| Summary: | ABSTRAK
The need for health service is a basic need. In providing health insurance for staff and their family Yogyakarta PKU Muhammadiyah Hospital entrusts its management to Takaful Community Helath Care Insurance owned by PKU Muhammadiyah Hospital Management. The cost of helath insurance tends to increase and deficit is occurring. A study on health service utilization and cost used by Takaful Community Health Care Insurance has never been carried out.
The study was meant to analyze the utilization and average cost of health service to be used for considering the amaount of helath cost for staff.
The study was of descriptive type which was conducted at Yogyakarta PKU Muhammadiyah Hospital. Variables of study were (1) utilization of outpstient and inpatient service, (2) cost of outpatient and inpatient service. Analysis methods used quantitative time sequence, visit ratio, utilization rate and average of health service cost. Indepth interview qualitative research result.
Result of outpatient visit ratio per 100 visits was 97. Ratio of prescreption sheets was 64, ratio of medical support was 11.2, ratio of inpatient visists was 2.8. Utilization rate of outpatient per 1000 participants per month was 502. Drug utilization rate was 56.51. Inpatient utilization rate was 14,83. Average cost for outpatient service per visit was Rp.43.808, for inpatient service was Rp.1,278,310. Higest cost component was outpatient service cost wich was Rp.450,85,821.
Total cost of health insurance was higher than health insurance fund for staff provided by PKU Muhammadiyah Hospital because the allocation of insurance fund was too low and not based on utilization analysis so that deficit occurred.
Keywords: Utilization review, services costs, community heath care insu
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