Analisis Efisiensi Biaya Operasi Bedah Umum Jaminan Kesehatan Nasional di Rumah Sakit Jakarta Tahun 2023
Keywords:
Analysis, Cost, Efficiency, General, Surgery
Abstract
The National Health Insurance (JKN) program has increased the volume and revenue of inpatient general surgery procedures. However, Jakarta Hospital experienced a profit decline in 2023 due to low Indonesian Case-Based Group (INACBG) tariffs and cost inefficiencies. This study aims to analyze the cost efficiency of JKN-covered inpatient general surgeries as a basis for hospital development strategies. A descriptive-analytic method was applied, using activity-based costing to calculate procedure costs. Cost efficiency was assessed by comparing actual costs to normative benchmarks from clinical pathways, and further analyzed using Data Envelopment Analysis (DEA). Results indicate that unit costs were inefficient compared to normative standards (efficiency score: 101.9%, average: IDR 3,488,115.59), driven by high expenditures on medical services, drugs, and disposable medical supplies. Total costs, including accommodation, were also inefficient (score: 108.1%, average: IDR 4,729,373.69), with accommodation accounting for 26.2%. DEA identified perianal abscess incision as the most efficient procedure, while hemorrhoidectomy, inguinal herniotomy, and breast tumor excision were relatively efficient. Overall, inpatient general surgery procedures remain cost-inefficient. Enhancing efficiency requires stricter clinical pathway adherence, optimized use of drugs and supplies, reduced length of stay, and revised physician payment models. Promoting efficient procedures is essential for hospital sustainability.
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2. Apriliana, H. D. (2013). RERATA WAKTU PASIEN PASCA OPERASI TINGGAL DI RUANG PEMULIHAN RSUP DR KARIADI SEMARANG PADA BULAN MARET-MEI 2013. Media Medika Muda.
3. Bastian, I. (2008). Akuntansi kesehatan. Erlangga.
4. Bisagni, P., D’Abrosca, V., Tripodi, V., Armao, F. T., Longhi, M., Russo, G., & Ballabio, M. (2024). Cost saving in implementing ERAS protocol in emergency abdominal surgery. BMC Surgery. https://doi.org/https://doi.org/10.1186/s12893-024-02345-y
5. Childers, C. P., Showen, A., Nuckols, T., & Maggard-Gibbons, M. (2018). Interventions to Reduce Intraoperative Costs. In Annals of Surgery (Vol. 268, Issue 1, pp. 48–57). Lippincott Williams and Wilkins. https://doi.org/10.1097/SLA.0000000000002712
6. Cifarelli, C. P., & Jacobson, G. M. (2021). Intraoperative Radiotherapy in Brain Malignancies: Indications and Outcomes in Primary and Metastatic Brain Tumors. Frontiers in Oncology, 11. https://doi.org/10.3389/fonc.2021.768168
7. Cooper, W. W., Seiford, L. M., & Tone, K. (2007). Data Envelopment Analysis. Springer US. https://doi.org/10.1007/978-0-387-45283-8
8. Cylus, J. , P. I. , & S. P. C. (2016). A framewok for thinking about health system efficiency. In J. Cylus, I. Papanicolas, & P. C. Smith (Eds.). Health System Efficiency: How to make measurement matter for policy and management. 1–20.
9. Dautremont, J. F., Rudmik, L. R., Yeung, J., Asante, T., Nakoneshny, S. C., Hoy, M., Lui, A., Chandarana, S. P., Matthews, T. W., Schrag, C., & Dort, J. C. (2013). Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction. http://www.journalotohns.com/content/42/1/59
10. Dewan Jaminan Nasional. (2024). Monthly Report Monitoring JKN.
11. GANI, A. (1996). IMPROVING QUALITY IN PUBLIC SECTOR HOSPITALS IN INDONESIA. The International Journal of Health Planning and Management, 11(3), 275–296. https://doi.org/10.1002/(SICI)1099-1751(199607)11:3<275::AID-HPM436>3.0.CO;2-C
12. Graff, V., Gabutti, L., Treglia, G., Pascale, M., Anselmi, L., Cafarotti, S., La Regina, D., Mongelli, F., & Saporito, A. (2023). Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature. Brazilian Journal of Anesthesiology (English Edition), 73(3), 316–339. https://doi.org/10.1016/j.bjane.2021.09.012
13. Habibah, Z., Purwadhi, & Handayani, N. (2024). THE EFFECT OF COMPLIANCE IN THE USE OF CLINICAL PATHWAY (CP) AND DURATION OF CARE ON COST EFFICIENCY IN PATIENTS WITH CAESARIAN SECTION (SC). http://ejurnalmalahayati.ac.id/index.php/kebidanan
14. Hassankiadeh, R. , F., Kazemnejad, A., Fesharaki, M. G., Jahromi, S. K., & Vahabi, N. (2024). Assessment of length of stay in a general surgical unit using a zero-inflated generalized Poisson regression. Medical Journal of The Islamic Republic of Iran.
15. Kementerian Kesehatan Republik Indonesia. (2024). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/1366/2024 Tentang Pedoman Pelaksanaan Selisih Biaya Oleh Asuransi Kesehatan Tambahan Melalui Koordinasi Antar Penyelenggaran Jaminan.
16. Kurhekar, P., Vinod, K., Krishna, S. D., & Raghuraman, M. S. (2017). Randomized Comparison of Isoflurane versus Sevoflurane and Desflurane for Maintenance of AmbulatoryAnesthesia. Anesthesia: Essays and Researches. https://doi.org/10.4103/aer.AER_174_17
17. Lötscher-Stamm, M., & Lenzin, G. (2024). Definition and understanding of “efficiency” in healthcare provision research: a scoping review. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1439788
18. Maeda, J. L. K., Raetzman, S. O., & Friedman, B. S. (2012). What Hospital Inpatient Services Contributed the Most to the 2001–2006 Growth in the Cost per Case? Health Services Research, 47(5), 1814–1835. https://doi.org/10.1111/j.1475-6773.2012.01460.x
19. Malhotra, R., Kumar, N., & Jain, A. (2020). Cost identification analysis of general anesthesia. Journal of Anaesthesiology Clinical Pharmacology, 36(2), 219–226. https://doi.org/10.4103/joacp.JOACP_77_19
20. Mulyati, Yunita, Satria, I., & Yusra, M. (2017). Akuntansi Biaya. CV Sefa Bumi Persada.
21. Niedar, A. , S. C. , H. D. , V. J. , P. N. A. , W. P. , H. P. , & al A. R. (2021). Manajemen Keuangan dan Akuntansi dalam Ekonomi Kesehatan. PPJK Kementerian Kesehatan Republik Indonesia.
22. Noba, L., Rodgers, S., Chandler, C., Balfour, A., Hariharan, D., & Yip, V. S. (2020). Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis. Journal of Gastrointestinal Surgery, 24(4), 918–932. https://doi.org/10.1007/s11605-019-04499-0
23. Ratmaya, K. A. (2012). Penghitungan Biaya Kamar Operasi Menggunakan Activity Based Costing di Rumah Sakit Umum Puri Raharja.
24. Rotter, T., Kugler, J., Koch, R., Gothe, H., Twork, S., van Oostrum, J. M., & Steyerberg, E. W. (2008). A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Services Research, 8(1), 265. https://doi.org/10.1186/1472-6963-8-265
25. Rumah Sakit Jakarta. (2023). Laporan Tahunan Rumah Sakit Jakarta Tahun 2023.
26. Sauro, K. M., Smith, C., Ibadin, S., Thomas, A., Ganshorn, H., Bakunda, L., Bajgain, B., Bisch, S. P., & Nelson, G. (2024). Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality. JAMA Network Open, 7(6), e2417310. https://doi.org/10.1001/jamanetworkopen.2024.17310
27. Sophia. (2018). ANALISIS BIAYA SATUAN TINDAKAN BEDAH APPENDIKTOMI DI KAMAR OPERASI RUMKITAL Dr MINTOHARDJO TAHUN 2017.
28. Thanassoulis, E., & Silva, M. C. A. (2018). Measuring Efficiency Through Data Envelopment Analysis. Impact, 2018(1), 37–41. https://doi.org/10.1080/2058802x.2018.1440814
29. Viano, N. C., & Junadi, P. (2025). Analisis Peran Case Manager dalam Kendali Mutu dan Kendali Biaya Pelayanan Rawat Inap Bedah di Rumah Sakit Universitas Indonesia Tahun 2022. Jurnal ARSI : Administrasi Rumah Sakit Indonesia, 11(1). https://doi.org/10.7454/arsi.v11i1.1197
30. Wibowo, D. B. (2014). Pengelolaan Dana dan Jasa Medis Dokter pada pasien BPJS (slide PowerPoint).
31. Wita, V. (2012). Perhitungan Biaya Satuan Tindakan Bedah Appendiktomi Akut di Kamar Operasi Rumah Sakit X Tahun 2010.
Published
2025-06-19
How to Cite
Mahardhika, J. C., Soewondo, P., Permanasari, V. Y., & Pramanto, H. (2025). Analisis Efisiensi Biaya Operasi Bedah Umum Jaminan Kesehatan Nasional di Rumah Sakit Jakarta Tahun 2023. Journal Scientific of Mandalika (JSM) E-ISSN 2745-5955 | P-ISSN 2809-0543, 6(9), 3600-3609. https://doi.org/10.36312/10.36312/vol6iss9pp3600-3609
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Copyright (c) 2025 Jeffrey Christian Mahardhika, Prastuti Soewondo, Vetty Yulianty Permansari, Heru Pramanto
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