Analisis Indikator INA-CBGs dalam Perencanaan Strategis Kinerja Rumah Sakit Karya Dharma Husada Singaraja

Dewa Ayu Sri Agung Suandewi; Heris Hendriana; Oke Andikarya

doi:10.55681/sentri.v5i2.5866

Authors

Dewa Ayu Sri Agung Suandewi Universitas Adhirajasa Reswara Sanjaya
Heris Hendriana Universitas Adhirajasa Reswara Sanjaya
Oke Andikarya Universitas Adhirajasa Reswara Sanjaya

DOI:

https://doi.org/10.55681/sentri.v5i2.5866

Keywords:

Performance Indicators, Casemix, Casemix Index, Hospital Base Rate, Performance Management, INA-CBGs, Strategic Planning

Abstract

Strategic planning plays a crucial role for hospitals in maintaining sustainability and competitiveness amid the dynamic healthcare environment and the National Health Insurance (JKN) financing system. The implementation of the prospective payment system based on Indonesian Case Based Groups (INA-CBGs) requires performance indicators that adequately reflect service volume, case complexity, and hospitals’ financial implications. INA-CBGs–based indicators, namely Casemix (CM), Casemix Index (CMI), and Hospital Base Rate (HBR), have the potential to support performance assessment and strategic planning; however, their utilization in private hospitals remains limited. This study aims to analyze the performance achievement of INA-CBGs indicators and examine their relevance for strategic performance planning at Karya Dharma Husada Hospital (RS KDH) Singaraja. This study employed a mixed methods approach with a sequential explanatory design. Quantitative analysis was conducted longitudinally using a trend study approach on inpatient INA-CBGs claim data from 2022 to January–June 2024, followed by qualitative analysis through in-depth interviews to interpret and contextualize the quantitative findings. The results showed a total of 7,361 inpatient JKN cases, predominantly involving class III patients and low-severity cases. Casemix values fluctuated in line with changes in service volume and case mix, with obstetric cases being the dominant contributor. CMI values remained within the typical range for private class C hospitals, reflecting low to moderate service complexity. HBR performance demonstrated periods of surplus and deficit, indicating discrepancies between actual service costs and national INA-CBGs tariffs. Overall, the study indicates that INA-CBGs indicators have not yet been systematically integrated into performance evaluation and strategic planning; however, hospital management has recognized them as valuable information with potential to support future managerial decision-making.

Downloads

Download data is not yet available.

References

Alshehri, A., Balkhi, B., Gleeson, G., & Atassi, E. (2023). Efficiency and Resource Allocation in Government Hospitals in Saudi Arabi: A Casemix Index Approach. Healthcare (Switzerland), 11(2513), 1–18. https://doi.org/10.3390/healthcare11182513

Bredenkamp, C., Bales, S., & Kahur, K. (2020). Transition to Diagnosis-Related Group (DRG) Payments for Health: Lessons from Case Studies. In International Development in Focus. Washington DC : World Bank. https://doi.org/10.1596/978-1-4648-1521-8

Bryson, J. M. (2017). Strategic Planning for Public and Nonprofit Organizations: A Guide to Strengthening and Sustaining Organizational Achievement (5th ed.). Wiley.

Budimir, V., Lutilsky, I. D., & Dragija, M. (2017). Performance Measurement as the Basis for Hospitals Strategic Management. Eurasian Studies in Business and Economics, 5, 825–845. https://doi.org/10.1007/978-3-319-46319-3_53

Chen, Y. J., Zhang, X. Y., Yan, J. Q., Xue-Tang, Qian, M. C., & Ying, X. H. (2023). Impact of Diagnosis-Related Groups on Inpatient Quality of Health Care: A Systematic Review and Meta-Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60, 1–16. https://doi.org/10.1177/00469580231167011

Fitri, D. El, & Sundari, S. (2023). The Cost Difference of Hospital Rates and Indonesia Case Base Grup (Ina CBGs) Rates of Inpatient with National Health Insurance Scheme at Private Hospital. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 8(2), 701–708. https://doi.org/10.30604/jika.v8i2.1986

Gathmyr, D., Purwana, D., Wahono, P., Saparuddin, & Hamidah. (2024). The Role of Strategic Planning In Improving Service Quality and Profitability of the Healthcare Industry: A Systematic Review. Journal of Economics, Finance And Management Studies, 07(06), 3394–3400. https://doi.org/10.47191/jefms/v7-i6-34

Gavurova, B., Kubak, M., & Vaculcikova, Z. (2024). Quantification of factors influencing differences in the Case Mix Index and their significance for health systems sustainability. Economic Research-Ekonomska Istrazivanja, 37(1), 1– 17. https://doi.org/10.1080/1331677X.2024.2341216

Hadian, S. A., Rezayatmand, R., Shaarbafchizadeh, N., Ketabi, S., & Pourghaderi, A. R. (2024). Hospital performance evaluation indicators: a scoping review. BMC Health Services Research, 24(561), 1–17. https://doi.org/10.1186/s12913-024-10940-1

Handayani, L., Suharmiati, & Pratiwi, N. (2018). Unit Cost Rumah Sakit dan Tarif INA-CBGs: Sudakah Pembiayaan Kesehatan Rumah Sakit Dibayar dengan Layak? Buletin Penelitian Sistem Kesehatan, 21(4), 219–227. https://doi.org/http://dx.doi.org/10.22435/hsr.v2Ii4.45 ABSTRAK

Idris, F., Nurwahyuni, A., Mundiharno, Saut, B., Jaya, C., Baros, W. A., Oktavia, A., Revelino, D., Dhanalvin, E., & Ginting, R. R. (2021). Sistem Pembayaran Mixed Method INA-CBGs dan Global Budget di Rumah Sakit: Tahap 1 Uji Coba Mixed Method INA- CBGs-Global Budget di Indonesia. Jurnal Ekonomi Kesehatan Indonesia, 5(2), 72–88. https://doi.org/10.7454/eki.v5i2.4819

Kuntz, L., Scholtes, S., & Vera, A. (2008). DRG cost weight volatility and hospital performance. OR Spectrum, 30(1), 331–354. https://doi.org/10.1007/s00291-006-0063-2

Manopo, W. L. M., & Susanti, N. (2025). Prediksi Kebangkrutan Rumah Sakit Akibat Ketidaksesuaian Sistem Tarif INA-CBGS. Journal of Accounting and Finance Management, 6(2), 724–731.

Mardiah, & Rivany, R. (2017). Cost Recovery Rate Tarif Rumah Sakit dan Tarif INA-CBG’s berdasarkan Clinical Pathway pada Penyakit Arteri Koroner di RS Pemerintah A di Palembang Tahun 2015. Jurnal Ekonomi Kesehatan Indonesia, 1(4), 175–184. http://jurnalkesmas.ui.ac.id/jurnal- eki/article/view/1782

Markazi-Moghaddam, N., Arab, M., Ravaghi, H., Rashidian, A., Khatibi, T., & Zargar Balaye Jame, S. (2016). A Knowledge Map for Hospital Performance Concept: Extraction and Analysis: A Narrative Review Article. Iranian Journal of Public Health, 45(7), 843–854. http://ijph.tums.ac.ir

Mendez, C. M., Harrington, D. W., Christenson, P., & Spellberg, B. (2014). Impact of hospital variables on case mix index as a marker of disease severity. Population Health Management, 17(1), 28–34. https://doi.org/10.1089/pop.2013.0002

Notoatmodjo, S. (2020). Manajemen Pelayanan Kesehatan. Rineka Cipta.

Nurwahyuni, A., & Setiawan, E. (2020). Kinerja Rumah Sakit Swasta dengan Pembayaran INA-CBGs di Era Jaminan Kesehatan Nasional: Casemix, Casemix Index, Hospital Base Rate. Jurnal Ekonomi Kesehatan Indonesia, 4(2), 1–11. https://doi.org/10.7454/eki.v4i2.3822

Peraturan Menteri Kesehatan Nomor 76 Tahun 2016 Tentang Pedoman Indonesian Case Base Groups (INA-CBG) Dalam Pelaksanaan Jaminan Kesehatan Nasional, Berita Negara Republik Indonesia Tahun 2017 Nomor 92 1 (2016). Peraturan Menteri Kesehatan Republik Indonesia No. 3 Tahun 2023 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan, Berita Negara Republik Indonesia Tahun 2023 Nomor 35 1 (2023). jdih.kemkes.go.id

Peraturan Menteri Kesehatan Republik Indonesia Nomor 64 Tahun 2016 Tentang Perubahan Atas Peraturan Menteri Kesehatan Republik Indonesia Nomor 52 Tahun 2016 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Jaminan Kesehatan, Berita Negara Republik Indonesia Tahun 2016 Nomor 1790 1 (2016).

Pinta, T. A., Ayuningtyas, D., & Simanjuntak, R. S. M. (2022). Potential Hospital Strategic Planning in the COVID-19 Era: A Systematic Review. Jurnal Ilmu Kesehatan Masyarakat, 13(1), 1–13. https://doi.org/10.26553/jikm.2022.13.1.1-13

Prasiska, T. O. (2021). Analisis Capaian Indikator Casemix, Casemix Index dan Hospital Baserate Rumah Sakit Muhammadiyah Jawa Timur Tahun 2017- 2020. Universitas Indonesia.

Prasiska, T. O., Pujiyanto, & Absor, S. (2021). Hospital Baserate Klaim Persalinan JKN-KIS Rumah Sakit. Higeia Journal of Public Health Research and Development, 5(4), 577–586. https://doi.org/https://doi.org/10.15294/higeia.v5i4.51659

Purwadhi, Widjaja, Y. R., Dimyati, F., & Sandi, G. P. (2025). Exploring New Methods for Measuring Hospital Performance and Quality of Care for More Effective Strategic Planning: A Systematic Review. AKADEMIK: Jurnal Mahasiswa Ekonomi & Bisnis, 5(1), 477–492. https://doi.org/10.37481/jmeb.v5i1.1225

Sari, P. P., Reski Mulia Paramita, Purwadhi Purwadhi, & Yani Restiani Widjaja. (2024). Transformasi Strategi Manajemen Rumah Sakit Dalam Menghadapi Tantangan Kesehatan Global: Sebuah Tinjauan Literatur. Journal of Innovation Research and Knowledge, 4(5), 2585–2592. https://doi.org/10.53625/jirk.v4i5.8684

Undang - Undang Republik Indonesia Nomor 24 Tahun 2011 Tentang Badan Penyelenggara Jaminan Sosial, Lembaran Negara Republik Indonesia Tahun 2011 Nomor 116, Tambahan Lembaran Negara Republik Indonesia Nomor 5256 1 (2011).

Undang - Undang Republik Indonesia Nomor 44 Tahun 2009 Tentang Rumah Sakit, Lembaran Negara Republik Indonesia Tahun 2009 Nomor 153, Tambahan Lembaran Negara Republik Indonesia Nomor 5072 1 (2009).

Verulava, T. (2023). Strategic Management and Planning for Health Care Organizations in Georgia. Asia Pacific Journal of Health Management, 18(3), 1–10. https://doi.org/10.24083/apjhm.v18i3.2697

Wenas, A. R., Tatura, S., & Langi, F. F. L. G. (2022). Factors Correlated to Hospital Performance. E-CliniC, 10(1), 151–159. https://doi.org/10.35790/ecl.v10i1.39348