Determinants of the Difference between Actual Cost and Indonesian Case Based Groups (INA-CBGs) Reimbursement for Birth Delivery at Hospitals in Mataram, West Nusa Tenggara
Abstract
Background: Health is the part of the economic and social development of the state. The application of the BPJS Health national social security system in Indonesia is one of the government's efforts to provide health financing protection for all citizens and prevent catastrophic health expenditures. Hospitals as providers of secondary or tertiary health services often suffer losses because the payment system from BPJS Kesehatan uses a case-based payment method or INA-CBGs. This study aimed to examine the factors that influence the difference in rates between INA-CBGs rates and real hospital rates in labor cases.
Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was carried out in Mataram and Siti Hajar Mataram Islamic hospitals, Mataram, West Nusa Tenggara, in May 2019. A sample of 200 postpartum women was selected by stratified random sampling. The dependent variable was the difference between real cost and INA-CBGs reimbursement. The independent variables were the type of hospital, class of treatment, type of birth delivery, length of stay, and severity disease. The data were collected from the medical record and analyzed by a multiple linear regression run on Stata 13.
Results: Difference between real cost and INA-CBGs tariff of birth delivery reimbursement was negatively affected by type III of class treatment (b = -390,725; 95% CI= -790,082 to 8,631; p= 0,055), section caesarean (b= -1,429,648; 95% CI= -1,811,275 to -1,048,022; p <0.001), length of stay (b= -211,912; CI (95%) = -427,786 to 3,960; p = 0.054), moderate severity (b= -114,028; 95% CIi= -507,057 to 279,000; p = 0.568), and the high level of severity (b = -1,735,612; CI (95%) = -3,482,347 to 11,123; p = 0.051). The INA-CBGs rate difference and RS real rates of labor cases decreased due to the classification of private hospitals (b = 281,021; CI (95%) = -73,054 to 635,097; p = 0,119), treatment class II (b = 8,736; CI (95 %) = -392,068 to 409,541; p = 0.966).
Conclusion: The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases would increase if it serves treatment class III, type of cesarean delivery, care days which are longer, and moderate or severe severity. The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases can decrease in services at private hospitals and serve treatment classes II.
Keywords: INA-CBGs rates, hospital real rates, labor costs.
Correspondence: Baiq Holisatul Ismiana. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Jawa Tengah, Indonesia. Email: baiqholis26@gmail.com. Mobile: +6287739031046.
Journal of Health Policy and Management (2019), 4(3): 161-169
https://doi.org/10.26911/thejhpm.2019.04.03.03
References
Borghans I, Lagoe RJ, Kool T, Westert GP (2012). Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital. Health Policy. 104(3): 222-33. doi: 10.1016/j.healthpol.2011.12.010.
Entringer AP, Pinto M, Gomes MA (2018) Cost-effectiveness analysis of natural birth and elective C-section in supplemental health. Rev Saude Publica. 52: 91. doi: 10.11606/S15188787.2018052000373.
Entringer AP, Pinto M, Gomes MA (2019). Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian Unified National Health System. Ciênc. Saúdecoletiva. 24(4) Rio de Janeiro. doi: 10.1590/141381232018244.06962017
Herrmann N, Tam DY, Balshaw R, Sambrook R, Lesnikova N, Lanctôt KL (2010). The relation between disease severity and cost of caring for patients with Alzheimer disease in Canada. Can J Psychiatry. 55(12): 768-75. doi: 10.1177/070674371005501204
Howland RE, Angley M, Won SH, Wilcox W, Searing H, Tsao TY (2018). Estimating the hospital delivery costs associated with severe maternal morbidity in New York City, 2008-2012. Obstet Gynecol. 131(2):242-252. doi: 10.1097/AOG.000000000000-2432.
Kemenkes RI (2018). Profil Kesehatan Indonesia Tahun 2017 (Indonesia Health Profile 2017). Jakarta: Kementerian Kesehatan RI
Mardhatillah, Tamtomo DG, Murti B (2017). Factors influencing the difference between Indonesian CaseBased Group reimbursement and medical cost for patients with chronic renal disease cases in Kasih Ibu Hospital, Surakarta. Journal of Health Policy and Management. 2(2): 117-127. doi: 10.26911/thejhpm.2017.02.02.03
Muslimah, Andayani TM, Pinzon R, Endarti D (2017). Comparison of Real Costs against the Price of INACBG's Ischemic Stroke in Bethesda Hospital. Jurnal Manajemen dan Pelayanan Farmasi. 7(2). doi: 10.22146/jmpf.30289
OECD (2013). Average length of stay in hospitals, in Health at a Glance 2013: OECD Indicators, OECD Publishing, Paris. doi: 10.1787/health_glance2013-36-en
Ministry of Health Regulation of RI No. 76 in 2016 Pedoman Indonesian Case Base Groups dalam pelaksanaan jaminan kesehatan nasional.
Rahayuningrum IO, Tamtomo DG, Murti B (2017). 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 1(2): 102-112. doi: 10.26911/theicph.2017.138
Spaan E, Mathijssen J, Tromp N, McBain F, Haveb AT, Baltussen R (2012). The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ, 90:685–692A. doi: 10.2471/BLT.12.102301
Trisnantoro L (2004). Memahami Ilmu Ekonomi Dalam Manajemen Rumah Sakit (Understanding Economics in Hospital Management). Yogyakarta; Gadjah Mada University Press
UU Republik Indonesia No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional (Republic of Indonesia Law No.40 of 2004 concerning the National Social Security System).
WHO (2010a). Health systems financing: The path to universal coverage; World Health Report 2010. Retrieved from http://www.who.int/whr/2010/en/
WHO (2010b). WHO urges all countries to strengthen health financing so more people can use services. Retrieved from http://www.who.int/mediacentre/news/releases/2010/whr_20101122/en/
Yuniarti E, Amalia, Handayani TM (2015). Analisis biaya terapi penyakit diabetes melitus pasien jaminan kesehatan nasional di RS PKU Muhammadiyah Yogyakarta: Perbandingan terhadap tarif INA CBGs. Jurnal Kebijakan Kesehatan Indonesia. 4(3): 97-103. doi: 10.22146/jkki.v4i3.36108.
