog
i
c
Approach, Seventh Ed
ition
”
, Th
e McGraw-Hil
l
Com
p
anies, In
c,
New York, 2008
.
[2]
Fagan SC., Hess DC., “Pharm
acotherap
y
:
A Pat
hoph
y
s
iolog
i
c Approach: Stroke, 6th ed”, McGraw-Hill, Medical
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
S
t
ro
ke Trea
tmen
t Co
st
Ana
l
ysis fo
r C
o
n
s
id
era
tio
n on
H
e
a
lth
C
o
st D
e
term
i
n
a
tion
.... (In
gen
i
da
H
adn
ing)
29
3
Publishing Divis
i
on, New
York,
2005.
[3]
Kasper DL., Br
aunwald E., Fauci AS.,
Hauser SL., Longo DL., Jameson JL.,
“Harrison’s Manual o
f
Medicin
e
, 16th
ed”, McGraw-Hill, Medical Publ
ishing Division,
New York, 2005
.
[4]
Lumbantobing SM., “Stroke B
e
ncan
a Peredar
a
n Darah di
Otak”, Fakultas Kedokteran
Univer
sitas Indonesia,
Jakarta, 2003
.
[5]
Adams HP., Jr,
delZoppo GJ., v
onKumme
r R.,
“Management o
f
Stroke: A Pr
actical Guid
e for
the Preven
tion,
Evalu
a
tion
and
Trea
tm
ent of
Ac
ute S
t
rok
e
,
1
st
ed
”, C
a
ddo US, Professional Com
m
unications In
c., 2000
.
[6]
Scottish Int
e
rco
llegi
at
e Guide
l
i
n
es Network,
“
M
anagem
ent
of Pati
ents wit
h
Stroke”
,
A
Nationa
l Cl
inic
al
Guidelin
es Reco
mmended for use in
Scotland, 19
97.
[7]
Depkes RI, “Su
r
at Keputusan
Ment
eri Keseh
a
tan Republik In
donesia
Nomor 989/Menkes/SK/IX/2007 tentang
Pemberlakuan
I
NA-DRG”, Departemen
K
e
sehatan RI, Jakar
t
a, 2
007.
[8]
Depkes RI, “Peraturan Menteri
Kesehatan Repu
blik
Indonesia N
o
mor 903/Menk
es/P
ER/V/2011 tentang Pedoman
Pelaksanaan Pro
g
ram Jami
nan K
e
sehatan Mas
y
ar
akat”, Depar
t
emen Keseh
a
tan
RI
, Jakarta, 2011
.
[9]
Gupta, SK., Gup
t
a, A., Gondhotr
a
, D., Gupta,
A., Gupta, S., “Role of Citicoline
in
Ishaemic Stroke”, Department o
f
Neurolog
y
and
G Medicin
e
, Govt, Med
i
cal Co
llege
Jammu-J&K, India, vol/issue: 10(4), pp. 160-
162, 2008
.
[10]
Armilawaty
, Amalia, H., Amir
uddin, R
., “Hipertensi dan Faktor Risikon
y
a
dalam Kajian Epidemiologi”, 2007
.
[Online],
Artikel Ilmiah,
Bagian
Epidemiologi FK
M U
NHA
S
,
www.
jurnal
pembahasan/hipertensi dan faktor
risikon
ya d
a
lam
kaji
an ep
idem
iol
ogi ”New
Paradigm for
Public Health”.h
t
m, [201
2, Desember 20]
.
[11]
A
y
al
a, D
E
.
,
Cre
s
po, J
J
., D
o
m
i
nguez-S
a
rdiñ
a, M
., M
o
ya
, A
.
,
O
t
ero, A
.
, Rios
,
M
T
., C
a
s
tiñe
i
ra
,
M
C
., S
i
nei
r
o,
E.,
Gomara, SM., C
a
llejas, PA., Pou
s
a, L., Mojon
,
A
., Fern
andez, JR., Herm
ida, R., In
vest, H
y
gi
a Project, “Prognostic
Value of
Differ
e
nt Ambulator
y
Blood Pr
essure
Parameters As Predictors
of Stro
ke: Th
e H
y
gia P
r
oject”,
Journal of
Hy
pe
rte
n
sion
, v
o
l. 33
, pp
. 3403
,
2015.
[12]
Simona L., Clau
dia C
.,
Leandro
P., Mauro S., “
B
lood Pressu
re Variability
and Clinical
Outcome in Patien
t
s with
Acute Intra
cer
e
b
ral Hem
o
rrhage”,
Journal of S
t
roke and Cereb
r
ovascular Diseases
, vol/issue: 24(7), pp. 1493–
1499.
[13]
H
u
ang Y
C
., H
u
CJ
., L
ee TH
., Y
a
ng J
T
.
,
W
e
ng
H
H
., Lin
LC.
,
L
a
i SL., “The Imp
act Factors on th
e Cost and
Leng
th
of Stay
among Acute Ischemic
Stroke”, 2012. [On
line]
, ht
tp://www.ncbi.n
lm.nih.g
ov/pubmed
, (20
13, Januari 31)
.
[14]
Cook CB., Nay
l
or DB., Hentz J
G
.,
Miller WJ.,
Tsui C.,
Ziemer
DC., Waller LA
., “Dispa
rities in
Diabetes- related
Hospitalizations: Relationship of
Age,
Sex,
and
Race
/Ethn
i
ci
t
y
with Hospital D
i
scharges,
Leng
t
h
s of Sta
y
, and
Direct Inpatien
t
Charges”, 2006.
[O
nline]
, http://www.ncbi.nlm.n
ih.gov/
pubmed
,
[2013, Janu
ari 3
1
]
.
[15]
Kemenkes RI, “Peraturan
Menteri Kesehatan R
e
publik
Indonesia Nomor 27 Tah
un 2014 ten
t
ang
Petunjuk
Teknis
INA-CBGs”, Kementrian Kes
e
hatan RI
, Jak
a
rta, 2
014.
[16]
Kemenkes RI,
“Peraturan Men
t
eri
Keseh
a
tan
Republik Indon
esia Nomo
r 59 Tahun 2014 ten
t
ang Tarif JKN”,
Kementrian K
e
sehata
n RI
, Jak
a
rta, 2014
.
[17]
Kemenkes RI,
“Peraturan Men
t
eri
K
e
sehatan
Republik Indon
esia No
mor 28 Tahun 2014
tentang Pedoman
Pelaksanaan Pro
g
ram Jami
nan K
e
sehatan Nasion
al
”, Kementr
i
an
Keseha
tan
RI, Jakarta, 2014
.
[18]
Sugiy
a
n
t
o, KC.,
“Analisis Biay
a
Pengoba
tan Stro
ke Iskemik Sebagai Pertim
bangan Dalam Penetapan Pembiay
aan
Kesehatan
Berd
a
s
ar INA-DRGs di RSUP Dr. Sard
jito”
,
The
s
is
, Un
iversitas Gadjah
Mada, Yog
y
akar
ta, 2009.
[19]
Jorgensen HS.,
Nakay
a
ma H.,
Raaschou HO.
,
Olsen TS., “Acute Strok
e
Car
e
a
nd Reh
a
bilitation:
an
Analy
s
is
of
The Direc
t
Cos
t
and Its
Clinical
and S
o
cial
Determinants: The
Copenhagen Str
oke Stud
y
”
,
Str
o
ke
, vol. 28, pp
.
1138–1141, 199
7.
[20]
Misbach J., H
a
mid AB., May
z
a A., Saleh
MK., “Buku Pe
doman Standar
Pelay
a
n
a
n
Medis (S
PM) dan Standar
Prosedur Operasional (SPO) Neurologi
”, Perh
impunan Dokter Spesialis Sa
raf
Indonesia, PER
DOSSI, Jakarta,
2006.
[21]
Chassin MR., “Health Technolog
y
Case St
ud
y
24: Variations in Hospital Len
g
th of Stay
: Th
eir Relationship
to
Health
Outcomes”, U.S. Govern
ment Printin
g
Office, Washingto
n
, D.C
.
, pp. 49-5
0
, 1983
.
[22]
Chang KC., Tseng, MC., Weng, HH., Lin,
Y
H
.,
Liou, CW
., T
a
n,
TY
., “
P
redictio
n
of Length of Stay
of First-Ev
er
Is
chem
ic S
t
rok
e
”,
St
ro
k
e
; vol. 33
, pp
. 2670-2674
, 2002.
[23]
Hollowa
y
RG.
,
W
itter DM. Jr., Lawton KB., Li
pscom
b
J., Sa
msa G., “
I
npatien
t
Costs of
Specifi
c Cerebrovascu
l
ar
Events
at
F
i
ve A
cadem
ic
M
e
di
ca
l Cen
t
ers
”
,
Neur
ology
, vol. 46
, p
p
. 854–860
, 199
6.
[24]
Misbach J., Tob
i
ng SML., Ranakusuma
TAS., Sur
y
amih
arja A.,
Harris S., Bustami M., “Guideline Stroke 2007
(Edisi R
e
visi)”,
Kelompok Studi Stroke
Perh
impunan Dokter
Spesialis Sar
a
f
Indo
nesia, PERDOSSI, Jakarta, 2007
.
[25]
Kemenkes RI,
“Peraturan Men
t
eri
Keseh
a
tan
Republik Indon
esia No
mor 71 Tahun 2014
tentang Pelay
a
nan
Kesehatan
Pada
Jamina
n Kesehatan Nasional”, K
e
mentrian
Keseh
a
tan
RI, Jakar
t
a,
2014.
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