Comparative Analysis of INA-CBGs Tariffs and Unit Cost of Cesarean Section: A Systematic Review in Indonesian Hospitals

Rizma Adlia Syakurah; Edwin Frymaruwah; Muhimatul Mufarikhah; Meiliza Izzatika

doi:10.56741/IISTR.jphs.001257

Authors

Rizma Adlia Syakurah
rizma.syakurah@gmail.com
Universitas Sriwijaya
Edwin Frymaruwah Politeknik Negeri Sriwijaya
Muhimatul Mufarikhah Universitas Sriwijaya
Meiliza Izzatika Universitas Sriwijaya

Keywords:

Unit cost, INA-CBGs, JKN, Sectio caesarea, Activity-based costing

Abstract

The National Health Insurance (JKN) requires efficient, equitable, and sustainable healthcare services. However, various studies indicate discrepancies between INA-CBGs tariffs and actual hospital service costs. One of the procedures with the highest claim rates is Cesarean Section (CS), which exhibits significant disparities. This study aims to analyze the average unit cost associated with Cesarean Sections (CS) across Indonesia using the Activity-Based Costing (ABC) method. A systematic literature review (SLR) approach was employed, analyzing articles published between 2017–2024. Relevant articles were retrieved through the Google Scholar database. Of the 79 articles initially identified, 37 passed the preliminary screening, and 12 articles met all inclusion criteria. Results indicate that INA-CBGs tariffs for CS procedures only cover 25%–54% of actual costs, varying by service class, hospital location, and operational efficiency. This mismatch contributes to financial deficits in hospitals, potentially compromising service quality, restricting medical equipment procurement, and increasing healthcare professionals’ workloads. Moreover, regional cost variations demonstrate that the current tariff system inadequately considers geographic factors and service complexity. Hospitals in major cities like Bandung report nearly double the unit costs compared to regions such as Yogyakarta or Lampung. Therefore, findings highlight the necessity of reformulating INA-CBGs tariffs to better reflect hospitals' actual conditions. Without updates based on cost-of-service, the financing system risks perpetuating service disparities and reducing the quality of national healthcare. The review findings indicate that the actual cost of Cesarean Section (CS) procedures in Indonesian hospitals is significantly higher than the INA-CBGs tariffs reimbursed by BPJS, with disparities ranging from 46% to 75%.

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Author Biographies

Rizma Adlia Syakurah, Universitas Sriwijaya

Rizma Adlia Syakurah is a Faculty of Public Health lecturer at Universitas Sriwijaya. She completed her bachelor's degree at the Faculty of Medicine UNSRI, her master's degree at the University of Indonesia, and earned her Ph.D. in Medical Education from Gadjah Mada University. Besides teaching, she actively researches on public health, health policy, healthcare management systems, mental health, and health communication. Recently, her research interests have expanded to digital health, and she is currently involved in a research collaboration on the development of an AI chatbot for university students’ mental health.

Edwin Frymaruwah, Politeknik Negeri Sriwijaya

Edwin Frymaruwah is an Accounting Lecturer at Politeknik Negeri Sriwijaya (Polsri), Palembang, with over 13 years of experience in auditing, finance, and business management. Since July 2024, he has served as Chief of Internal Audit (SPI) at Polsri, overseeing audits, risk assessment, and internal controls. In addition to teaching, he is actively engaged in research on risk-based auditing, financial management, and business sustainability, including corporate performance during COVID-19, fraud prevention in government procurement, IPO strategies, and digital innovations such as IoT applications in accounting.

Muhimatul Mufarikhah, Universitas Sriwijaya

Muhimatul Mufarikhah is a Health Policy and Administration lecturer at Akademi Kebidanan Rangga Husada, Prabumulih. She earned her bachelor's and master's degrees from the Faculty of Public Health, Universitas Sriwijaya (UNSRI). Her expertise focuses on health policy, healthcare administration, and public health management.

Meiliza Izzatika, Universitas Sriwijaya

Meiliza Izzatikais a research assistant in the Education and Training Unit at Azzahra Clinic, Palembang, and is currently a master’s student in Public Health Sciences at Universitas Sriwijaya.

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