Factors Affecting Medical Doctors in Charge (MDiC) Obedience in

Filling Medical Resumes Based on the Table of Eleven (Study in

Private Hospital “X”)

Azizah Anisafitri, Ernawaty Ernawaty

Faculty of Public Health, Airlangga University, Surabaya, Indonesia

azizanisafitri@yahoo.co.id

Keywords: Claim, Medical doctor in charge (MDiC), Medical record, Obedience, Table of eleven.

Abstract: Medical resume are a required file in a Social Health Insurance Agency’s (BPJS) claim document.

Incomplete claim documents detain the claim proposal between the hospital and the BPJS. Medical Doctor

in Charge (MDiC) was the person in charge of filling in the medical resume. The purpose of this research

study was to analyse the obedience of MDiC in filling in the medical resume based on the table of eleven.

The method in this research was descriptive quantitative and observational. This research was accomplished

by questionnaires, observations, and checklists. The result of this research illustrate that the majority of

MDiC (57.10%) was classified as obedient in filling of medical resume. Dimension of knowledge of rules,

cost or benefit, degree of acceptance, respect of authority, risk of detection, selectivity, risk of sanction, and

severity of sanction have positive value to doctors obedience in filling medical resume. Risk of being

reported and risk of being inspection have a negative value to doctors’ obedience in filling medical resume.

Social control was not related to doctor’s obedience in filling medical resume.

1 INTRODUCTION

The Government of Indonesia is establishing a

program called National Health Insurance (NHI) in

order to achieve health coverage for all citizens. The

NHI program started operations on January 2014.

The implementer of the NHI program is the Social

Health Insurance Agency’s (BPJS Kesehatan)

established by the government. In the era of JKN

known health referral system. Referral system starts

from health service at Fasilitas Kesehatan Tingkat

Pertama (FKTP) to Fasilitas Kesehatan Tingkat

Lanjutan (FKTL).

Payment system in NHI is capitation and fee for

service payment based on Indonesian-Case Based

Group (INA-CBG) tariff. Payment is made by

making a claim from the health facility to BPJS

Kesehatan. Claims consist of several documents, one

of them is a medical resume

Medical resumes are one of the files contained

in a medical record document. A medical resume is

a treatment summary file that is given to the patient

from the start of hospitalisation up until discharge

from the hospital. Currently in the era of National

Health Insurance (NHI), medical resumes are one of

the most important documents. The medical resume

is one of the files in the claim document, because the

resume contains a diagnosis which will be coded

into the software in the form of ICD-9 and ICD-10.

Incomplete claims documents cannot be submitted

to Social Health Insurance Agency’s (BPJS).

Postponed claim’s processes will affect the

hospital’s cashflow. The Medical Doctor in Charge

(MDiC) is the person in charge of filling in the

medical resume. The preliminary study indicates that

117 (86.67%) incomplete claim documents have

been because there is no medical resume in Hospital

"x". The purpose of this research is analyse the

obedience of MDICs in filling in the medical resume

based on the table of eleven.

2 METHOD

Sampling method in this research used total

sampling. The primary data was obtained from

questionnaires to 35 doctors. Secondary data were

obtained from observation and a checklist of 266

medical resume documents. The independent

variables in this study include the perception of the

knowledge of rules, cost or benefit, degree of

acceptance, respect of authority, social control, risk

of reported, risk of inspection, risk of detection,

selectivity, risk of sanction, and severity of sanction.

The independent variable in this research was MDiC

Anisaﬁtri, A. and Ernawaty, .

Factors Affecting Medical Doctors in Charge (MDiC) Obedience in Filling Medical Resumes Based on the Table of Eleven (Study in Private Hospital “X”).

In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 355-359

ISBN: 978-989-758-335-3

355

obedience in filling in the medical resume. Data

analysis technique used is cross tabulation. Cross

tabulation can show the relationship between

variables

3 RESULT

The MDIC’s obedience in relation to the medical

resume was rated based on timeliness and the

completeness of the medical resume. The results

based on the research obtained are as follows.

Table 1: MDIC obedience levels in filling medical

resumes in private hospital “x”

Level of obedience in filling

medical resumes

Amount

(n)

Percentages

(%)

Obey

Not obey

57,10

42,90

Total

100,00

Based on Table 1, the majority of MDICs

(57.10%) obey when it comes to filling in the

medical resume. The table of eleven has 11

dimensions that can affect a person’s obedience to

adhere to a rule. The results of the research present

the relationship between the 11 dimensions of the

table of eleven with MDIC obedience in filling in

the medical resumes at private hospital "x".

Table 2: Relationship table of eleven with MDIC

obedience in filling in the medical resume

Dimension

table of eleven

Result

Explanation

Knowledge of

rules

A better the perception

of the knowledge of

the rules, the better the

obedience of MDIC in

the filling in of the

medical resume vice

versa.

Positively

Cost or

benefit

The better the

perception of cost and

benefit, the better the

obedience of MDIC in

filling in the medical

resume.

Positively

Degree of

acceptance

The better the degree

of acceptance

perception, the better

the MDIC obedience

in filling out the

medical resume.

Positively

Respect of

authority

The better the

perception in respect

Positively

of authority tends to

lead to better

obedience of MDIC in

relation to the medical

resume.

Social control

Good or bad

perceptions of social

control tend not to

affect the obedience of

the MDIC in filling in

the medical resume.

Not related

Risk of being

reported

MDIC’s with a good

risk of being reported

tend to be less

obedient in filling out

the medical resume.

Negatively

Risk of being

inspection

MDIC with a good

inspection perception

tend to be less

obedient in filling out

the medical resume.

Negatively

Risk of being

detection

The better the

perception risk of

being detected tends to

lead to better

obedience of the

MDIC in filling in the

medical resume.

Positively

Selectivity

The better perception

of selectivity tends to

lead to better

obedience of the

MDIC in filling in the

medical resume.

Positively

Risk of

sanction

The better perception

of the risk of sanction

tends to lead to better

obedience of the

MDIC in filling in the

medical resume.

Positively

Severity of

sanction

The better the

perception of the

severity of sanctions

tend to lead to better

obedience of the

MDIC in filling in the

medical resume.

Positively

Table 2 is the result of data analysis technique

used cross tabulation, so there is no p-test value in

this research. Based on Table 2, it was identified that

the dimensions of knowledge of the rules, cost or

benefit, degree of acceptance, respect of authority,

risk of detection, selectivity, risk of sanction, and the

severity of the sanction has a positive relationship to

the obedience of the doctor in filling in the medical

resume. The dimensions of risk of being reported

and the risk of being inspection has a negative result

towards the obedience of the doctor in filling in the

INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association

356

medical resume. The dimensions of social control

were not related to the doctor’s obedience in filling

in the medical resume.

4 DISCUSSIONS

Obedience is obeying when it comes to performing a

particular behavior that is suggested or as a response

given outside of the subject (Green and Kreuter,

2005). Obedience is influenced by several factors:

predisposing factors, enabling factors, and

reinforcing factors. Predisposing factors are factors

that become the basis or motivation of a given

behavior. Possible factors are factors that enable or

facilitate a particular behaviour. The reinforcing

factor is the factor that encourages and reinforces the

occurrence of a behaviour or action.

A medical resume is a treatment summary file

that has been given to the patient since the start of

hospitalisation up until discharge from the hospital.

According to the Minister of Health No. 269 2008

on medical records, medical resumes include patient

identification, admission diagnosis, patient care

indications, summary of physical and auxiliary

examinations, final diagnosis, treatment, follow-up,

the doctor's name and signature. Based on the results

of the research, it is noted that the majority of

MDICs (57.10%) are classified as obedient in

relation to filling in medical resumes in private

hospital "x". Based on the results of this study, it can

be observed that the timeliness and completeness of

medical resume filling in is quite good.

The table of eleven is a model developed by the

Dutch Ministry of Justice in 1994. The table of

eleven is based on the science of behaviour and

consists of 11 dimensions that determine a person's

level of obedience with rules or laws

(Dutch

Ministry of Justice, 2004).

Knowledge of the rules is the familiarity and

clarity of the regulations or legislation among the

target setting. A lack of knowledge about a rule may

encourage disobedience

(Elffers, et al, 2003). The

knowledge of rule perceptions tends to have a

positive effect on the doctors' obedience in filling

out medical resumes in "x" hospitals.

Cost or benefits are an advantage or disadvantage

that exists or not in relation to a person's obedience

or non-obedience with the rules. Cost or benefit can

be expressed in time, money, and effort. The

perception of cost or benefit tends to have a positive

effect on the doctors' obedience in filling in medical

resumes in hospital "x". This can be interpreted that

the majority of doctors feel the benefits gained

greater than the cost incurred when filling medical

resume. This is appropriate compared with

Widayanti’s research (2017) which explained the

relationship between the perception of cost and

benefit with the obedience of doctors in filling in

referral letters

(Widayanti, 2017).

A person can obey a rule if the rule is considered

reasonable to be accepted

. Perceptions of the degree

of acceptance tend to positively influence the

obedience of doctors in filling in medical resume in

hospital "x". This is appropriate compared with

Widayanti’s research (2017) which explains the

relationship between the perception of cost and

benefit with the obedience of doctors in filling in

referral letters

(Widayanti, 2017). Obedience may

occur due to pressure from a group and personal

acceptance

(Smith and Mackie, 2000).

Respect of authority is a condition in which the

target group can respect an authority. People comply

with a rule because it has respect for the authority

(Milgram, 1974). The results showed that the

perception of respect of authority tended to

positively influence the doctor's obedience in filling

in the medical resume at hospital "x". This may

mean that the majority of MDiCs have a high degree

of respect for hospital directors and professional

medical ethics.

Social control is the target group's perception of

positive or negative punishment against obedience

or disobedience received from the surrounding

environment. Social control is a measure of whether

the environment will support or criticise non-

obedience. The results show that good or bad social

perception tended not to influence the obedience of

MDIC in filling out the medical resumes in "x"

hospital. Research by Widayanti (2017) stated that

the lower the social control received, the lower the

obedience of the doctors for filling in the referral

letter.

The risk of being reported is the target group's

perception of a violation that can be detected by

others and then reported to the authority holder. The

dimension of risk of being reported is a punishment

received from social control. The results showed that

MDIC with a good risk of being reported perception

tended to be less obedient in filling out the medical

resumes. This is because obedience does not only

arise from external factors, but also from internal

factors derived from the person.

Risk of being inspection is the target group's

perception of an inspection being conducted by an

authorised division. Inadequate inspections in high-

risk areas are less effective inspections

(Parker, et al,

1990). The results showed that MDIC with a good

Factors Affecting Medical Doctors in Charge (MDiC) Obedience in Filling Medical Resumes Based on the Table of Eleven (Study in Private

Hospital “X”)

357

risk of being inspected perception tended to be less

obedient in filling out the medical resumes. This can

happen if the inspection is not tight enough and

rarely, so some people feel not at risk to be

inspected.

Risk of detection is the target group's perception

of violations being detected during inspection.

Violations should be detectable by various forms of

inspection, depending on the type of violation

committed and the depth of the examination. The

results showed that the dimension of risk of

detection tended to positively affect the obedience of

doctors in filling in the medical resume in hospital

"x". This means that the majority of the MDiC feels

a high risk of finding non-obedience in the filling of

medical resumes.

Selectivity is an increased risk of inspection and

detection of violations caused by the selection of

interests, persons, actions, or areas to be examined.

The results showed that there is a positive

relationship between selectivity perception and

physician obedience. This can be interpreted that the

better the perception of selectivity owned by the

doctor, then the obedience in the filling in of the

medical resume also tends to be better.

Risk of sanction is the target group's perception

of the risk of getting punished if the inspection find

a violation or non-obedience with a rule. The results

showed a positive relationship between the

perceptions of risk of sanction that doctors have on

obedience in relation to filling in the medical resume

in hospital "x". This is in accordance with the

research by Regaletha (2009) which explained that

there was a relationship between the punishment

system with the obedience of doctors in prescribing

outpatient recipes based on the formulary in RSUD

Prof. Dr. W. Z. Johannes Kupang

(Regaletha, 2009).

Severity of sanction is the severity associated

with the form of violation and punishment. The

severity of punishment concerns the duration of

detention, the number of penalties, or attempts made

to correct the ongoing damage

(Solicitors Regulation

Authority, 2011). The results showed a positive

relationship between the perceptions of risk of

punishment that doctors have on their obedience in

filling in the medical resumes in hospital "x"

5 CONCLUSIONS

The majority of MDICs (57,10%) are classified as

being obedient in filling in medical resumes in

private hospital “x”. The dimension of knowledges

of rules, cost or benefit, degree of acceptance,

respect of authority, risk of detection, selectivity,

risk of sanction, and severity of sanction has a

positive value towards doctor obedience in filling in

medical resumes. The dimension of the risk of being

reported and risk of being inspection has a negative

value towards doctor obedience in filling in medical

resumes. The dimension of social control was not

related to the doctor’s obedience in filling in the

medical resumes.

Doctors' obedience in filling medical resumes can be

improved by

1. Socialisation of doctors about regulations or

the SOP of medical resume filling in private

hospital “x”.

2. Socialisation to doctors about the importance

of medical resumes in the era of National

Health Insurance (NHI) that can affect the

claims process and hospital cashflow.

3. Completeness and timeliness in medical

resume filling can be used as an indicator of

Medical Doctor in Charge (MDiC)

performance assessment.

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Factors Affecting Medical Doctors in Charge (MDiC) Obedience in Filling Medical Resumes Based on the Table of Eleven (Study in Private

Hospital “X”)

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