Perbandingan Tarif Rumah Sakit dan INA-CBG pada Pasien Diabetes Mellitus Tipe II Rawat Jalan di RSIJ Sukapura

Abstract

Background: The National Health Insurance Program helps patients pay for medical expenses and provides financial protection against unexpected health risks. INA-CBG system is used for healthcare payments, where the payment is determined based on type of disease the patient has. However, the rates set by INA-CBG are lower than hospital rates, causing financial losses and affecting the quality of service. Purpose: This research aims to compare rates to maintain hospital financial balance and fair access to services. Method: This study uses comparative quantitative research method with cross-sectional approach. The research was conducted at Rumah Sakit Islam Jakarta Sukapura. The sampling technique used was saturated sampling, with a sample of 374 claim data for type II diabetes mellitus patients from October to December 2023. Data were taken from Zi-Care system, which has been bridged with INA-CBG. The data collection tool used was a checklist. The analysis techniques included univariate and bivariate analysis using Wilcoxon Signed Rank Test. Results: The research results show that the total hospital cost is Rp265,805,506, with the highest value being Rp2,746,407 and the lowest value being Rp161,000. The total INA-CBG cost is Rp73,341,400. P-value of 0.0001 indicates a significant difference between both variables. Conclusion: The difference in rates resulted in the hospital experiencing a loss of IDR 192,464,106. Hospitals need to refer drug collection to external pharmacies, and BPJS must evaluate INA-CBG rates to match hospital expenditure to prevent losses.