Comparison Between Hospital Inpatient Cost and INA-CBGs Tariff of Inpatient Care in the National Health Insurance Scheme in Solo, Boyolali and Karanganyar Districts, Central Java

Abstract

Background: Hospital has an important referral system role in the implementation on the National Health Insurance (NHI) Scheme. BPJS Kesehatan (NHI Implementing Agency) pays hospitals by Indonesian Case Based Groups (INA-CBGs) method. This payment method may potentially cause loss or profit to the hospital, when there is discrepancy between hospital inpatient cost and INA-CBGs tariff of inpatient care. This study aimed at investigating the discrepancy between hospital inpatient cost and INA-CBGs tariff of inpatient care and the determinants of hospital inpatient cost. Subjectsand Method: This was an analytic and observational study cross sectional approach. This study was conducted in 2 publichospitals and 2 private hospitals, from October to December 2016. A total sample of 100 inpatients was selected at random for this study. The dependent variables were hospital inpatient cost and INA-CBGs tariff. The independent variables included hospital type, inpatients class, disease severity, use of ICU, and length of stay. The data were analyzed by a multiple linear regression model. Results: Average hospital inpatient cost (mean= Rp. 2,280,000; SD=1,690,000) was lower than average INA-CBGs (mean=Rp. 3,060,000). There were negative relationships between hospital type, inpatient class, disease severity, and hospital inpatient cost. Private hospital inpatient cost (b=-5.66; 95% CI= -1.20 to 0.06; p= 0.078) was lower than public hospital inpatient cost. Class 2 inpatient care (b= -0.34; 95% CI=-1.09 to 0.41, p =0.371), class 3 inpatient care (b =-0.50; 95% CI= -1.23 to 0.23, p=0.177), had lower hospital inpatient cost than class 1 inpatient care. Severe disease (b= -0.12; 95% CI= -1.95 to 1.71; p= 0.894) had lower hospital inpatient cost than mild disease, although it was not statistically significant. There were positive relationships between use of ICU, disease severity, length of stay, and hospital inpatient cost. Using ICU (b= 1.58; 95% CI= 0.76 to 2.4; p= <0.001) had higher hospital inpatient cost than not using ICU. Moderate disease severity (b= 0.55; 95% CI = -0.20 to 1.30; p= 0.150) had higher hospital inpatient cost than mild disease. Longer stay (b= 0.27; 95% CI= 0.08 to 0.45; p= 0.005) had higher hospital inpatient cost than shorter stay. Conclusion: Average hospital inpatient cost was lower than average INA-CBGs tariff. Hospital type, use of ICU, and length of stay, are important determinants of hospital inpatient cost.

Factors Affecting The Cost Gap Between INA CBGs Tariff and Hospital Tariff for Patients with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java

“…Within the five years of JKN, there have been various opinions which state that medical services with INA CBG rates are judged to have differences with hospital medical service tariffs. Research done by Rahayuningrum et al (2016) said similar things that the average hospital inpatient costs were lower than the average INA CBG rates. Mardhatillah et al (2017) also stated that the mean of INA CBG reimbursement in hospitalization for chronic kidney disease was lower than the mean of hospital medical care costs.…”

“…However, the relationship was not significant. Rahayuningrum et al (2016) stated that between the class of care with the difference in INA CBG rates and hospital rates, there was a statistically insignificant relationship. The study showed that the average of patient chose class 3.…”

Factors Influencing the Difference between Indonesian Case-Based Group Reimbursement and Medical Cost for Patients with Chronic Renal Disease Cases in Kasih Ibu Hospital, Surakarta

“…Association between ICU utilization with tariff difference The analysis result showed that there was negative association which was insignificant between the use of inpatient care in ICU with tariff difference of INA CBGs' and medical care cost for CRD cases at the hospital. It different from the previous study that showed that there was a significant association between ICU care with hospital's tariff (Rahayuningrum, 2016). Karabatsou et al (2016) explained that the total cost of ICU care is greatly influenced by 3 things namely the length of stay in ICU, disease severity, the need for mechanic ventilator and the use of continous dialysisatau CRRT (Continous Renal Replacement Therapy).…”

“…The previous study found that INA CBGs' reimbursement was higher than hospital's tariff regardless the diagnosis/ case of disease (Rahayuningrum, 2016).…”

DRG-based payment system and management accounting changes in an Indonesian public hospital: exploring potential roles of big data analytics

“…Cases with CRR greater than 100% indicate profit/overfunding, while cases with less than 100% CRR indicate deficit/underfunding. Prior studies have revealed determinants of CRR, for example, patient characteristics, severity and LOS (see for instances Rahayuningrum et al, 2016;Ariwardani et al, 2019).…”