KESANS : International Journal of Health and Science
Vol 5 No 9 (2026): KESANS: International Journal of Health and Science

A Systematic Review of Reimbursement Mechanisms: Effectiveness, Efficiency, and Patient Satisfaction in Insurance-Based Health Financing Systems

Neliyana Neliyana (Faculty of Medicine and Health Sciences, Universitas Jambi, Indonesia)
Ummi Kalsum (Universitas Jabmbi, Indonesia)
Asparian Asparian (Universitas Jabmbi, Indonesia)
Dwi Noerjoedianto (Universitas Jabmbi, Indonesia)
Wilia Novita Eka Rini (Universitas Jabmbi, Indonesia)
Muldiasman Muldiasman (Universitas Jabmbi, Indonesia)



Article Info

Publish Date
23 Jun 2026

Abstract

Introduction: The reimbursement mechanism is a fundamental component in an insurance-based financing system that affects service effectiveness, operational efficiency, and patient satisfaction. Objective: This study aims to conduct a systematic review of the literature that discusses reimbursement mechanisms with a focus on these three main dimensions. Method: Using the Systematic Literature Review approach following the PRISMA 2020 guidelines, a comprehensive search was conducted through four electronic databases to identify peer-reviewed articles for the 2021-2025 period. Of the 30 articles initially identified, six studies met the inclusion criteria and were analyzed in depth. Results and Discussion: Results show that the Diagnosis Related Groups system is effective in reducing costs but has the potential to negatively impact the quality of service. Differential reimbursement and cost-sharing mechanisms have been shown to be able to direct healthcare seeking behavior, although their effectiveness is highly contextual dependent on geographic and socio-economic factors. Patient satisfaction shows significant variation by service class with disparities in the dimensions of effectiveness, accessibility, patient-centeredness, and equity. The utilization rate of health services in Indonesia's National Health Insurance system is still relatively low, indicating the need for a comprehensive evaluation of the design of reimbursement mechanisms. Conclusion: This study emphasizes that optimizing the reimbursement system requires a holistic approach that balances cost efficiency, service quality, and patient satisfaction as interrelated outcomes in the health financing ecosystem

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Journal Info

Abbrev

kesans

Publisher

Subject

Chemistry Health Professions Medicine & Pharmacology Physics Public Health

Description

KESANS : International Journal of Health and Science provides a means for ongoing discussion of the relevant issues that fall within the focus and scope of the journal that can be examined empirically. This journal publishes research articles in the medicine, Nursing, Midwifery, Public Health, ...