The Differences in INA-CBG's Claims and Direct Medical Costs for Inpatient Breast Cancer in Class A and B Hospital IN PRESS

Abstract

With a total cost of 3.5 trillion rupiahs, cancer ranks second due to its high price and potential for life-threatening complications. The purpose of this study is to ascertain whether real costs in Indonesian Hospital Types A and B that use INA-CBG rates for JKN patients are appropriate given INA-CBG code C-3-13-0. Methods: A cross-sectional research approach was used in this observational study. By looking up medication information, cost information, and medical record documents for outpatient cancer patients at Type A and B hospitals for 2021, data was obtained retroactively. The Mann-Whitney test was employed in statistical analysis to determine the discrepancy between INA-CBG's rates and actual expenditures. Findings: PBI outpatient breast cancer patients at Type A Hospital had average direct medical costs of IDR 3,397,073, non-PBI patients IDR 3,439,253, and medical cost components IDR 2,619,355.26 at Type B Hospital. Drug bills are the largest direct contributor. The true costs in Type A hospitals for PBI patients are less than Rp 88,041,600; for non-PBI patients, the difference is minus Rp 91,386,300; and for patients in Type B hospitals, the difference is minus Rp 164,113,635. Conclusion: For patients with outpatient breast cancer at Type A and B hospitals, there is a considerable discrepancy between the true expenses and the total INA-CBG rates (p = 0.0001).