Cost-to-Revenue Dynamics of Indonesia’s National Health-Insurance (BPJS Kesehatan) Services: Evidence from a Government Hospital Case Study
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https://doi.org/10.24843/EJA.2025.v35.i05.p08
Abstrak
This study employs the cost-recovery rate (CRR) to evaluate the profitability of services delivered to National Health Insurance (BPJS Kesehatan) patients at the Regional General Hospital of Buleleng Regency. The hospital was selected for its comprehensive BPJS Kesehatan coverage, robust financial records, and logistical accessibility. Adopting a quantitative descriptive design, we juxtapose case-level revenues against corresponding costs to trace profitability patterns across key diagnoses. The analysis reveals positive CRR values—indicating financial surpluses—for stroke, acute diarrhoea, diabetes mellitus, and dengue haemorrhagic fever, yet shows a deficit for heart-failure management. These results provide an empirical basis for hospital administrators and policy-makers to refine reimbursement tariffs and optimise resource allocation in the treatment of BPJS Kesehatan patients.
Keywords: Hospital Profitability; BPJS Kesehatan; Cost Recovery Rate.
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Referensi
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Ahmad, S. R., & Khan, I. A. (2024). Effectiveness and impact of management accounting in hospitals: Evaluation of the effectiveness of cost accounting and revenue budgeting. Journal of Infrastructure, Policy and Development, 8(5), 4159.
Arfiani, M., & Fahlevi, H. (2020). Cost Recovery Rate dan Pengendalian Biaya di Rumah Sakit: Studi kasus pada Rumah Sakit Pemerintah. Jurnal ASET (Akuntansi Riset), 12(2), 372–383.
Ariwardani, B. N., Tamtomo, D. G., & Murti, B. (2019). Factors affecting the cost gap between INA CBGs tariff and hospital tariff for patients with dengue hemorrhagic fever in Ngawi regional public hospital, East Java. Journal of Health Policy and Management, 4(3), 204–213.
Aulia, S., Supriadi, S., Sari, D. K., & Mutiha, A. (2015). Cost recovery rate program jaminan kesehatan nasional BPJS kesehatan. Akuntabilitas, 8(2), 111–120.
Evans, J., Kobewka, D., Thavorn, K., D’Egidio, G., Rosenberg, E., & Kyeremanteng, K. (2018). The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada. Canadian Journal of Anesthesia, 65(6), 627–635.
Fahlevi, H. (2016). Understanding why the role of accounting is unchanged in Indonesian public hospitals. Journal of Accounting & Organizational Change, 12(2), 203–222.
Fahlevi, H., Irsyadillah, I., Arafat, I., & Adnan, M. I. (2022). The inefficacy of accrual accounting in public sector performance management: Evidence from an emerging market. Cogent Business & Management, 9(1), 2122162.
Fahlevi, H., Irsyadillah, I., Indriani, M., & Oktari, R. S. (2022). DRG-based payment system and management accounting changes in an Indonesian public hospital: exploring potential roles of big data analytics. Journal of Accounting & Organizational Change, 18(2), 325–345.
Indupurnahayu, I., Aminda, R. S., & Rahayu, R. (2021). Komparasi Penetapan Tarif INA_CBGs dan Tarif Rumah Sakit dengan Diagnosa Dengue Hemorrhagic Fever (DHF) Peserta Jaminan Kesehatan Nasional, Studi Empiris di Rumah Sakit Medika Dramaga-Bogor. Jurnal Manajemen (Edisi Elektronik), 12(1), 66–77.
Kuo, C.-Y., Yu, L.-C., Chen, H.-C., & Chan, C.-L. (2018). Comparison of models for the prediction of medical costs of spinal fusion in Taiwan diagnosis-related groups by machine learning algorithms. Healthcare Informatics Research, 24(1), 29–37.
Lachmann, M., Trapp, R., & Wenger, F. (2024). Transparency in performance measurement systems: an exploration of rationales and diverging perceptions in the hospital setting. Journal of Management Control, 1–41.
Maharani, A., Femina, D., & Tampubolon, G. (2015). Decentralization in Indonesia: lessons from cost recovery rate of district hospitals. Health Policy and Planning, 30(6), 718–727.
Mardaleta, M., Lubis, A. R., Diantimala, Y., & Fahlevi, H. (2022). Determinants of patient behavioural loyalty on primary health centres: Evidence from a cross-sectional study in Indonesia. F1000Research, 11.
Mardiah, M. (2015). Cost Recovery Rate Tarif Rumah Sakit dan Tarif INA-CBG’s Berdasarkan Clinical Pathway pada Penyakit Arteri Koroner di RSUP Dr. Mohammad Hoesin Palembang Tahun 2015. Jurnal ARSI (Administrasi Rumah Sakit Indonesia), 2(3), 7.
Marques, I. C. P., & Alves, M.-C. (2023). Hospital Costing Methods: Four Decades of Literature Review. Journal of Risk and Financial Management, 16(10), 433.
Marwan, A., Prapanca, Y., Himawati, S., & Widiyaningsih, C. (2024). Analisis Biaya Satuan (Unit Cost) Penggunaan Alat Ventilator lama rawat 3 hari Pada Pasien Diagnosis Utama Respiratory Failure (J969) Dengan Kode INA-CBG J-1-20-III di Ruang Intensive Care Unit (ICU) Rumah Sakit Hermina OPI Jakabaring. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 8(1), 1–25.
Mutmainnah, A. A., & Shinta, G. (2024). Analisis Cost Recovery Rate Pada Pasien Geriatri Di Unit Rehabilitasi Medis Di Rumah Sakit Siloam Asri. Jurnal Administrasi Bisnis (JAB), 14(3), 250–263.
Nelson-Williams, H., Gani, F., Kilic, A., Spolverato, G., Kim, Y., Wagner, D., Amini, N., Ejaz, A., & Pawlik, T. M. (2016). Factors associated with interhospital variability in inpatient costs of liver and pancreatic resections. JAMA Surgery, 151(2), 155–163.
Nurkholis, N., Mardiati, E., Fachriyah, N., Prayudi, M. A., & Widaninggar, N. (2023). Is it possible to achieve a" fit" of management control practices and strategies in Indonesia’s reformed public hospitals? Journal of Accounting and Investment, 24(2), 272–291.
Permenkes, R. I. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 27 Tahun 2014 tentang Petunjuk Tekniks Sistem Indonesian Case Base Groups (INA-CBGs). Jakarta.
Polverejan, E., Gardiner, J. C., Bradley, C. J., Holmes‐Rovner, M., & Rovner, D. (2003). Estimating mean hospital cost as a function of length of stay and patient characteristics. Health Economics, 12(11), 935–947.
Sun, L., Wang, T., Hui, B., Li, Y., & Tian, L. (2022). Explainable and personalized medical cost prediction based on multitask learning over mobile devices. Mobile Information Systems, 2022(1), 8966266.
Theodorakopoulos, L., Thanasas, G., & Halkiopoulos, C. (2024). Implications of Big Data in Accounting: Challenges and Opportunities. Emerging Science Journal, 8(3), 1201–1214.
Upadhyay, S., Weech-Maldonado, R., Lemak, C. H., Stephenson, A., Mehta, T., & Smith, D. G. (2020). Resource-based view on safety culture’s influence on hospital performance: The moderating role of electronic health record implementation. Health Care Management Review, 45(3), 207–216.
Wu, S.-W., Pan, Q., & Chen, T. (2020). Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model. World Journal of Clinical Cases, 8(12), 2484.
Ahmad, S. R., & Khan, I. A. (2024). Effectiveness and impact of management accounting in hospitals: Evaluation of the effectiveness of cost accounting and revenue budgeting. Journal of Infrastructure, Policy and Development, 8(5), 4159.
Arfiani, M., & Fahlevi, H. (2020). Cost Recovery Rate dan Pengendalian Biaya di Rumah Sakit: Studi kasus pada Rumah Sakit Pemerintah. Jurnal ASET (Akuntansi Riset), 12(2), 372–383.
Ariwardani, B. N., Tamtomo, D. G., & Murti, B. (2019). Factors affecting the cost gap between INA CBGs tariff and hospital tariff for patients with dengue hemorrhagic fever in Ngawi regional public hospital, East Java. Journal of Health Policy and Management, 4(3), 204–213.
Aulia, S., Supriadi, S., Sari, D. K., & Mutiha, A. (2015). Cost recovery rate program jaminan kesehatan nasional BPJS kesehatan. Akuntabilitas, 8(2), 111–120.
Evans, J., Kobewka, D., Thavorn, K., D’Egidio, G., Rosenberg, E., & Kyeremanteng, K. (2018). The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada. Canadian Journal of Anesthesia, 65(6), 627–635.
Fahlevi, H. (2016). Understanding why the role of accounting is unchanged in Indonesian public hospitals. Journal of Accounting & Organizational Change, 12(2), 203–222.
Fahlevi, H., Irsyadillah, I., Arafat, I., & Adnan, M. I. (2022). The inefficacy of accrual accounting in public sector performance management: Evidence from an emerging market. Cogent Business & Management, 9(1), 2122162.
Fahlevi, H., Irsyadillah, I., Indriani, M., & Oktari, R. S. (2022). DRG-based payment system and management accounting changes in an Indonesian public hospital: exploring potential roles of big data analytics. Journal of Accounting & Organizational Change, 18(2), 325–345.
Indupurnahayu, I., Aminda, R. S., & Rahayu, R. (2021). Komparasi Penetapan Tarif INA_CBGs dan Tarif Rumah Sakit dengan Diagnosa Dengue Hemorrhagic Fever (DHF) Peserta Jaminan Kesehatan Nasional, Studi Empiris di Rumah Sakit Medika Dramaga-Bogor. Jurnal Manajemen (Edisi Elektronik), 12(1), 66–77.
Kuo, C.-Y., Yu, L.-C., Chen, H.-C., & Chan, C.-L. (2018). Comparison of models for the prediction of medical costs of spinal fusion in Taiwan diagnosis-related groups by machine learning algorithms. Healthcare Informatics Research, 24(1), 29–37.
Lachmann, M., Trapp, R., & Wenger, F. (2024). Transparency in performance measurement systems: an exploration of rationales and diverging perceptions in the hospital setting. Journal of Management Control, 1–41.
Maharani, A., Femina, D., & Tampubolon, G. (2015). Decentralization in Indonesia: lessons from cost recovery rate of district hospitals. Health Policy and Planning, 30(6), 718–727.
Mardaleta, M., Lubis, A. R., Diantimala, Y., & Fahlevi, H. (2022). Determinants of patient behavioural loyalty on primary health centres: Evidence from a cross-sectional study in Indonesia. F1000Research, 11.
Mardiah, M. (2015). Cost Recovery Rate Tarif Rumah Sakit dan Tarif INA-CBG’s Berdasarkan Clinical Pathway pada Penyakit Arteri Koroner di RSUP Dr. Mohammad Hoesin Palembang Tahun 2015. Jurnal ARSI (Administrasi Rumah Sakit Indonesia), 2(3), 7.
Marques, I. C. P., & Alves, M.-C. (2023). Hospital Costing Methods: Four Decades of Literature Review. Journal of Risk and Financial Management, 16(10), 433.
Marwan, A., Prapanca, Y., Himawati, S., & Widiyaningsih, C. (2024). Analisis Biaya Satuan (Unit Cost) Penggunaan Alat Ventilator lama rawat 3 hari Pada Pasien Diagnosis Utama Respiratory Failure (J969) Dengan Kode INA-CBG J-1-20-III di Ruang Intensive Care Unit (ICU) Rumah Sakit Hermina OPI Jakabaring. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 8(1), 1–25.
Mutmainnah, A. A., & Shinta, G. (2024). Analisis Cost Recovery Rate Pada Pasien Geriatri Di Unit Rehabilitasi Medis Di Rumah Sakit Siloam Asri. Jurnal Administrasi Bisnis (JAB), 14(3), 250–263.
Nelson-Williams, H., Gani, F., Kilic, A., Spolverato, G., Kim, Y., Wagner, D., Amini, N., Ejaz, A., & Pawlik, T. M. (2016). Factors associated with interhospital variability in inpatient costs of liver and pancreatic resections. JAMA Surgery, 151(2), 155–163.
Nurkholis, N., Mardiati, E., Fachriyah, N., Prayudi, M. A., & Widaninggar, N. (2023). Is it possible to achieve a" fit" of management control practices and strategies in Indonesia’s reformed public hospitals? Journal of Accounting and Investment, 24(2), 272–291.
Permenkes, R. I. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 27 Tahun 2014 tentang Petunjuk Tekniks Sistem Indonesian Case Base Groups (INA-CBGs). Jakarta.
Polverejan, E., Gardiner, J. C., Bradley, C. J., Holmes‐Rovner, M., & Rovner, D. (2003). Estimating mean hospital cost as a function of length of stay and patient characteristics. Health Economics, 12(11), 935–947.
Sun, L., Wang, T., Hui, B., Li, Y., & Tian, L. (2022). Explainable and personalized medical cost prediction based on multitask learning over mobile devices. Mobile Information Systems, 2022(1), 8966266.
Theodorakopoulos, L., Thanasas, G., & Halkiopoulos, C. (2024). Implications of Big Data in Accounting: Challenges and Opportunities. Emerging Science Journal, 8(3), 1201–1214.
Upadhyay, S., Weech-Maldonado, R., Lemak, C. H., Stephenson, A., Mehta, T., & Smith, D. G. (2020). Resource-based view on safety culture’s influence on hospital performance: The moderating role of electronic health record implementation. Health Care Management Review, 45(3), 207–216.
Wu, S.-W., Pan, Q., & Chen, T. (2020). Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model. World Journal of Clinical Cases, 8(12), 2484.
Diterbitkan
2025-02-07
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MARTADINATA, I Putu Hendra; MUSMINI, Lucy Sri; PRAYUDI, Made Aristia.
Cost-to-Revenue Dynamics of Indonesia’s National Health-Insurance (BPJS Kesehatan) Services: Evidence from a Government Hospital Case Study.
E-Jurnal Akuntansi, [S.l.], v. 35, n. 5, feb. 2025.
ISSN 2302-8556.
Tersedia pada: <https://ojs.unud.ac.id/index.php/akuntansi/article/view/124063>. Tanggal Akses: 14 oct. 2025
doi: https://doi.org/10.24843/EJA.2025.v35.i05.p08.
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