The Hidden Costs of Inpatient Glaucoma Treatment: Out-of-Pocket Burden at a Tertiary Care Hospital in Yogyakarta

Sang Ayu Putu Udara Pradnyadewi (Departement of Ophtalmology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta)
Krisna Dwi Purnomo Jati (Departement of Ophtalmology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta)
Meta Rahma An Nazzila (Departement of Ophtalmology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta)
Tatang Talka Gani (Departement of Ophtalmology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta)

Ophthalmologica Indonesiana
Vol 52 No 2 (2026): Ophthalmologica Indonesiana

Introduction and Objective: Glaucoma requires lifelong care, generating out-of-pocket (OOP) costs despite insurance coverage. This study assessed OOP expenditure among hospitalized glaucoma patients covered by Indonesia’s National Health Insurance (JKN). Methods: A hospital-based cross-sectional study included 40 purposively selected glaucoma inpatients from December 2024 to February 2025. Self-reported data were collected through structured interviews. Multiple linear regression examined associations between sociodemographic and cost-related factors and total OOP expenditure. Results: Participants’ mean age was 56 years, with a male-to-female ratio of 1:1.9; 52.5% were unemployed and received subsidized JKN contributions. Mean OOP expenditure per hospitalization was IDR 640,090, comprising direct non-medical expenses (92%) and indirect costs (8%). Transportation (mean IDR 352,670; 61% of direct non-medical costs), meals for accompanying relatives (mean IDR 184,125; 32%), and indirect costs (mean IDR 50,375) were significantly associated with total OOP expenditure (all p < 0.001). The model explained 84.3% of expenditure variance (R² = 0.843). Conclusion: Transportation and meals for accompanying relatives dominated direct non-medical OOP costs, highlighting the need to strengthen financial protection for patients and their households.