Dampak Implementasi Case Manager terhadap Mutu Pelayanan, Lama Rawat Inap, dan Biaya Perawatan Rumah Sakit di Indonesia: Tinjauan Literatur Sistematis
Keywords:
biaya pelayanan kesehatan, case manager, lama rawat inap, mutu pelayanan kesehatan, rumah sakitAbstract
Implementasi case manager di rumah sakit merupakan strategi penting untuk meningkatkan koordinasi pelayanan, efisiensi penggunaan sumber daya, mutu layanan, dan luaran pasien. Dalam era Jaminan Kesehatan Nasional (JKN), rumah sakit dituntut menjaga mutu pelayanan sekaligus mengoptimalkan lama rawat inap dan pengendalian biaya. Namun, bukti ilmiah terkait efektivitas case manager terhadap mutu pelayanan, lama rawat inap, dan efisiensi biaya rumah sakit di Indonesia masih terbatas. Penelitian ini bertujuan mengevaluasi dampak implementasi case manager terhadap mutu pelayanan, lama rawat inap, dan biaya pelayanan rumah sakit di Indonesia. Penelitian menggunakan metode systematic literature review berdasarkan pedoman PRISMA 2020. Pencarian artikel dilakukan melalui PubMed, Google Scholar, SciSpace Basic Search, dan SciSpace Full-Text Search pada publikasi tahun 2015–2025. Kata kunci pencarian adalah case manager, Rumah Sakit dan mutu pelayanan. Seleksi studi menggunakan kerangka PICOS dengan kriteria penelitian empiris terkait implementasi case manager pada pelayanan rawat inap rumah sakit di Indonesia. Sebanyak 430 artikel ditemukan dan tujuh studi memenuhi kriteria inklusi untuk sintesis akhir, terdiri dari studi kuantitatif (n=2), kualitatif (n=3), dan metode campuran (n=2). Implementasi case manager meningkatkan mutu pelayanan melalui peningkatan kepuasan pasien dan kepatuhan clinical pathway, menurunkan lama rawat inap melalui koordinasi multidisiplin dan perencanaan pulang, serta meningkatkan efisiensi biaya melalui optimalisasi penggunaan sumber daya. Hambatan implementasi meliputi keterbatasan kompetensi, ketidakjelasan peran, beban kerja tinggi, dan kurangnya dukungan organisasi. Implementasi case manager berpotensi meningkatkan mutu pelayanan, mengurangi lama rawat inap, dan meningkatkan efisiensi biaya rumah sakit. Keberhasilan implementasi membutuhkan penguatan kompetensi, dukungan organisasi, kejelasan peran, sistem informasi terintegrasi, dan kolaborasi multidisiplin.
References
Adima, F., & Arini, M. (2025). The influence of healthcare workers’ social support on compliance to medication in multi drug resistant tuberculosis patients at the Regional General Hospital of Dr. Saiful Anwar. Clinical Epidemiology and Global Health, 31(June 2024), 101890. https://doi.org/10.1016/j.cegh.2024.101890
Auladi, S. (2022). Efektivitas Case Manager dalam Upaya Kendali Mutu dan Kendali Biaya Pelayanan Kesehatan Di RSUP Dr. Hasan Sadikin. Jurnal Jaminan Kesehatan Nasional, 2(1), 2021. https://doi.org/10.53756/jjkn.v2i1.49
Baek, H., Cho, M., Kim, S., Hwang, H., Song, M., & Yoo, S. (2018). Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. PLoS ONE, 13(4), 1–16. https://doi.org/10.1371/journal.pone.0195901
Bramantio, A. F., & Arini, M. (2026). Determinants of User Satisfaction and Net Benefits of Electronic Medical Record Information Systems in Eastern Military Hospitals. 8(3), 262–274.
Buja, A., Francesconi, P., Bellini, I., Barletta, V., Girardi, G., Braga, M., Cosentino, M., Marvulli, M., Baldo, V., & Damiani, G. (2020). Health and health service usage outcomes of case management for patients with long-term conditions: a review of reviews. Primary Health Care Research & Development, 21. https://doi.org/10.1017/s1463423620000080
Doyle, M., & Gallagher, N. (2025). Case management in a fragmented health and social care ecosystem: An exploration of community-based services for older people in Ireland. International Journal of Integrated Care. https://doi.org/10.5334/ijic.icic24092
Fitri, D. El, & Sundari, S. (2023). The cost difference of hospital rates and Indonesia Case Base Group (Ina CBGs) rates of inpatient with national health insurance scheme at private hospital. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 8(1), 1–10.
Gorman, D., & Horn, M. (2022). Challenges to health system sustainability. Internal Medicine Journal, 52(8), 1300–1303. https://doi.org/10.1111/imj.15873
Gunarti, Chriswardani Suryawati, S. P. A. (2019). comparison of medical treatment cost analysis using activity based costing and double distribution method: a scoping review. Indonesian Journal of Global Health Research, 2(4), 283–290. https://doi.org/10.37287/ijghr.v2i4.250
Hatija, M. A., Woro, S., Rahmat, B. A., & Endang, D. (2025). Perbandingan Biaya Medik Langsung Dan Tarif Ina-Cbg’s Pada Pasien Bedah Ortopedi Di Rumah Sakit X Kota Yogyakarta Februari-Mei 2025. Pharmacoscript, 8(2), 622–636.
Hirani, R., Podder, D., Stala, O., Mohebpour, R., Tiwari, R. K., & Etienne, M. (2025). Strategies to Reduce Hospital Length of Stay: Evidence and Challenges. Medicina (Lithuania), 61(5), 1–26. https://doi.org/10.3390/medicina61050922
Hudon, C., Chouinard, M. C., Bisson, M., Brousselle, A., Lambert, M., Danish, A., Rodriguez, C., & Sabourin, V. (2022). Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis. International Journal of Integrated Care, 22(1), 1–13. https://doi.org/10.5334/ijic.5652
Ispandiyah, W., Endartiwi, S. S., & Fuad, M. D. F. N. (2023). Analisis Tarif Pelayanan Kesehatan Di FKTP: Analysis Of Health Services Rates At FLHSF. Jurnal Kesmas Untika Luwuk: Public Health Journal, 14(2), 106–115.
Joo, J., & Huber, D. (2018). Case Management Effectiveness on Health Care Utilization Outcomes: A Systematic Review of Reviews. Western Journal of Nursing Research, 41, 111–133. https://doi.org/10.1177/0193945918762135
Joo, J. Y. (2023). Fragmented care and chronic illness patient outcomes: A systematic review. Nursing Open, 10(6), 3460–3473. https://doi.org/10.1002/nop2.1607
Kasim, F. (2025). Optimalisasi Case Manager Dalam Meningkatkan Kepuasan Pasien dan Menurunkan Biaya Perawatan Pasien Jantung di RS Mitra Mulia Husada Optimization of Case Manager in Increasing Patient Satisfaction and Reducing Heart Patient Care Costs at Mitra Mulia Husada. Medistra Medical Journal, 2(2), 77–81. https://doi.org/10.35451/mmj.v2i2.2751
Listiowati, E., Sjaaf, A. C., Achadi, A., Bachtiar, A., Arini, M., Rosa, E. M., & Pramayanti, Y. (2023). How to engage patients in achieving patient safety: A qualitative study from healthcare professionals’ perspective. Heliyon, 9(2), e13447. https://doi.org/10.1016/j.heliyon.2023.e13447
Molina-Gil, M. J., Guerra-Martín, M. D., & De Diego-Cordero, R. (2025). Impact on Health, Resources, and Satisfaction: A Qualitative Study of Primary Health Care Case-Management Nurses. Healthcare, 13. https://doi.org/10.3390/healthcare13090974
Nurhamdanah, S., & Gero, S. (2025). Pelaksanaan Fungsi Case Management Untuk Meningkatkan Kendali Mutu dan Biaya Pelayanan Rawat Inap: Studi Fenomenologi di RSUD RAA Soewondo Pati. JUKEJ : Jurnal Kesehatan Jompa, 4(3), 1013–1120. https://doi.org/10.57218/jkj.vol4.iss3.2004
Polanco, B., Oña, A., Gemperli, A., & Barzallo, D. P. (2025). Excess healthcare utilization and costs linked to chronic conditions: a comparative study of nine European countries. European Journal of Public Health, 35(2), 216–227. https://doi.org/10.1093/eurpub/ckaf012
Press, U. G. M. (2022). Metode penelitian: Prinsip dan aplikasi untuk manajemen rumah sakit. Ugm Press.
Rachmat, R. (2021). perhitungan unit cost dengan metode activity based costing (abc) di instalasi gawat darurat rumah sakit hikmah makassar= Calculation of Unit Cost with Activity Based Costing (ABC) Method in the Emergency Room of Hikmah Hospital Makassar.(supervised by M. . Universitas Hasanuddin.
Rachmawaty, R., Wahyudin, E., & Bukhari, A. (2025). Exploring patient’s clinical outcomes, hospital costs, and satisfaction after the implementation of integrated clinical pathway-based nursing practice model. Cost Effectiveness and Resource Allocation, 23(1). https://doi.org/10.1186/s12962-025-00645-5
Sofiaturrohmah, S., & Kasman, A. (2025). Service Quality Disparities in Public Healthcare: A Comparative Study of Customer Expectations and Perceptions in Urban and Remote Areas of Indonesia. Government & Resilience. https://doi.org/10.62503/gr.v3i2.29
Sunayya, M. M. (2024). Analisis Perbedaan Tarif Riil Rumah Sakit Dengan Tarif INA CBG’S Di Rumah Sakit X Ponorogo Pada Semester Pertama Tahun 2024. Innovative: Journal Of Social Science Research, 4(5), 7609–7621.
Viano, N. C. (2025). Analisis Peran Case Manager dalam Kendali Mutu dan Kendali Biaya Pelayanan Rawat Inap Bedah di Rumah Sakit Universitas Indonesia Tahun 2022. Jurnal ARSI : Administrasi Rumah Sakit Indonesia, 11(1). https://doi.org/10.7454/arsi.v11i1.1197
Zhang, L., Chen, X., & Du, N. (2024). Case Management Implications for Pediatric Patients With Congenital Heart Disease in China: A Randomized Controlled Trial. Global Pediatric Health, 11. https://doi.org/10.1177/2333794x241290364
