Analisis Perbedaan Tarif INA-Cbgs Dengan Tarif Rumah Sakit Pada Pasien Tonsilektomi Peserta BPJS Kesehatan di Rumah Sakit Lotim Medical Center

Nurmarani Fatin Hafifatin, Dr. Dra. Diah Ayu Puspandari, Apt., M.Kes., Tanggal : 19 Juni 2026 M.B.A., A.A.K ; dr. Haryo Bismantara, MPH

2026 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Implementasi Jaminan Kesehatan Nasional (JKN) masih menghadapi tantangan berupa kesenjangan antara tarif Indonesian Case Base Groups (INA-CBGs) dengan tarif rumah sakit yang berpotensi memengaruhi keberlanjutan finansial rumah sakit. Tonsilektomi merupakan tindakan bedah yang paling banyak dilakukan pada pasien BPJS Kesehatan di RS Lotim Medical Center tahun 2025 dan menunjukkan adanya selisih negatif antara tarif rumah sakit dengan tarif INA-CBGs.

Tujuan: Menganalisis perbedaan antara tarif INA-CBGs dengan tarif rumah sakit pada tindakan tonsilektomi serta mengidentifikasi komponen yang paling berkontribusi terhadap perbedaan tarif tersebut.

Metode: Penelitian kuantitatif dengan desain deskriptif analitik terhadap 296 pasien BPJS Kesehatan yang menjalani tonsilektomi di RS Lotim Medical Center selama Januari–Desember 2025. Analisis dilakukan dengan membandingkan tarif INA-CBGs terhadap tarif rumah sakit dan unit cost menggunakan metode Time Driven Activity Based Costing (TDABC), serta mengidentifikasi komponen biaya yang paling berkontribusi pada masing-masing metode.

Hasil : Rata-rata tarif INA-CBGs sebesar Rp4.090.000. lebih rendah dibandingkan rata-rata tarif rumah sakit sebesar Rp6.930.000. sehingga terdapat selisih negatif sebesar Rp2.830.000. Sebaliknya, perbandingan tarif INA-CBGs dengan unit cost TDABC menunjukkan selisih positif sebesar Rp2.176.014. Komponen biaya terbesar pada tarif rumah sakit adalah biaya tindakan operasi, obat dan bahan medis habis pakai (BMHP), serta pelayanan rawat inap. Pada metode TDABC, komponen biaya terbesar berasal dari biaya personal, biaya obat dan BMHP, serta biaya sarana. 

Kesimpulan : Terdapat perbedaan antara tarif rumah sakit, tarif INA-CBGs, dan unit cost TDABC. Perbandingan tarif INA-CBGs dengan tarif rumah sakit menunjukkan selisih negatif yang mengindikasikan rumah sakit mengalami defisit, dengan komponen biaya yang paling mempengaruhi meliputi biaya tindakan operasi, obat dan bahan medis habis pakai (BMHP), serta pelayanan rawat inap. Sebaliknya, perhitungan tarif INA-CBGs terhadap unit cost menggunakan metode TDABC menunjukkan selisih positif sehingga rumah sakit berpotensi memperoleh surplus, dengan komponen biaya terbesar berasal dari biaya personal, biaya obat, dan biaya sarana.

Background : The implementation of Indonesia’s National Health Insurance (JKN) continues to face challenges due to the gap between Indonesian Case Base Groups (INA-CBGs) reimbursement rates and hospital tariffs, which may affect hospital financial sustainability. Tonsillectomy was the most frequently performed surgical procedure among BPJS Kesehatan patients at Lotim Medical Center Hospital in 2025 and showed a negative difference between hospital tariffs and INA-CBGs reimbursement rates.

Objective: To analyze the differences between INA-CBGs reimbursement rates and hospital tariffs for tonsillectomy procedures and to identify the cost components that contribute most significantly to these differences.

Methods : This quantitative study employed a descriptive-analytic design involving 296 BPJS Kesehatan patients who underwent tonsillectomy at Lotim Medical Center Hospital between January and December 2025. The analysis compared INA-CBGs reimbursement rates with hospital tariffs and unit costs calculated using the Time-Driven Activity-Based Costing (TDABC) method, and identified the major cost components of each costing approach.

Result : The average INA-CBGs reimbursement rate was IDR 4.090.000. which was lower than the average hospital tariff of IDR 6.930.000. resulting in a negative difference of IDR 2.830.000. In contrast, the comparison between INA-CBGs reimbursement rates and TDABC unit costs showed a positive difference of IDR 2.176.014. The largest cost components of the hospital tariff were surgical procedure costs, drugs and medical consumables, and inpatient services. In the TDABC method, the largest cost components were personnel costs, drugs and medical consumables, and facility costs.

Conclusion : Hospital tariffs exceeded INA-CBGs reimbursement rates by IDR 2.830.000. indicating a financial deficit primarily driven by surgical procedure costs, drugs and medical consumables, and inpatient services. In contrast, TDABC unit costs were IDR 2.176.014. lower than INA-CBGs reimbursement rates, indicating a potential surplus, with personnel, drugs and medical consumables, and facility costs as the major cost components.

Kata Kunci : Time Driven Activity Based Costing, INA-CBGs, Hospital Tariff, Tonsillectomy, National Health Insurance (BPJS Kesehatan).