Analisis Komparatif Biaya Klaim Pasien Diabetes Melitus Berdasarkan Tingkat Keparahan: Studi Big Data Jaminan Kesehatan Nasional
DOI:
https://doi.org/10.54259/sehatrakyat.v5i2.7316Kata Kunci:
Diabetes Mellitus, BPJS Kesehatan, INA-CBGs, Severity Level, Claim CostAbstrak
Diabetes Mellitus (DM) poses a substantial financial burden on Indonesia’s National Health Insurance (JKN), particularly for inpatient services at Advanced Referral Health Facilities (FKRTL). The INA-CBGs payment system classifies cases by severity level to determine BPJS Kesehatan reimbursement. This study aimed to examine differences in BPJS Kesehatan claim costs according to DM severity levels among hospitalized patients. A quantitative comparative design was applied using the 2025 BPJS Kesehatan Sample Data. A total of 58,101 inpatient DM claims were analyzed using total sampling. The independent variable was INA-CBGs severity level, and the dependent variable was total BPJS Kesehatan claim cost. Data were analyzed descriptively and inferentially using the Kruskal–Wallis test followed by post-hoc Mann–Whitney U tests with Bonferroni correction. The results indicated a consistent increase in length of stay and median claim costs with higher severity levels. Median claim costs were IDR 4,038,200 for mild cases, IDR 5,748,650 for moderate cases, and IDR 8,627,650 for severe cases. Differences in claim costs across severity levels were statistically significant (p < 0.05). In conclusion, DM severity level is significantly associated with BPJS Kesehatan claim costs, indicating that the INA-CBGs system adequately differentiates reimbursement based on case complexity.
Unduhan
Referensi
Ahsan, A., Baros, W. A., Siregar, D. R., Pertiwi, Y. B. A., Utami, M. G., Aminde, L., Manurung, K. K., & Febriyanti, M. (2025). Correlation between economic status and severity of type 2 diabetes mellitus in Indonesia: Analysis of claim data from the national health insurance scheme, 2018-2022. BMJ Open , 15(5). https://doi.org/10.1136/bmjopen-2024-091115
Alvianto, M. J., & Pribadi, F. (2025). Analysis of Indonesian Case-Based Groups with Global Budget Pilot Project Implementation. Indonesian Journal of Innovation Studies, 26(4), 1. https://doi.org/10.21070/ijins.v26i4.1419
Andersson, E., Persson, S., Hallén, N., Ericsson, Å., Thielke, D., Lindgren, P., Steen Carlsson, K., & Jendle, J. (2020). Costs of diabetes complications: hospital-based care and absence from work for 392,200 people with type 2 diabetes and matched control participants in Sweden. Diabetologia, 63(12), 2582–2594. https://doi.org/10.1007/s00125-020-05277-3
Arshad, M. S., Alqahtani, F., & Rasool, M. F. (2024). A Systematic Review of the Economic Burden of Diabetes in Eastern Mediterranean Region Countries. Diabetes, Metabolic Syndrome and Obesity, 17, 479–487. https://doi.org/10.2147/DMSO.S440282
Asante, A., Cheng, Q., Susilo, D., Satrya, A., Haemmerli, M., Fattah, R. A., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., & Wiseman, V. (2023). The benefits and burden of health financing in Indonesia: analyses of nationally representative cross-sectional data. The Lancet Global Health, 11(5), e770–e780. https://doi.org/10.1016/S2214-109X(23)00064-5
Asegu, L. M., Kitschen, A., Neuwirth, M. M., & Sauerland, D. (2024). The economic burden of nosocomial infections for hospitals: evidence from Germany. BMC Infectious Diseases, 24(1), 1. https://doi.org/10.1186/s12879-024-10176-8
Bala, C., Rusu, A., Ciobanu, D., & Roman, G. (2022). Length of Hospital Stay, Hospitalization Costs, and Their Drivers in Adults with Diabetes in the Romanian Public Hospital System. International Journal of Environmental Research and Public Health, 19(16), 1–13. https://doi.org/10.3390/ijerph191610035
Chalkley, M., Hidayat, B., Ramadani, R. V., & Aragón, M. J. (2022). The sensitivity of hospital coding to prices: evidence from Indonesia. International Journal of Health Economics and Management, 22(2), 147–162. https://doi.org/10.1007/s10754-021-09312-7
Copello, F., Dattaro, M., Leporatti, L., & Montefiori, M. (2025). Adjusting hospital reimbursements to the onset of a new disease: Lesson from Covid-19. Health Policy OPEN, 9, 11–19. https://doi.org/10.1016/j.hpopen.2025.100148
Fadila, R., Purnamasari, A. T., & Dewiyani, A. A. I. C. (2025). Direct Medical Costs of Diabetes Mellitus Treatment for Patients with Cardiovascular and Renal Complications. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 20(5), 21–27. https://doi.org/10.7454/kesmas.v20isp1.2124
Febriany, F. (2023). Kualitas Hidup Peserta Prolanis Diabetes Melitus Tipe II: A Systematic Review. Jurnal Jaminan Kesehatan Nasional, 3(2), 56–64. https://doi.org/10.53756/jjkn.v3i2.169
Hidayat, B., Ramadani, R. V., Rudijanto, A., Soewondo, P., Suastika, K., & Siu Ng, J. Y. (2022). Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value in Health Regional Issues, 28, 82–89. https://doi.org/10.1016/j.vhri.2021.04.006
Islam, Z., Rusdi, N. K., & Nurhasnah. (2017). The Analisys Different of Treatment Diabetes Melitus Type II on General Patients and National Health Insurrance Patients (BPJS). Media Farmasi Jurnal Ilmu Farmasi, 14(2), 151–161. https://doi.org/10.12928/mf.v14i2.11240
Jalmav, M. M. A., & Hoiriyah, Y. (2021). Cost Analysis Terapi Antidiabetik pada Pasien Diabetes Melitus Tipe 2 Rawat Inap di RSU Anwar Medika. Jurnal Farmasi Indonesia, 13(2), 202–209. https://doi.org/10.35617/jfionline.v13i2.130
Li, Q., Fan, X., & Jian, W. (2023). Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China. BMC Health Services Research, 23(1), 1–9. https://doi.org/10.1186/s12913-023-09686-z
Marpaung, F. S. A., Girsang, E., & Lubis, Y. E. P. (2022). Cost-Based Evaluation Of INA-CBG’s Rates In Patients With Type II Diabetes Mellitus Inpatient At Royal Prima Public Hospital Medan. International Journal of Health and Pharmaceutica, 3(2), 294–303. https://doi.org/10.51601/ijhp.v3i3.155
Meliana, M., Jalmav, A., & Hoiriyah, Y. (2021). Cost Analysis Terapi Antidiabetik pada Pasien Diabetes Melitus Tipe 2 Rawat Inap di RSU Anwar Medika. Jurnal Farmasi Indonesia, 13(2), 202–209. https://doi.org/https://doi.org/10.35617/jfionline.v13i2.130
Muhamad, A. N., Teh, C. S. J., Draman, M. R., Adnan, Y. K., Abbas, A. A., Khong, T. L., Narayanan, V., Tang, S. N., Karunakaran, R., Manan, N. A., Kukreja, A., Razali, S. Z. M., Cham, C. Y., Hontz, R. D., Gregory, M. J., Selariu, A., Nguyen, H. C., Letizia, A. G., & Ponnampalavanar, S. S. L. S. (2025). High incidence of multidrug-resistant organisms and modifiable risk factors associated with surgical site infections: a cohort study in a tertiary medical center in Kuala Lumpur, Malaysia from 2020 to 2023. Antimicrobial Resistance and Infection Control, 14(1), 1. https://doi.org/10.1186/s13756-025-01537-2
Nugraha, E. C., Pujiyanto, P., & Permanasari, V. Y. (2024). Utilisation of Hospital Outpatient Services by Diabetes Mellitus Sufferers, Analysis of BPJS Kesehatan Sample Data. Jurnal Jaminan Kesehatan Nasional, 4(2), 144–159. https://doi.org/10.53756/jjkn.v4i2.258
Octa, M. M., Faizatun, Putriana, L., Silvyana, A. E., & Chairunnisa, D. F. (2025). Analisis Biaya INA-CBG Terapi Kombinasi Insulin Pada Pasien BPJS Rawat Jalan Penderita Diabetes Melitus Tipe 2 Di RS Bhakti Kartini. Jurnal Farmasi Higea, 17(2), 175–184. https://doi.org/10.52689/higea.v17i2.757
Patty, Y. F. P. P., Mufarrihah, & Nita, Y. (2021). Cost of illness of diabetes mellitus in Indonesia: a systematic review. Journal of Basic and Clinical Physiology and Pharmacology, 32(4), 285–295. https://doi.org/10.1515/jbcpp-2020-0502
Patty, Y. F. P. P., Nita, Y., & Libriansyah. (2022). Cost of illness analysis of diabetes mellitus with complications in one hospital in Surabaya. Pharmacy Education, 22(2), 254–258. https://doi.org/10.46542/pe.2022.222.254258
Pradnyantara, I. G. A. N. P. (2023). Analisis Selisih Biaya Antara Tarif riil Rumah Sakit Dengan Tarif Ina-CBG’S Pada Kasus Sectio Caesarean Di Rumah Sakit Panti Nugroho. Jurnal Manajemen Informasi Kesehatan Indonesia (JMIKI), 11(2), 91–95. https://doi.org/10.33560/jmiki.v11i2.406
Rahagyan, D. D., Widjaja, L., Fannya, P., & Yulia, N. (2024). Perbandingan Tarif Rumah Sakit dan INA-CBG pada Pasien Diabetes Mellitus Tipe II Rawat Jalan di RSIJ Sukapura. Jurnal Kesehatan Medika Udayana, 10(02), 172–182. https://doi.org/10.47859/jmu.v10i02.491
Ridzkyanto, R. P. (2025). Biaya Rawat Jalan dan Rawat Inap di Rumah Sakit pada Pasien Diabetes Melitus. Al-Tamimi Kesmas Jurnal Ilmu Kesehatan Masyarakat (Journal of Public Health Sciences), 14(2), 140–146. https://doi.org/10.35328/kesmas.v14i2.3022
Sitompul, E. M. S., & As Shidieq, F. H. (2024). Effectiveness of Diabetes Mellitus Type 2 Management in Prolanis Participants at the BPJS Kesehatan Sibolga. Jurnal Jaminan Kesehatan Nasional, 4(2), 251–268. https://doi.org/10.53756/jjkn.v4i2.251
World Health Orgabization. (2016). Global Report on Diabetes. World Health Organization.
Youpita, N., Purwidyaningrum, I., & Rahmawati, I. (2025). Analisis Biaya Riil pada Tarif INA-CBG’s Pasien Diabetes Melitus Rawat Inap di RS X Surakarta Tahun 2023 dan Analisis SWOT. Jurnal Mandala Pharmacon Indonesia, 11(1), 188–199. https://doi.org/10.35311/jmpi.v11i1.781
Yuliastuti, F., Andayani, T. M., Endarti, D., & Kristina, S. A. (2023). Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance. Pharmacy Practice, 21(1), 1–7. https://doi.org/10.18549/PharmPract.2023.1.2768
Unduhan
Diterbitkan
Cara Mengutip
Terbitan
Bagian
Lisensi
Hak Cipta (c) 2026 Zulkifli Walangadi, Siti Qomaria Usu, Marhawati Marhawati, Cici Nila Ardila, Luthfiana Nur
Artikel ini berlisensi Creative Commons Attribution 4.0 International License.
Hak cipta pada setiap artikel adalah milik penulis.
Penulis mengakui bahwa SEHATRAKYAT (Jurnal Kesehatan Masyarakat) sebagai publisher yang mempublikasikan pertama kali dengan lisensi Creative Commons Attribution 4.0 International License.
Penulis dapat memasukan tulisan secara terpisah, mengatur distribusi non-ekskulif dari naskah yang telah terbit di jurnal ini kedalam versi yang lain, seperti: dikirim ke respository institusi penulis, publikasi kedalam buku, dan lain-lain. Dengan mengakui bahwa naskah telah terbit pertama kali pada SEHATRAKYAT (Jurnal Kesehatan Masyarakat).
