Cost analysis of inpatient hypertension patients at Panembahan Senopati Hospital, Bantul, Yogyakarta, Indonesia: comparison between INA-CBGs rates and hospitalized actual rate 10.55131/jphd/2023/210312
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Abstract
Hypertension as a cardiovascular disease ranks first as a disease with the highest expenditure on health insurance costs. In the financing system implemented by the Indonesian Social Security Program, hospitals as health service providers no longer break down bills based on details of services provided, but only by submitting a diagnosis code that comes out in the form of Indonesia Case-Based Groups (INA-CBGs). The INA-CBGs code for mild hypertension with a severity level of 1 is I-4-17-1. The purpose of this study was to determine the implementation of INA-CBGs rates by comparing the cost difference between the INA-CBG rates and the actual hospital rates for inpatients with hypertension code I-4-17-1 with the parameters studied in the form of gender, age, and length of stay, comorbidities, and drug usage. The analytic observational method with a cross-sectional design was used. Data were hospital financial records and patients medical record documents (inpatient hypertension patients) coded I-4-17-I with the following classes; first class, second class, and third class treatment rooms from October 2016 to July 2017 at Panembahan Senopati Hospital. Data were tested for normality with the Kolmogorov-Smirnov test. One Way ANOVA test and t-test were used to analyze the data in determining the difference in costs between the INA-CBGs rates and the actual hospital rates and in determining the factors that influenced the difference in costs. The results showed that 53 patients met the inclusion criteria. The total cost incurred by the hospital for hospitalized hypertensive patients was Rp. 140,963,105, while the total claim rate for INA-CBGs was Rp. 109,960,000. Gender, length of stay, comorbidities, and drug usage were contributed to the difference in cost, while age had no significant effect. It can be concluded that hospitals need to evaluate the implementation of INA-CBGs rates to minimize financial losses.
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References
Fentri HB, Oktia WKH. Jurnal of Health Education. 2017;2(1):66-72.
Tarigan AR, Lubis Z, Syarifah S. The Effect of Knowledge, Attitudes and Family Support on Hypertension Diet in Hulu Village, Pancur Batu District in 2016. J Kesehat. 2018;11(1):9-17. doi:10.24252/kesehatan.v11i1.5107
Banik KK. Save lives: Make hospitals safe for emergencies. J Indian Med Assoc. 2009;107(4):206-207.
Joseph AC, Karthik MS, Sivasakthi R, Venkatanarayanan R, Sam Johnson Udaya Chander J. JNC 8 versus JNC 7 – Understanding the evidences. Int J Pharm Sci Rev Res. 2016;36(1):38-43.
Rustiani E, Andrajati R, Arsyanti L. Analysis of Antihypertensive Drug Use in Outpatient Polyclinic, PMI Hospital Bogor: Comparison of Cost Effectiveness and Patient Quality of Life. J Ilmu Kefarmasian Indones. 2013;12(2):209-215. http://jifi.ffup.org/wp-content/uploads/2015/11/209-215_Erni.pdf
Ariana R, Sari CWM, Kurniawan T. Perception of Prolanis Participants About Chronic Disease Management Program Activities (PROLANIS) in the Primary Health Service Universitas Padjadjaran. NurseLine J. 2020;4(2):103. doi:10.19184/nlj.v4i2.12687
Solihati S, Ruswanti R. Obesity with Hypertension Incidence in New Students at the University of Indonesia in 2013 and 2014. J Ilm Ilmu Keperawatan Indones. 2019;8(01):388-393. doi:10.33221/jiiki.v8i01.326
Ernawati CT, Uswatul D. The Relationship of JKN Mandiri Participation with Income, Knowledge, Perception, Access, and Trust of the Sakai Tribe Community in Farmer Village, Mandau District, Bengkalis Regency in 2018. J Kebijak Kesehat Indones JKKI. 2019;8(1):25-29. doi:10.22146/JKKI.45017
BPJS Kesehatan. Panduan Layanan Bagi Peserta Jaminan Kesehatan Nasional.; 2018.
BPJS Kesehatan. Perubahan Tarif INA- CBGs.; 2014.
Munawaroh S, Sulistiadi W. Differences in INA – CBG ’s Rates with Real Hospital Rates for BPJS Patients Ischemic Stroke Cases Inpatient Class I at PON Hospital in 2018. 2019;3(2):155-165.
Kementerian Kesehatan RI. Permenkes No 76 2016 Tentang Pedoman Indonesian Case Base Groups (INA-CBG) Dalam Pelaksanaan Jaminan Kesehatan Nasional.; 2016.
Indonesian Health Ministry. Regulation of the Minister of Health Number 52 of 2016 Concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program.; 2016.
Indonesian Health Ministry. Minister of Health Regulation Number 27 of 2014 Concerning Technical Guidelines for the Indonesian Case Base Groups System.; 2014.
Specogna A V., Turin TC, Patten SB, Hill MD. Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke. BMC Neurol. 2017;17(1):1-8. doi:10.1186/s12883-017-0930-2
Adane E, Atnafu A, Aschalew AY. The cost of illness of hypertension and associated factors at the university of gondar comprehensive specialized hospital northwest Ethiopia, 2018. Clin Outcomes Res. 2020;12:133-140. doi:10.2147/CEOR.S234674
Shafiq M, Shah NB, Newman JS. Hospital Medicine. Mayo Clin Intern Med Board Rev. Published online 2014:741-755. doi:10.1093/med/9780199948949.003.0054
Kirkland EB, Heincelman M, Bishu KG, et al. Trends in healthcare expenditures among US adults with hypertension: National estimates, 2003-2014. J Am Heart Assoc. 2018;7(11):2003-2014. doi:10.1161/JAHA.118.008731
Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation. 2011;123(8):933-944. doi:10.1161/CIR.0b013e31820a55f5
Baker-Goering MM, Roy K, Howard DH. Relationship between adherence to antihypertensive medication regimen and outof- pocket costs among people aged 35 to 64 with employer-sponsored health insurance. Prev Chronic Dis. 2019;16(3):1-6. doi:10.5888/pcd16.180381
Egan BM. and Control of Hypertension , 1988-2008. Hypertension. 2010;303(20):2043-2050. doi:10.1001/jama.2010.650
Olives C, Myerson R, Mokdad AH, Murray CJL, Lim SS. Prevalence, Awareness, Treatment, and Control of Hypertension in United States Counties, 2001-2009. PLoS One. 2013;8(4). doi:10.1371/journal.pone.0060308
Nuraini B. Risk Factors of Hypertension. J Major. 2015;4(5):10-19.
Wulansari J, Ichsan B, Usdiana D. Correlation of Knowledge About Hypertension With Blood Pressure Control in Hypertension Patients in Internal Disease Polyclinic RSUD Dr. Moewardi Surakarta. Biomedika. Published online 2005:17-22.
Naftali AR, Ranimpi YY, Anwar MA. Spiritual Health and Elderly Readiness in Facing Death. Bul Psikol. 2017;25(2):124-135. doi:10.22146/buletinpsikologi.28992
Riauwi HM, N YH, Lestari W. The Effectiveness of Health Education with the Implementation of The Health Belief Model on Family Knowledge About Diarrhea. J Online Mhs. 2014;Volume 1:1-9.
Nuamah K, Affran Bonful H, Danso Yeboah J, et al. Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: An Analytic Cross-Sectional Study. Int J Hypertens. 2017;2017. doi:10.1155/2017/6537956
Fang J, Zhao G, Wang G, Ayala C, Loustalot F. Insurance Status Among Adults With Hypertension-The Impact of Underinsurance. J Am Heart Assoc. 2016;5(12):1-7. doi:10.1161/JAHA.116.004313
Setiawan Z. Prevalensi dan Determinan Hipertensi di Pulau Jawa, Tahun 2004. Kesmas Natl Public Heal J. 2006;1(2):57. doi:10.21109/kesmas.v1i2.312
Rosendorff C, Black HR, Cannon CP, et al. Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association council for high blood pressure research and the councils on clinical cardiology and epidemiology and preventi. Circulation. 2007;115(21):2761-2788. doi:10.1161/CIRCULATIONAHA.107.183885
Adam L. Determinan hipertensi pada lanjut usia. Jambura Heal Sport J. 2019;1(2):82-89.
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2013 update: A Report from the American Heart Association. Circulation. 2013;127(1). doi:10.1161/CIR.0b013e31828124ad
Xu J, Tang M, Shen J. Trends and factors affecting hospitalization costs in patients with inflammatory bowel disease: A two-center study over the past decade. Gastroenterol Res Pract. 2013;2013. doi:10.1155/2013/267630
Mutowo MP, Lorgelly PK, Laxy M, Renzaho AMN, Mangwiro JC, Owen AJ. The hospitalization costs of diabetes and hypertension complications in Zimbabwe: Estimations and correlations. J Diabetes Res. 2016;2016. doi:10.1155/2016/9754230
Biswas A, Singh RK, Singh SK. Medical and non-medical cost of hypertension and heart diseases in India. Cogent Soc Sci. 2016;2(1). doi:10.1080/23311886.2016.1250616
Sirait. Tiga Dimensi Farmasi :Ilmu Teknologi, Kesehatan, Dan Potensi Ekonomi.; 2001.
Johnston A, Stafylas P, Stergiou GS. Effectiveness , safety and cost of drug substitution in hypertension. Br J Clin Pharmacol. Published online 2010. doi:10.1111/j.1365-2125.2010.03681.x
Hadiningsih H. Analysis of Medication Costs for Some Outpatient Diseases and Influencing Factors at RS. Beginning of Bekasi Bros 2014. J Adm Rumah Sakit Indones. 2015;2(1):53-63. doi:10.7454/ARSI.V2I1.2188
WHO. Medication Safety in Polypharmacy. World Health Organ Tech Rep Ser. Published online 2019:11-13.
Almalki Z, Alatawi Y, Alharbi A, et al. Cost-Effectiveness of More Intensive Blood Pressure Treatment in Patients with High Risk of Cardiovascular Disease in Saudi Arabia: A Modelling Study of Meta-Analysis. Int J Hypertens. 2019;2019. doi:10.1155/2019/6019401.