Analisis Tarif Layanan BPJS Kesehatan: Studi Kasus Pada Poliklinik Saraf Rumah Sakit X
DOI:
https://doi.org/10.35870/jemsi.v11i6.5286Keywords:
BPJS Kesehatan, INA-CBGs, Service Rates, Hospitals, CasemixAbstract
The Jaminan Kesehatan Nasional (JKN) system with the INA-CBG's payment scheme is the basis for payment of BPJS Kesehatan claims to hospitals. However, many hospitals complain about discrepancies between BPJS-provided rates and the actual cost of hospital services. This discrepancy has the potential to impact hospital finances, resulting in losses. The purpose of this research To determine the factors causing these rate discrepancies and the hospital's strategies to deal with tariff discrepancies. This research is a qualitative analysis with a case study design. Secondary data were collected from hospital service and financial data in 2024. Primary data were obtained through in-depth interviews with hospital management and functional staffs. Descriptive analysis of the secondary data was conducted, and the interview data were analyzed qualitatively to explore the factors causing these rate discrepancies and the hospital's strategies to deal with tariff discrepancies. Interviews were conducted in May-June 2025. research results show There was a negative difference in service costs for BPJS patients based on the INA-CBGs tariff package and the hospital's neurology polyclinic rates in 2024, amounting to 30.3%. The cost factor that contributed most to the difference in rates was the cost of medicines at 28.4%. Factors contributing to this difference were related to the complexity of patient cases in the neurology polyclinic, the majority of which are chronic disease patients. The hospital implemented strategies to address this situation, including optimizing the use of digitalization systems, establishing a casemix team, developing a Clinical Pathway, implementing a cross-subsidy strategy, negotiating with BPJS verifiers for pending claims, and improving human resource competency.
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