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

Abstract

Background: Dengue Hemorrhagic Fever (DHF) has a high cost burden. Payment for hospital treatment was paid by Health insurance (BPJS) with a case based payment method in the era of the National Health Insurance. This method allowed the hospital to gain profit or loss. This study aimed to analyze the factors that influence the differences in Indonesian Cased Based Groups (INA CBGs) with the medical service costs for DHF in Dr. Soeroto hospitals, Ngawi Regency. Subjects and Method:This study used an observational analytic study with a cross-sectional approach conducted at Dr. Soeroto Hospital, Ngawi Regency, East Java in September -October 2019. A sample of 200 subjects was selected by using simple random sampling. The dependent variable was the difference in rate. The independent variables were class of care, length of stay, age, blood transfusion, comorbidity and complications. Data analysis was using multiple linear regression with Stata 13.Results: INA CBG rates (mean= Rp 6,120,000; SD= Rp 2,330,000) was lower than the cost of hospital treatment (mean= Rp 7,070,000; SD= Rp 4,650,000). There is a negative relationship between the difference in rates and it was statistically significant on the length of stay (b= 0.73; 95% CI= -1,131,915 to -329,501; p= <0.001), patients' age (b= 0.41; 95% CI= -707,099 to -110,293; p= 0.008), blood transfusion action (b= 0.79; 95% 549,190; p= 0.041), and comorbidity (b= 1.14 ; 95% CI= -1,817,112 to -474,641; p= 0.001). While there was a statistically insignificant relationship between classes of care (b= 0.42; 95% CI = -931,443 to 82,607; p= 0.100) and complication (b= 0.34; 95% CI= -1,093,208 to 408,223; p= 0.369). Conclusion:Difference in INA CBG rates and hospital medical service costs were affected by the class of care, length of stay, age, blood transfusion, comorbidity and complications.

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

“…These findings are consistent with previous studies conducted by Rahayuningrum et al (2016), Nelson-Williams et al (2016, Wu et al (2020), and Kuo et al (2018). The finding also supports the study undertaken by Ariwardani et al (2019) which discovered age as the determinant of CRR of inpatient care. However, the relationship between gender and CRR was not found in this study, and thus, the result of this study is not fully aligned with previous literature (for instance Wu et al, 2020).…”

“…Prior studies have confirmed that LOS determines inpatient care cost (Rahayuningrum et al, 2016;Ariwardani et al, 2019;Aljunid and Jadoo, 2018;Nelson-Williams et al, 2016;Wu et al, 2020;Kuo et al, 2018) and variation of hospitalisation cost (Xu et al, 2020). For instance, Kuo et al (2018) compared models to predict the medical costs of spinal fusion surgery in Taiwan.…”

“…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).…”

“…Chaikledkaew et al (2008) suggested that patient age and sex are determinants of health-care costs and hospitalisation probability. Ariwardani et al (2019) discovered that patient age is one of the causes of differences in DRG rates and hospital costs in Indonesia, while Aljunid and Jadoo (2018) found that total inpatient pharmacy costs in a Malaysian University Hospital were determined by patient gender. More recently, Xu et al (2020) discovered that age has a positive association with hospitalization cost of patients in Chinese Naval hospitals.…”

The Cost Difference of Hospital Rates and Indonesia Case Base Grup (Ina CBGs) Rates of Inpatient with National Health Insurance Scheme at Private Hospital

“…The study of Tamtomo Hospital type, use of ICU, and length of stay, are important determinants of hospital inpatient cost( (Tamtomo & Murti, 2018). Difference in INA CBG rates and hospital medical service costs were affected by the class of care, length of stay, age, blood transfusion, comorbidity and complications (Ariwardani et al, 2019).…”