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Analysis of hospital costs and insurance reimbursement systems for pneumonia patients: A literature review Nopriyan Pujokusuma; Muhammad Syamsu Hidayat; Rochana Ruliyandari
Science Midwifery Vol 13 No 6 (2026): February: Health Sciences and related fields
Publisher : Institute of Computer Science (IOCS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35335/midwifery.v13i6.2225

Abstract

Pneumonia has remained one of the leading causes of global morbidity and mortality and has imposed a substantial clinical and financial burden on healthcare systems. The high cost of pneumonia care was influenced by disease severity, comorbidities, length of hospital stay, and the use of therapeutic and diagnostic interventions. The implementation of prospective payment systems, such as Diagnosis Related Groups (DRGs) and INA-CBG’s, aimed to improve cost efficiency; however, it often resulted in gaps between actual hospital costs and reimbursement tariffs. This literature review aimed to analyze hospital costs and insurance reimbursement systems for pneumonia patients. A Systematic Literature Review was conducted following PRISMA guidelines through searches of PubMed and Google Scholar for publications from 2020 to 2025. Eleven articles met the inclusion criteria and were analyzed narratively. The findings indicated that length of stay, clinical complexity, and the use of broad-spectrum antibiotics were the main determinants of high costs. Package-based payment systems improved efficiency but continued to face underfunding challenges. This study concluded that optimizing pneumonia cost management required clinical efficiency, accurate claims coding, and technological support to ensure hospital financial sustainability.
Co-Authors Abiyusa, Annisaa Yuniarti Adnan, Muhammad Luthfi Afthina, Rifka Ellya Agra Nabilfavian Evandinnartha Agung Kristanto Anggi Triya Septiani Anggita, Dila Astia Putri, Dela Bariya, Umi Khoirul Dodik Prakoso Eko Hery Suwandojo Dwi Yulianti Dyah suryani Elysanti Toring Elma Bura Fatma Nuraisyah, Fatma Fatwa Tentama Fitriana Putri Utami Fitro Adilla Fitroh Adhilla Fitroh Adila Handayani, Lina Handayani, Tika Sri Helfi Agustin Ianto, Sadam Alfian Galang Ichsan Priyotomo Ifada Rahmayanti Khoiriyah, Salsabila Laila, Linda Lina Handayani Lina Handayani Mahmood, Afzal Marwati, Tri Ani Mentes Hartanti Moss, John Muhammad Ihsan Pratama Muhammad Syapril Mustika Cahya Nirmala Dewinta Nabila Fanda Syafitri Neni Ramayani Nopriyan Pujokusuma Nuramelia, Yulianti Nurhafisah Nurhafisah Nurmaningsih Nurmaningsih Pangastuti, Palupi Melati Rahim, Mohammad Afiff Bin Rifka Ellya Afthina Rochana Ruliyandari Rochana Ruliyandari Rokhmayanti Rokhmayanti Rokhmayanti Rosyidah Rosyidah Rosyidah Rosyidah, Rosyidah rubaida, ida Ruwanto, Ruwanto Safrotul Laely Selegani, Ferdinan Septian Emma Dwi Jatmika, Septian Emma Dwi Siti Kurnia Widi Hastuti Sitti Nur Djannah Siwi Pramatama Mars Wijayanti Solikhah, Dina Putri Sri Wahyunita Mohamad Sulistyawati Sulistyawati Sulistyawati Sulistyawati Sumadi, Andrias Feri Sumiyati Sumiyati Surahma Asti Mulasari Teti Sukmawati Tri Ani Marwati Tri Ani Marwati Tri Ani Marwati Tri Wahyuni Sukesi Tri Wahyuni Sukesi Trismadani Erlina Putri Ulinnuha Yudiansa Putra Wardiyanta Wardiyanta Wardiyanta, Wardiyanta Widodo Hariyono Widodo Hariyono Wiji Astuti Wiji Astuti Wiji Astuti Yanasta Yudo Pratama Zahra, Aini