Disparities in hospital cost and INA-CBGs tariff with unit cost analysis of inpatient services




The National Health Insurance Program, a form of health insurance that has been implemented since 2014, which uses the Indonesian Case Based Groups (INA-CBGs) system. The implementation of this system ensures that patients get good service and hospitals get standard tariff. The intended tariff is in the form of a package which includes all components of hospital costs. This study aims to determine the relationship between the unit cost of all health service cost components and the INA-CBGs tariff and how the gap is. The research sample was taken from the INA-CBGs claim document in the second quarter of 2020 as many as 4,833. Data were analyzed using linear regression to find a relationship between hospital health service costs and the INA-CBGs tariff. Hospital service costs are calculated based on unit cost analysis. The average unit cost of laboratory was IDR 853,500 (7.91%), radiology IDR 366,198 (3.39%), treatment IDR 2,031,850 (18.82%), Examination IDR 4,205,745 (38.95%), Consumables IDR 345,092 (3.17%), and Drugs IDR 3,022,694 (27.76%). The results of the analysis showed Laboratory (b = 1.639; 95% CI = 1.177 to 2.100; p <0.001), Treatment (b = 0.915; 95% CI = 0.852 to 0.978; p <0.001), Examination and Accommodation (b = 1.211; 95% CI = 1.138 to 1.285; p <0.001), and Drug (b = 0.015; 95% CI = 0.007 to 0.024; p <0.001) had a significant relationship with the INA-CBGs tariff. Other variables such as Radiology (b = -0.141; 95% CI = -0.629 to 0.347; p <0.001) and Consumable Costs (b = -0.343; 95% CI = -696 to 0.009; p <0.001) had no significant relationship with INA-CBGs Tariff. However, all cost components have a significant effect (p <0.001) of 42.7% on the INA-CBG tariff with a strong influence category (R = 0.654). Hospitals must be wiser in managing finances with the INA-CBGs pattern, because the tariff may look small because there are some treatment that are not cost effective or there are still unnecessary treatment for patients taking a large portion of the cost of the package.



Ministry of Health, “Regulation of the Minister of Health of the Republic of Indonesia Number 76 of 2016 concerning Guidelines for INA-CBHs in the Implementation of National Health Insurance”, Jakarta, Indonesia, 2016.

IO Rahayuningrum, DG Tamtomo, A Suryono, “Comparison between hospital inpatient cost and INA-CBGs reimbursement of Inpatient Care in the National Health Insurance Scheme in Solo, Karanganyar, Boyolali District Central Java”, Journal of Health Policy and Management vol. 1, no. 2, 2017, pp.102-112.

I Mathauer, F Wittenbecher, “Hospital payment systems based on diagnosis – related groups : experiences in low- and middle- income countries”, Bulletin World Health Organization, vol. 91, no. 2, 2013, pp. 746-756

MI. Putri, “Analysis of the Calculation of Hospital Inpatient Rates with the Activity Based Costing Method at Sunan Kalijaga Hospital, Demak”, Thesis, Fakultas Ekonomi & Bisnis, 2014.

Fieda, “Application of the Activity Based Costing Method on Inpatient Rates for Regional General Hospitals in Makassar”. Thesis. Makasar : Universitas Hassanudin, 2007.

F. Edya, “Comparative Analysis of INA-CBGs Rates with Hospital Rates and Cost Recovery Rates for Inpatient BPJS Health Participants (Case Study at RSUD dr. Achmad Mochtar Bukittinggi)” Thesis. Padang: Universitas Andalas, 2017.

S. Aulia, Supriadi, K. Dewi, M. Arthaingan, “Cost Recovery Tariff for BPJS Health National Health Insurance Program”, Akuntabilitas, vol. 8, no. 2, 2015, pp. 111–120.

W. Budiarto, M. Sugiharto, “INA CBGs Claim Costs and Real Costs of Catastrophic Diseases in Jamkesmas Participants at Study Hospitals in 10 Hospitals Owned by the Ministry of Health January– March 2012”, Buletin Penelitian Sistem Kesehatan, vol. 16, no. 1, 2013, pp. 58–65

W. Maryati, N. Yuliani, AI Justika, “Hospital Characteristics And Accuracy of Diagnosis Codes Affect INA-CBGs Claim Results”, LINK vol. 16, no. 2, 2020, pp. 141-148

W Maryati, IO Rahayuningrum, VN Astuti, “Hospital Tariff Gap With Final Claims in The Indonesian Case Base Groups (INA-CBGs) System”, Proceeding of ICOHETECH 1, 2019, pp. 40-43

GF. Anderson, J. Hurst, PS. Hussey, MJ. Hughes, “Health spending and outcomes: trends in OECD countries” Health Affairs, vol. 19, no. 3, 2000, pp. 150-157

W. Quentin, D. Scheller-Kreinsen, M. Blumel, A. Geissler, R. Busse, “Hospitalpayment based on diagnosis related groups differs in europe and holds lessons for the united states”, Health Affairs, vol. 32, no. 4, 2012, pp. 713-723

M. Younis, PA. Rivers, MD.Fottler, “The impact of HMO and hospital competition on hospital costs”, Journal healthcare finance, vol. 31, no. 4, 2005, pp. 60-74

HJ. Jiang, B. Friedman, JW. Begun, “Factors assiciated with high quality/ low cost hospital performance”, Journal Healthcare Finance, vol. 32, no. 3, 2006, pp. 39-52

L. Chang, YW. Lan, “Has the national insurance scheme improved hospital efficiency in taiwan ? identifying factors that affects its efficiency”, African Journal of Business Management vol. 4, no. 17, 2010, pp. 3752-3760

JB. Scwartz, DK. Guilkey, R. Racelis, “Decentralization, allocative efficiency and healthcare service outcome in the philipines”, Chapel Hill, NC. University of North California, 2002.

Hosizah, “Case-Mix: Efforts to Control Hospital Service Costs in Indonesia”, Forum Ilmiah Indonusa vol. 4, no. 3, 2007.

D. Firmanda, “Children's Health Clinical Pathways”, Sari Pediatri, Vol. 8, no. 3, 2006, pp. 195 – 208

DRS Kusumaningtyas, L Kresnowati, D Ernawati, “Analysis of the difference between real hospital costs and INA-CBG rates 3.1 for cases of delivery with cesarean section in Jamkesmas patients at Tugurejo hospital, Semarang first quarter of 2013”, Thesis, Semarang : Universitas Dian Nuswantoro, 2013