Revenue Projection of Padang Panjang General Hospital Based on Standard Inpatient Class (KRIS) Policy Based on Ina-CBGs Tariff Simulation
DOI:
https://doi.org/10.69855/laceri.v2i2.744Keywords:
Clinical Governance, Kris, Ina-Cbgs, Revenue Projection, Regional HospitalAbstract
The Standard Inpatient Class (KRIS) policy, which replaces the BPJS Kesehatan class 1, 2, and 3 system, poses financial implications for regional public hospitals, particularly regarding conformity of INA-CBGs tariffs to real service costs. This tariff gap can suppress hospital cash flow, leaving Padang Panjang Hospital, a Regional Referral Hospital, with uncertain revenue projections following KRIS implementation. Purpose: This study aims to analyze the projected revenue of Padang Panjang Hospital based on INA-CBGs tariff simulation under the KRIS scheme. Methods: The study used a quantitative descriptive design using a retrospective approach on secondary data, conducted at Padang Panjang Hospital, West Sumatra. The sample comprised all inpatient claims from January–December 2025, totaling 1,240 episodes, selected through total sampling. Data were collected via documentation study of medical record and INA-CBGs claim data. Univariate analysis described the distribution of tariffs and case volumes, while bivariate analysis used the Paired t-test/Wilcoxon test to examine tariff differences and Pearson correlation to examine the relationship between case severity and tariff differences. Results: Results showed a mean difference between real and INA-CBGs tariffs of IDR 387,500 per episode (SD = 112,300), with a projected revenue decrease of 8.7% following KRIS implementation. Bivariate analysis showed a significant relationship between case severity and tariff difference magnitude (p = 0.012; r = 0.341). Implications: These findings imply the need to strengthen clinical pathways and improve operational cost efficiency. Conclusion: Padang Panjang Hospital needs to develop a case-mix strategy and a real-time claims monitoring system to maintain financial sustainability in the KRIS era
References
Averill, R. F., Goldfield, N. I., Hughes, J. S., Bonazelli, J., McCullough, E. C., Steinbeck, B. A., Mullin, R. L., Tang, A. M., & Muldoon, J. H. (2020). Development and evaluation of the Medicare Severity Diagnosis Related Group (MS-DRG) system. Journal of Healthcare Management, 65(2), 85–97.
Barasa, E., Kazungu, J., Nguhiu, P., & Ravishankar, N. (2022). Examining the level and inequality of health insurance coverage in sub-Saharan Africa. BMJ Global Health, 7, e008189. https://doi.org/10.1136/bmjgh-2021-008189
Braithwaite, J., Testa, L., Lamprell, G., Herkes, J., Ludlow, K., & McPherson, E. (2020). Built to last? The sustainability of healthcare quality improvement initiatives. BMJ Quality & Safety, 29(10), 805–813. https://doi.org/10.1136/bmjqs-2019-010207
Buntin, M. B., Haviland, A. M., McDevitt, R., & Sood, N. (2022). Healthcare spending and quality under alternative payment models: Evidence from bundled payment systems. Health Affairs, 41(3), 366–374. https://doi.org/10.1377/hlthaff.2021.01492
Dewi, R., Laksono, A. D., & Wulandari, R. D. (2024). Health financing challenges and hospital sustainability under national health insurance implementation in Indonesia. BMC Health Services Research, 24, Article 112. https://doi.org/10.1186/s12913-024-10612-5
Ham, C., Berwick, D., & Dixon, J. (2021). Improving quality and efficiency in healthcare through clinical governance. International Journal for Quality in Health Care, 33(2), mzab049. https://doi.org/10.1093/intqhc/mzab049
Kementerian Kesehatan Republik Indonesia. (2019). Regulation of the Minister of Health of the Republic of Indonesia Number 16 of 2019 concerning the Prevention and Handling of Fraud and the Imposition of Administrative Sanctions for Fraud in the Implementation of the Health Insurance Program. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2021). Regulation of the Minister of Health of the Republic of Indonesia Number 26 of 2021 concerning Guidelines for Indonesian Case Base Groups (INA-CBG) in the Implementation of the Health Insurance Program. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2023). Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Standard Tariffs for Health Services in the Implementation of the Health Insurance Program. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2024a). Regulation of the Minister of Health of the Republic of Indonesia Number 16 of 2024 concerning the Referral System for Individual Health Services. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2024b). Standard Inpatient Class (KRIS) in the Transformation of the National Health Insurance System. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2022). Indonesia Health System Transformation and National Health Insurance Implementation Report. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kruse, C. S., Kothman, K., Anerobi, C., & Abanaka, L. (2020). Adoption factors of the electronic health record: A systematic review. JMIR Medical Informatics, 8(6), e17368. https://doi.org/10.2196/17368
Kutzin, J., Witter, S., Jowett, M., & Bayarsaikhan, D. (2021). Developing a national health financing strategy: A reference guide. World Health Organization.
Mathauer, I., Dale, E., Jowett, M., & Kutzin, J. (2021). Purchasing health services for universal health coverage: How to make it more strategic? World Health Organization Technical Series.
Ministry of Health Republic of Indonesia. (2022). Indonesia Health System Transformation and National Health Insurance Implementation Report. Jakarta: Ministry of Health Republic of Indonesia.
Nugraheni, W. P., Hartono, R. K., & Kusumawardani, N. (2023). Strengthening hospital governance for improving healthcare quality and efficiency in Indonesia. Health Policy and Planning, 38(5), 623–632. https://doi.org/10.1093/heapol/czad015
Nurwahyuni, A., Hidayat, B., & Pujiyanto. (2022). Cost analysis and reimbursement adequacy of INA-CBGs payment system in Indonesian hospitals. BMC Health Services Research, 22, Article 1457. https://doi.org/10.1186/s12913-022-08798-1
O’Malley, A. S., Reschovsky, J. D., & Saiontz-Martinez, C. (2021). Clinical documentation improvement and payment accuracy in diagnosis-related group systems. Health Care Management Review, 46(4), 310–319.
Pemerintah Republik Indonesia. (2024). Presidential Regulation of the Republic of Indonesia Number 59 of 2024 concerning the Third Amendment to Presidential Regulation Number 82 of 2018 concerning Health Insurance. Jakarta: Pemerintah Republik Indonesia.
Papanicolas, I., Mossialos, E., Gundersen, A., Woskie, L., & Jha, A. K. (2023). Performance of healthcare systems under financial pressure: International perspectives. The Lancet, 401, 2137–2149. https://doi.org/10.1016/S0140-6736(23)00738-8
Pratiwi, A., Nurwahyuni, A., & Pujiyanto. (2021). Analysis of INA-CBGs tariff differences and hospital costs in the Indonesian National Health Insurance Program. Kesmas: National Public Health Journal, 16(3), 145–152. https://doi.org/10.21109/kesmas.v16i3.4815
Rotter, T., Kinsman, L., James, E., Machotta, A., Steyerberg, E., & DiCenso, A. (2020). Clinical pathways as a quality strategy for healthcare improvement. Cochrane Database of Systematic Reviews, 2020(3). https://doi.org/10.1002/14651858.CD006632.pub3
Sari, R. M., Handayani, P. W., & Hidayanto, A. N. (2022). Hospital information systems and financial performance improvement under national health insurance. BMC Health Services Research, 22, Article 1560. https://doi.org/10.1186/s12913-022-08910-5
World Health Organization. (2021). Health financing for universal health coverage: Principles and progress. Geneva: World Health Organization.
World Health Organization. (2024). Global health expenditure report 2024: Strengthening health financing for universal health coverage. Geneva: World Health Organization.
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