The Implementation of INA-CBGs System Impact on Financial Performance of Public Hospital, the Indonesia Case: A Systematic Review


Indonesia started the national health insurance system on 1 January 2014. In this system, there is only one insurer institution, BPJS Kesehatan, a social security agency established by the government to provide health insurance for Indonesian people. This new national health insurance system pays all claims based on package system called Indonesia Case-Based Groups (INA-CBGs). The aim of this review is to describe the application of the INA-CBGs system and its effect on financial performance of the public hospital and helping them in identifying and anticipating problems in implementation of the INA-CBGs system. This review shows prism flowchart using Proquest and Portal Garuda with INA-CBGs, public hospital finance performance, universal health coverage, and Indonesia as the keywords. From the 15 selection research journals, we found that the implementation of the INA-CBGs system with the prospective payment system can provide a positive impact on the financial performance in public hospital, when the hospital could reduce inefficient cost of treatment. Furthermore, public hospitals achieve a surplus since they receive a donation from the government for salary expenses and investment-related expenses. Public hospital management in Indonesia should consider the competence of their accounting and financial managers so they can manage their hospitals properly. Each
public hospital management must have a strategy and innovation to improve the quality of service so they can compete with other hospitals and financial performance can be improved in this JKN era.

Keywords: INA CBGs, Public Hospital financial performance, universal health coverage, Indonesia

[1] World Health Organization. (2014). What is health financing for universal coverage? Health Financing. Retrieved from universal_coverage_definition/en/ (accessed on 04 June 2016).

[2] Hussein, R. (2015). A review of realizing the Universal Health Coverage (UHC) goals by 2030: Part 1- Status quo, requirements, and challenges. Journal of Medical Systems, vol. 39, no. 7.

[3] Latko, B., et al. (2011). The growing movement for universal health coverage. Lancet, vol. 377, no. 9784, pp. 2161–2163.

[4] Republik Indonesia. (1945). Undang-Undang Dasar Negara Republik Indonesia Tahun 1945. Indonesia.

[5] Republik Indonesia. (2004). Undang-Undang Nomor 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional. Indonesia.

[6] Wa Ode, D. W., Karimuna, S. R., and Munandar, S. (2016). Studi Penerapan Ssitem Pembayaran Layanan Kesehatan dengan Sistem Diagnosis Penyakit (Indonesia Case Based Groups/INA-CBGs) di Ruang Rawat Inap Rumah Sakit Umum Bahteramas Kota Kendari Tahun 2015. J. Ilm. Mhs. Kesehat. Masy., vol. 1, no. 3.

[7] Widmer, P. K. (2015). Does prospective payment increase hospital (in)efficiency? Evidence from the Swiss hospital sector. The European Journal of Health Economics, vol. 16, no. 4, pp. 407–419.

[8] Ambarriani, A. S. (2014). Hospital financial performance in the Indonesian national health insurance era. Soc. Interdiscip. Bus. Res., vol. 4, no. 1, pp. 367–379.

[9] Nugraheni, S. W. (2015). Evaluasi Penerapan Jaminan Kesehatan Nasional ( JKN) di RSUD dr. Moewardi Surakarta. J. Ilm. Rekam Medis dan Inf. Kesehat., vol. 5, no. 2.

[10] Mathauer, I. and Wittenbecher, F. (2013). Hospital payment systems based on diagnosis-related groups: Experiences in low- and middle-income countries. Bulletin of the World Health Organization, vol. 91, no. 10, pp. 746–756A.

[11] Wang, Z., Liu, R., Li, P., et al. (2014). Exploring the transition to DRGs in developing countries: A case study in Shanghai, China. Pakistan Journal of Medical Sciences, vol. 30, no. 2, pp. 250–255