Ina-Cbgs Claim versus Total Hospital Cost: A Vaginal Delivery Investigation at Airlangga University Academic Hospital, Indonesia

Wardhana, Manggala Pasca; Gumilar, Khanisyah Erza; Rahmadhany, Prima; Dewi, Erni Rosita; Laksana, Muhammad Ardian Cahya

doi:10.4081/jphr.2020.1999

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…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).…”

Section: Strengths Limitationsmentioning

confidence: 94%

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

Fitri,

Sundari

2023

jika

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Background: Universal Health Coverage (UHC) stands for the ideal that everyone should have access to high-quality healthcare without facing financial hardship. Hospitals have an important role in the implementation of the referral system with the National HeaIth Insurance scheme. The porspektif payment system allows for difference between the Hospital rates and the INA CBGs rates. The difference in costs has the potential to cause benefits or losses for hospitals and plays an important role in supporting the sustainability of the hospitals. The challenges faced by private hospitals are different from those of government hospitals. Private hospitals must self-fund all costs incurred including investment costs and operating expenses This study aimed to evaluate the difference between hospital rate and INA-CBG's rate, focus on inpatient with NHI scheme at a private hospital at Yogyakarta, identifying the cases that contributes to a common effect of cost difference and identifying the cost components that have the most impact to the dominant cost difference. Methods: We performed a retrospective quantitative research with secondary data analysis. Data was obtained from hospital billing of a Private Hospital type C at Yogyakarta, a referral hospital in Indonesia, at period of January-December 2021. The data involved of 4474 cases of inpatient with National Health Insurance Scheme. The analysis was carried out with Pareto analysis. Results: The difference between hospital rate and Ina CBGs rate of all case is 32,5 %. The pareto analysis results that there are some NHI inpatient cases contribute a common cost difference as 1389 (31% of total cases) as high-cost case. These cases contribute 80 % of total cost difference. The cost components that have the most impact to the dominant cost difference are surgical prosedurs (26,1 %) and room and acomodation cost (19,7%). Conclusions: There are cost difference in which the hospital rate is higher than the Ina CBGs rate. There are 31 % of total cases as high cost cases, for the bulk of the cost difference. Surgical procedurs, room and acomodation cost are the cost components that have the most impact to the dominant cost differences. This study support the necessary for hospitals to evaluate the cost difference of hospital rate and Ina CBGs rate periodically for improving quality and cost efficiency at hospitals

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Section: Strengths Limitationsmentioning

confidence: 94%

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

Fitri,

Sundari

2023

jika

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“…Meanwhile, the World Health Organization (WHO) has set a global target of reducing maternal mortality to less than 70 per 100,000 live births by 2030 7 . JKN aims to support this vision by addressing the three delays that contribute to maternal deaths, ensuring easy access to health services for all women 8 .…”

Section: Introductionmentioning

confidence: 99%

Hospital Cost vs INA-CBGs Claim for Obstetrics Procedure In Soe Rural General Hospital, East Nusa Tenggara

Surya,

Gani,

Saroyo

2023

Indones J Obstet Gynecol

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Objective: To depict the discrepancy and analyze the difference between hospital cost and INA-CBGs claim in obstetrics’ cases in SoE Rural General Hospital, Timor Tengah Selatan regent, East Nusa Tenggara. Methods: This is an observational descriptive study using medical record documents of spontaneous vaginal, assisted vaginal, and cesarean delivery cases from the period of October to December 2022. We included all completed billing documents on that period. Cases paid by fee-for-service and local government were excluded. Data analysis was conducted using IBM SPSS Statistic 23.0 Results: From the total of 323 delivery cases recorded in SoE Rural General Hospital, only 245 cases were included. Most subjects were patients aged around 30 years old, referred from primary healthcare facility in the district, were in term pregnancy, and in 3rd class inpatient rooms. The median of length of stay (LOS) in vaginal delivery (spontaneous and assisted) and cesarean delivery were 2 days and 3 days, respectively. Mean difference between hospital cost to INA-CBGs claim was 67% to 158% for either vaginal or cesarean delivery based on class inpatient room. We found that hospital cost was always higher than claim cost based on INA-CBGs claim. Conclusion: There is a significant discrepancy between hospital cost and INA-CBGs claim (from 67% to 158%) for obstetric services in SoE Rural General Hospital. Keywords: hospital cost, INA-CBGs claim, obstetric. Abstrak Tujuan: Untuk memberikan gambaran perbedaan dan menganalisis perbedaan antara tarif RS dengan klaim INA-CBGs pada kasus obstetrik di RSUD SoE, Timor Tengah Selatan, Nusa Tenggara Timur. Metode: Studi deskriptif observasional menggunakan dokumen rekam medis dari kasus persalinan pervaginam spontan, persalinan pervaginam dengan alat, dan seksio sesarea dari Oktober hinga Desember 2022. Kami memasukkan seluruh dokumen billing yang lengkap. Dokumen biling yang dibayarkan mandiri dan oleh pemerintah lokal dieskslusi. Analisis data dengan menggunakan IBM SPSS Statistik 23.0. Hasil: Dari 323 persalinan yang terekam di RSUD SoE, hanya 245 kasus diinklusikan. Kebanyakan subjek berusia 30 tahun, dirujuk dari puskesmas, kehamilan cukup bulan, dan ruang perawatan kelas 3. Angka median dari lama rawat pervaginam (baik spontan maupun dengan alat) adalah 2 hari dan seksio sesarea 3 hari. Rerata perbedaan tarif RS dengan klaim INA-CBGs ialah 67% hingga 158% baik persalinan pervaginam maupun seksio sesarea berdasarkan ruang kelas perawatan. Kami menemukan angka tarif RS selalu lebih tinggi cukup jauh dari klaim INA-CBGs. Kesimpulan: Terdapat perbedaan antara tarif RS dan klaim INA-CBGs (antara 67 hingga 158%) untuk prosedur obstetrik di RSUD SoE. Kata kunci: tarif RS, klaim INA-CBGs, obstetrik.

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“…However, there were still differences between hospital rates compared to INA-CBG's rates for both inpatients and outpatients (Swandayana and Sastrawan, 2021). For some diagnoses and medical procedures, INA-CBG's rates are lower than hospital rates (Wardhana et al, 2020). Research regarding the analysis of hospital rates and INA-CBG's has been carried out previously.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Hospital and INA-CBG’S Rates of JKN Outpatient in Genteng Regional Public Hospital in 2021

Triyudawati,

Kustriyani,

Prasasti

2023

planar

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The Government's effort improves the health status of the Indonesian people by establishing a Jaminan Kesehatan Nasional (JKN). JKN’s program was formed by Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan). Payment of health costs by BPJS uses the Indonesian-Case Based Group (INA-CBG's) especially for advanced health care services. INA-CBG's is payment to the main health center for a predetermined service package according to the disease diagnosis category. This makes hospitals strive to continue providing quality health services to JKN patients while still controlling costs. The aim of this research is analyze the difference between the outpatient BPJS patient rates and INA-CBG's rates at the Genteng Regional General Hospital in 2021. The research method is a retrospective observational study with simple random sampling. The total sample was 400 obtained during the period January to December 2021. The results of the research showed that the hospital rates was IDR 105,995,056 and the INA-CBG's rates was IDR 89,484,300. It was known that there were three largest cost components including drugs (drugs and chronic drugs) was IDR 51,878,574 (48.70%); patient care costs was IDR 33,980,600 (24.65%); and consultation fee was IDR. 10,400,000 (9.40%). The three largest components of hospital rates included minor chronic disease procedures and dialysis procedures. The conclusion was hospital rates are greater than INA-CBG's rates.

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Ina-Cbgs Claim versus Total Hospital Cost: A Vaginal Delivery Investigation at Airlangga University Academic Hospital, Indonesia

Cited by 4 publications

References 15 publications

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

Hospital Cost vs INA-CBGs Claim for Obstetrics Procedure In Soe Rural General Hospital, East Nusa Tenggara

Analysis of Hospital and INA-CBG’S Rates of JKN Outpatient in Genteng Regional Public Hospital in 2021

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