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All Journal Cakradonya Dental Journal
Munifah Abdat
Faculty of Dentistry, Universitas Syiah Kuala, Banda Aceh, Indonesia

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Analysis of Inpatient Care Cost Under Indonesia’s National Health Insurance Program (JKN) for Low-Income Families: Estimating Hospital Inpatient Capitation Rates Munifah Abdat; Wachyu Sulistiadi; Ronnie Rivany
Cakradonya Dental Journal Vol. 18 No. 2 (2026): August
Publisher : FKG Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/cdj.v18i2.1983

Abstract

Indonesia's National Health Insurance Program (JKN) aims to achieve universal health coverage, including subsidized care for low-income populations. Sustainable inpatient financing remains vital for access. This study aimed to estimate average inpatient service costs, utilization rates, and capitation values for JKN low-income in East Jakarta using hospital claim data. A descriptive quantitative study was conducted using 1,343 inpatient claims from five hospitals. Key variables included patient volume, length of stay (ALOS), diagnoses, and claim costs. The average length of stay was 7.21 days, with a utilization rate of 6.9 admissions per 1,000 population annually. The mean cost per patient was IDR 3,359,799, with public hospitals averaging IDR 2,484,366 and private hospitals IDR 7,244,316. The estimated annual inpatient expenditure was IDR 33,638,311,570, resulting in a capitation rate of IDR 191,063 per person per year (IDR 15,922 per month). Ultimately, capitation may enhance financial predictability for inpatient services; however, implementation should include risk adjustment, quality monitoring, and updated datasets to ensure equitable and efficient healthcare delivery.
Co-Authors Ronnie Rivany Wachyu Sulistiadi