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Fathi, Gemia Clarisa
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Humanities Computer Science & IT Economics, Econometrics & Finance Education Social Sciences

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Analysis of Claims for Acute Ischemic Stroke Patients with National Health Insurance (JKN) Financing at the University of Indonesia Hospital in 2024 Fathi, Gemia Clarisa; Junadi, Purnawan
Journal of Social Research Vol. 4 No. 7 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v4i7.2641

Abstract

Acute ischemic stroke is a leading cause of mortality and disability in Indonesia, with thrombolysis therapy using alteplase being a high-cost treatment. The gap between the INA-CBGs tariff and actual hospital costs, particularly for ischemic stroke, poses a significant challenge to health financing efficiency. This study aims to analyze the disparity between INA-CBGs rates and actual costs for treating acute ischemic stroke at the University of Indonesia Hospital (RSUI). Using a retrospective descriptive design, the study examines JKN claim data from January to December 2024, with a sample of 340 claims of ischemic stroke patients (ICD-10 code I63.9) in the INA-CBGs G-4-14 group. The analysis includes patient characteristics, treatment class, severity level, and cost components. Results show that the majority of patients were male (57.4%) and aged 60–74 years (46.5%). Most patients (90.3%) did not receive thrombolysis, with moderate severity being the most common case (66.8%). A significant discrepancy was found between the INA-CBGs tariff (IDR 2,716,782,600) and actual hospital costs (IDR 3,468,927,095), with a negative difference of 27.7%. The main cost components were medicines (22.5%), followed by room accommodation, radiology, and laboratories. The study highlights the need for policy evaluation to address the financing gap in stroke services to ensure equitable and sustainable health financing.
Co-Authors Purnawan Junadi