<![CDATA[Background: The management of hazardous solid medical waste (B3) poses a challenge for hospitals in South Tangerang City, as no hospital in the area currently has its own on-site treatment facilities, meaning Hospital X still relies on third-party providers (outsourcing). Method: Employing a mixed-methods case study design, this research examines public acceptance of on-site incinerators through statistical association analysis (involving six key informants) and evaluates financial feasibility via a cost-benefit analysis (CBA) using three years of secondary budget data (2023–2025). Financial metrics—evaluated at a 10% discount rate across three CAPEX sensitivity scenarios, include Net Present Value (NPV) and Benefit-Cost Ratio (BCR). Findings: The results indicate that storage and processing aspects are significantly associated with community acceptance (p = 0.044, OR = 1.661; p = 0.034, OR = 2.538). Although the standalone incinerator generated a positive NPV over the 3-year horizon, its BCR remained below 1, whereas outsourcing resulted in cumulative savings of approximately IDR 241 million. Conclusion: Given low waste volumes, outsourcing is more economically rational, while public acceptance depends more on proper storage and treatment practices than technology choice. Novelty/Originality of this article: This study integrates social acceptance and financial feasibility within a single framework, offering practical, economically viable, and socially acceptable decision insights to guide hospital decision making in developing urban contexts, subject to a three year budget horizon limitation.]]>
