Analisis Dampak Kebijakan Tarif Paket Layanan PTCA Terhadap Biaya Layanan Penyakit Jantung Iskemik Pensiunan Perusahaan X Berbasis Episode Rawat Inap

Didit Fathurrahman, Prof. Dr. drg. Julita Hendrartini, M.Kes, FISDPH, FISPD, AAK; Drs. M. Arif Budiarto, M.Si., Ak., CA.

2026 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Peningkatan biaya layanan kesehatan menjadi tantangan global, terutama pada penyakit katastropik seperti penyakit jantung iskemik. Untuk meningkatkan efisiensi pembiayaan, penyelenggara jaminan kesehatan pekerja menerapkan kebijakan tarif paket layanan percutaneous transluminal coronary angioplasty (PTCA) sejak tahun 2024. Penelitian ini bertujuan mengidentifikasi dampak penerapan tarif paket layanan PTCA terhadap biaya layanan dan kelangsungan hidup pasien berbasis episode rawat inap.

Metode: Penelitian ini merupakan studi observasional retrospektif dengan rancangan kuasi-eksperimental sebelum-sesudah tanpa kelompok kontrol, menggunakan data sekunder klaim episode rawat inap tindakan PTCA tahun 2023 dan 2024. Perbedaan biaya antarperiode dianalisis secara komparatif serta melalui Generalized Linear Model dengan distribusi Gamma dan fungsi log-link.

Hasil: Rerata biaya per episode pada kelompok satu stent meningkat dari Rp87.675.764 menjadi Rp93.759.585 (p = 0,169) dan pada kelompok dua stent dari Rp96.365.130 menjadi Rp110.929.006 (p = 0,054). Periode penerapan tarif paket berasosiasi dengan biaya sebesar 13,3% (IK 95% 1,066–1,205; p < 0> 0,05), serta jumlah tindakan per pasien 1,06 dan 1,04 (p = 0,483).

Kesimpulan: Tidak terdapat perbedaan biaya layanan yang menunjukkan penurunan setelah penerapan tarif paket, meskipun harga komponen stent relatif terkendali, sehingga diperlukan penyempurnaan desain tarif dan penguatan tata kelola utilisasi.

Background: Rising healthcare costs have become a global challenge, particularly for catastrophic diseases such as ischemic heart disease. To improve financing efficiency, health insurance administrator implemented a bundled payment policy for percutaneous transluminal coronary angioplasty (PTCA) services in 2024. This study aimed to identify the impact of the PTCA bundled payment policy on healthcare costs and patient survival based on inpatient episodes.

Methods: This study was a retrospective observational study using a quasi-experimental before-and-after design without a control group. Secondary claims data from inpatient episodes involving PTCA procedures in 2023 and 2024 were used. Differences in costs between the two periods were analyzed comparatively and using a Generalized Linear Model with a Gamma distribution and log-link function.

Results: The mean cost per episode in the one-stent group increased from IDR 87,675,764 to IDR 93,759,585 (p = 0.169), while that in the two-stent group increased from IDR 96,365,130 to IDR 110,929,006 (p = 0.054). The bundled payment implementation period was associated with a 13.3% increase in costs (95% CI: 1.066-1.205; p < 0> 0.05). The mean numbers of procedures per patient were 1.06 and 1.04, respectively (p = 0.483).

Conclusion: No difference in healthcare costs indicating a reduction was observed following the implementation of the bundled payment policy, although the price of the stent component remained relatively controlled. Therefore, improvements in the tariff design and stronger utilization governance are required.

Kata Kunci : tarif paket tindakan PTCA, biaya layanan kesehatan, episode rawat inap