INA-CBGs claim versus total hospital cost: A vaginal delivery investigation at Airlangga University Academic Hospital, Indonesia

  • Manggala Pasca Wardhana | manggala.pasca@fk.unair.ac.id Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia. https://orcid.org/0000-0001-8013-4639
  • Khanisyah Erza Gumilar Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.
  • Prima Rahmadhany Department of Obstetrics and Gynaecology, Universitas Airlangga Academic Hospital, Surabaya, Indonesia.
  • Erni Rosita Dewi School of Midwifery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. https://orcid.org/0000-0002-1328-7800
  • Muhammad Ardian Cahya Laksana Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.

Abstract

Background: Inadequate funding for vaginal delivery can be one of the barriers to reducing the maternal mortality rate. It could be therefore critical to compare the vaginal delivery cost between total hospital cost and INA-CBGs cost in national health insurance. 
Methods: This was a retrospective cross-sectional study conducted from October to December 2019 in Universitas Airlangga Academic Hospital. It collected data on primary diagnosis, length of stay, total hospital cost, INA-CBGs cost, and counted disparity. The data analyzed statistically using t-test independent sample (or Mann-Whitney test).
Results: A total of 149 vaginal delivery claims were found, with the majority having a level II severity (79.87%) and moderate preeclampsia as a primary diagnosis (20.1%). There was a significant disparity in higher total hospital costs compared with government INA-CBGs costs (Rp. 9,238,022.09±1,265,801.88 vs 1,881,521.48±12,830.15; p<0.001). There was also an increase of LOS (p<0.001), total hospital cost (p<0.001), and cost disparity (p<0.01) in a higher severity level of vaginal delivery.
Conclusion: Vaginal delivery costs in INA-CBGs scheme are underneath the actuarial value. There was also an increase in total hospital costs and a more significant disparity in the higher severity levels of vaginal delivery.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Indonesian Ministry of Health. Law of the Republic of Indonesia number 40 of 2004 concerning the national social security system. Timur Putra Mandiri; 2004.

Indonesian Ministry of Health. Regulation No. 27/2014 on the Technical Guidelines for the Indonesian Case Base Groups (INA – CBGs) System. Jakarta; 2014.

Indonesian Ministry of Health. Regulation No. 58 of 2014 concerning Standards for Pharmaceutical Services in Hospitals. Jakarta; 2014;

Central Bureau of Statistics. Statistik Indonesia 2017. Available from: https://www.bps.go.id/publication/2017/07/26/b598fa587f5112432533a656/statistik-indonesia-2017.html

WHO. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2019. Available from: https://apps.who.int/iris/handle/10665/327596

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994;38:1091-110. DOI: https://doi.org/10.1016/0277-9536(94)90226-7

Prasetyo B, Winardi B, Pranadyan R, et al. Increasing of early high-risk pregnancy detection with proactive intervention in Bangkalan District, Madura Indonesia. J Global Pharma Technol 12:26-31.

Indonesian Ministry of Health. Riskesdas 2018 National Report. Jakarta Kemenkes 2018.

Indonesian Ministry of Health. Regulation No. 64 of 2016 concerning Standard Health Service Rates in the Implementation of Health Insurance Programs. 2016.

Indonesian Ministry of Health. Presidential Regulation of the Republic of Indonesia Number 64 of 2020 concerning Second Amendment to Presidential Regulation Number 82 of 2018 concerning Health Insurance. 2020.

Republic of Indonesia. Presidential Regulation No. 82 of 2018 concerning Health Insurance. Jakarta Secretary of the Republic of Indonesia District. 2018.

Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009;113:1299-306. DOI: https://doi.org/10.1097/AOG.0b013e3181a45b25

Wardhana MP, Dachlan EG, Dekker G. Pulmonary edema in preeclampsia: an Indonesian case - control study. J Matern Neonatal Med 2018;31:689-95. DOI: https://doi.org/10.1080/14767058.2017.1295442

Bellanger MM, Quentin W, Tan SS. Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries. Eur J Obstet Gynecol Reprod Biol 2013;168:12–9. DOI: https://doi.org/10.1016/j.ejogrb.2012.12.027

Indonesia KK. Doctor Competency Standards. 2006. National Library of Jakarta.

Relph S, Delaney L, Melaugh A, et al. Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations. BMJ Open 2020;10:e040022. DOI: https://doi.org/10.1136/bmjopen-2020-040022

Callander E, Shand A, Ellwood D, et al. Financing maternity and early childhood healthcare in the Australian healthcare system: costs to funders in private and public hospitals over the first 1000 days. Int J Heal Policy Manag 2020. doi: 10.34172/ijhpm.2020.68 DOI: https://doi.org/10.34172/ijhpm.2020.68

Witter S, Govender V, Ravindran TS, Yates R. Minding the gaps: health financing, universal health coverage and gender. Health Policy Plan 2017;32:v4-12. DOI: https://doi.org/10.1093/heapol/czx063

de Brantes F, Love K. A Process for structuring bundled payments in maternity care. NEJM Catalyst 2016;2.

Kozhimannil KB, Graves AJ, Ecklund AM, et al. Cesarean delivery rates and costs of childbirth in a state Medicaid program after implementation of a blended payment policy. Med Care 2018;56:658-64. DOI: https://doi.org/10.1097/MLR.0000000000000937

Nugraheni W, Mubasyiroh R, Kusuma R. The role of National Health Insurance (JKN) in reducing the financial burden of childbirth. 2019. Available from: http://www.healthpolicyplus.com/ns/pubs/17359-17651_PBRoleofJKN.pdf

Bonu S, Bhushan I, Rani M, Anderson I. Incidence and correlates of ‘catastrophic’maternal health care expenditure in India. Health Policy Plan 2009;24:445-56. DOI: https://doi.org/10.1093/heapol/czp032

Qosaj FA, Froeschl G, Berisha M, et al. Catastrophic expenditures and impoverishment due to out-of-pocket health payments in Kosovo. Cost Eff Resour Alloc 2018;16:26. DOI: https://doi.org/10.1186/s12962-018-0111-1

Söderlund N, Gray A, Milne R, Raftery J. Case mix measurement in English hospitals: an evaluation of five methods for predicting resource use. J Health Serv Res Policy 1996;1:10-9. DOI: https://doi.org/10.1177/135581969600100104

Astoguno AP, Kaeng JJ, Mewengkang M. [The profile of childbirth during the JKN-BPJS era in Prof. Dr. RD Kandou Manado for the period January 1-June 30 2016].[Article in Indonesian with English abstract]. e-CliniC 2016. doi: 10.35790/ecl.4.2.2016.14496 DOI: https://doi.org/10.35790/ecl.4.2.2016.14496

Esteves-Pereira AP, Deneux-Tharaux C, Nakamura-Pereira M. Caesarean delivery and postpartum maternal mortality: A population-based case control study in Brazil. PLoS One 2016;11:e0153396. DOI: https://doi.org/10.1371/journal.pone.0153396

Dewi ER, Laksana MAC, Rahmawati NA, et al. The role of universal health coverage in supporting national family planning program: A comparative study. Medico Legal Update 2020;20:544-9.

Betrán AP, Torloni MR, Zhang J-J, et al. WHO statement on caesarean section rates. BJOG 2016;123:667-70. DOI: https://doi.org/10.1111/1471-0528.13526

Visser GHA, Ayres-de-Campos D, Barnea ER, et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet 2018;392:1286-7. DOI: https://doi.org/10.1016/S0140-6736(18)32113-5

Holtz J, Sarker I. Integrating family planning into universal health coverage efforts. 2018. Brief. Bethesda, MD: Sustaining Health Outcomes through the Private Sector Plus Project, Abt Associates. Available from: https://www.shopsplusproject.org/sites/default/files/resources/Integrating Family Planning into Universal Health Coverage Efforts.pdf

Published
2020-12-18
Info
Issue
Section
Original Articles
Keywords:
Vaginal delivery cost, total hospital cost, health insurance, Indonesia Case Base Groups
Statistics
  • Abstract views: 268

  • PDF: 171
  • HTML: 0
How to Cite
Wardhana, M. P., Gumilar, K. E., Rahmadhany, P., Rosita Dewi, E., & Laksana, M. A. C. (2020). INA-CBGs claim <em>versus</em&gt; total hospital cost: A vaginal delivery investigation at Airlangga University Academic Hospital, Indonesia. Journal of Public Health Research, 9(4). https://doi.org/10.4081/jphr.2020.1999