Analysis of Actual Costs and Compliance with the INA-CBGS Tariff for Inpatient Nasopharyngeal Cancer Patients at Dr. Moewardi Regional General Hospital, Surakarta In 2018

Abstract

Nasopharyngeal cancer is a type of head and neck cancer. According to Globocan data in 2018, it is estimated that there were approximately 17,992 new cases and 11,204 deaths related to this type of cancer. The high incidence and mortality rates, as well as the high actual treatment costs, are the main factors behind the establishment of the National Health Insurance program through the Indonesian Case Base Groups (INA-CBGs) package. However, the INA-CBGs tariff may not always align with the actual costs, leading to cost discrepancies. The objective of this study was to determine the compatibility of actual costs with the INA-CBGs tariff and the factors associated with the actual costs for nasopharyngeal cancer patients at Dr. Moewardi Regional General Hospital in Surakarta. This research utilized an observational study design with a cross-sectional approach from the hospital's perspective. Retrospective data were collected from medical records and patient claims files of the National Health Insurance (BPJS) for nasopharyngeal cancer patients in 2018. Data analysis was conducted using the one-sample t-test to compare the average actual costs with the INA-CBGs tariff. Correlation analysis was performed to identify factors associated with the actual costs. The novelty of this study compared to previous research lies in the object of study, sample size, research period, data, and different conditions from previous studies. The results of the study revealed that there were 54 patients undergoing chemotherapy with a total of 162 treatment episodes and 20 patients undergoing surgery with 21 treatment episodes. For chemotherapy under code C-4-13-I, a total negative difference of -Rp102,565,776 was found across 146 treatment episodes. In contrast, for chemotherapy under code C-4-13-II, a total positive difference of Rp26,972,439 was observed in 16 treatment episodes. As for surgery under code U-4-10-I, a total negative difference of -Rp7,420,989 was found across 4 treatment episodes, and for surgery under code U-4-10-II, a total positive difference of Rp177,572,067 was observed in 17 treatment episodes. Factors associated with the actual costs for chemotherapy were the length of stay (LOS), while for surgery, the factors included LOS, secondary diagnosis, procedure, and severity level, with a p-value < 0.05.