Journal of Social Research
Vol. 4 No. 7 (2025): Journal of Social Research

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 (Unknown)
Junadi, Purnawan (Unknown)



Article Info

Publish Date
25 Jun 2025

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.

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Journal Info

Abbrev

ijsr

Publisher

Subject

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

Description

The Journal of Social Research is a double blind peer-reviewed academic journal and open access to social and scientific fields. The journal is published monthly by International Journal Labs. The Journal of Social Research provides a means for sustained discussion of relevant issues that fall ...