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

Abstract

Backgorund: JKN program has stipulated the INA CBGs reimbursement for the payment of treatment in referral health facilities, including for chronic renal disease which is a disease burden. This study aimed to analyze 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. Subjects and Method: The study design was an analytic observational with cross sectional design. The study was conducted in Kasih Ibu Hospital Surakarta in August-October, 2017. With a total of 231 subjects sample which was selected by using proportional random sampling. The dependent variable was the difference between Indonesian case-based group reimbursement and medical cost. The independent variables were length of stay, type of class, medical treatment/ surgery, ICU treatment, and medication use. The data were analyzed using multiple linear regression. Result: INA CBGs reimbursement (mean= Rp 6,120,000; SD= Rp 2,330,000) paid by BPJS Kesehatan was lower than actual hospital's medical care cost (mean= Rp 7,070,000; SD= Rp 4,650,000). Factors profitable for hospitals were medical treatments/ surgery (b= 0.032; p= 0.552). Factors that inflicted financial loss were class 1 care (b= -0.104; p= 0.094), class 2 care (b= -0.033; p= 0.590) compared to class 3 care, length of stay (b= -0.541; p<0.001), medication use in accordance with national formulation (b= -0.183; p= 0.008) and the use of ICU (b= -0.045; p= 0.543). Patients who upgraded the class type (mean= Rp 5,526,074; SD= Rp 1,449,621) was higher than hospital's medical cost for class 2 (mean= Rp 3,933,767; SD= Rp 1,887,900). Conclusion: Mean of INA CBGs reimbursement on inpatient care of chronic renal disease is lower than the mean of hospital's medical care cost. Length of stay and doctors' compliance in using national medication formulation are important determinants to increase medical care cost. Hospital obtains profit from patients who upgrade type of class.

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 results is inline with study of Latifah, an increase in the length of stay and the delay of the surgery schedule will increase the cost difference (Lathifah et al, 2020). 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).…”

“…There was a significant disparity in higher total hospital costs compared with government INA-CBGs cost (Wardhana et al, 2020). The mean INA CBGs reimbursement for inpatient chronic renal disease care is lower than the mean hospital medical care cost (Tamtomo & Murti, 2018). The study of Satibi, 2019 shows there were significant differences of non-chemotherapy expenditures based on the real cost and INA-CBG's tariff rates, in which the cost were higher than Ina CBGs (Hidayat et al, 2022) This study is not inline with earlier study by Rahayuningrum, 2016 shows that hospital inpatient cost was lower than average INA-CBGs tariff.…”