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Abstract

The INA-CBGs payment system in the National Health Insurance (JKN) program requires hospitals to improve cost efficiency through quality and cost containment. This study aims to analyze the implementation of the Clinical Pathway (CP) for diabetic ulcers, calculate the unit cost of care, and evaluate the Cost Recovery Rate (CRR) at XYZ Hospital, Central Java, using the Activity-Based Costing (ABC) method. A descriptive quantitative study with a cross-sectional design was conducted on all inpatients with a single diagnosis of diabetic ulcer without comorbidities from October to December 2024. Data were collected through activity-based CP observation, medical record review, and hospital financial reports. This study shows that the CP for diabetic ulcers is mostly implemented according to protocol, with mandatory actions concentrated in the first three days of hospitalization. However, variations in length of stay (LOS) and clinical interventions persist based on patient needs. CP optimization and LOS control are crucial, as they strongly correlate with cost efficiency and service quality under the INA-CBGs scheme. Patients without surgery had 558.5 minutes of activity and a unit cost of IDR 1,974,120 (70% direct, 30% overhead; CRR 222%), while those with debridement had 1,051 minutes and a unit cost of IDR 5,275,858 (79% direct, 21% overhead; CRR 83%). INA-CBGs groups different interventions under the same case category, causing payment disparities and risking hospital financial sustainability. The study recommends revisiting INA-CBGs tariffs, enforcing disciplined CP implementation, and optimizing activity-based cost management to maintain efficiency and healthcare quality.

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Bahasa Abstract

Sistem pembayaran INA-CBGs pada Jaminan Kesehatan Nasional (JKN) menuntut rumah sakit untuk melakukan efisiensi biaya melalui pengendalian mutu dan biaya layanan. Penelitian ini bertujuan menganalisis implementasi Clinical Pathway (CP) ulkus diabetes, menghitung unit cost perawatan, dan mengevaluasi Cost Recovery Rate (CRR) di Rumah Sakit XYZ di Jawa Tengah, menggunakan metode Activity-Based Costing (ABC). Studi deskriptif kuantitatif dengan desain cross-sectional dilakukan terhadap seluruh pasien rawat inap JKN dengan diagnosis tunggal ulkus diabetes tanpa komorbid pada Oktober–Desember 2024. Data dikumpulkan melalui observasi aktivitas berbasis CP, telaah rekam medis, dan laporan keuangan rumah sakit. Hasil penelitian menunjukkan implementasi CP ulkus diabetes sebagian besar telah sesuai protokol, dengan tindakan wajib terkonsentrasi pada tiga hari pertama rawat inap. Meskipun demikian, masih ditemukan variasi pada length of stay (LOS) dan jenis intervensi sesuai kebutuhan klinis masing-masing pasien. Optimalisasi CP dan pengendalian LOS terbukti krusial karena berkorelasi kuat dengan efisiensi biaya serta peningkatan mutu layanan dalam skema pembayaran INA-CBGs. Selanjutnya, pasien tanpa intervensi bedah memiliki total aktivitas 558,5 menit dan unit cost Rp1.974.120, terdiri atas 70% biaya langsung dan 30% biaya overhead, dengan CRR 222%. Sementara pasien dengan debridemen mencatat aktivitas 1.051 menit dan unit cost Rp5.275.858, dengan 79% biaya langsung dan 21% biaya overhead, serta CRR 83%. Skema pembayaran INA-CBGs mengelompokkan kasus ulkus diabetes dengan tindakan berbeda dalam satu grup kasus yang sama, sehingga menimbulkan disparitas pembayaran dan berpotensi mengancam keberlanjutan finansial rumah sakit. Studi ini merekomendasikan perlunya evaluasi kebijakan tarif INA-CBGs, penguatan implementasi CP secara disiplin, serta peningkatan manajemen biaya berbasis aktivitas guna menjaga efisiensi serta mutu layanan kesehatan.

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