Evaluation of BPJS Financing Efficiency and Characteristics of Outpatient ENT Patients In 2023 – 2025 Based on INA CBGs Rates at RS X Surabaya

Andie Roesbiantoro (Doctoral Professional Education Study Program, Faculty of Medicine, Universitas Nahdlatul Ulama Surabaya, 60237 Surabaya, East Java, Indonesia)
Rizka Dany Effendi (Doctoral Professional Education Study Program, Faculty of Medicine, Universitas Nahdlatul Ulama Surabaya, 60237 Surabaya, East Java, Indonesia)
Budhi Setianto (Department of Public Health, Faculty of Health, Universitas Nahdlatul Ulama Surabaya, 60237 Surabaya, East Java, Indonesia 4 Head of Hospital Planning, Development, and Management Information Systems Department, RS Islam Surabaya Ahmad Yani, 60243, S)
Agus Aan Adriansyah (universitas nahdlatul ulama surabaya)
Yauwan Tobing Lukiyono (Department of Medical Laboratory Technology, Faculty of Health, Universitas Nahdlatul Ulama Surabaya, 60237 Surabaya, East Java, Indonesia)
Nikmatus Sa'adah (Department of Dentistry, Faculty of Dentistry, Bhakti Wiyata Institute of Health Sciences,Kediri 64144, East Java, Indonesia)

Journal of Health Sciences
Vol 19 No 03 (2026): Jurnal Ilmiah Kesehatan (Journal of Health Science)

The National Health Insurance Program (JKN) through BPJS Kesehatan uses the INA- CBGs payment system to improve financing efficiency and the quality of hospital services. However, the increase in service complexity and changes in patient characteristics can affect service efficiency, especially in Ear, Nose, Throat (ENT) specialist services. This study aims to evaluate changes in patient characteristics, distribution of service financing, efficiency of INA-CBGs tariffs, and management of BPJS services for outpatient ENT Poly at Surabaya Islamic Hospital in 2023–2025. The research uses an evaluative method with a descriptive quantitative approach. The research data came from secondary data on TXT BPJS outpatient ENT which included patient characteristics, diagnosis, service cost components, hospital rates, and INA- CBGs rates. The sampling technique used total sampling of all BPJS patients in the outpatient ENT period of the study period. The results showed that patient visits were dominated by women and adult age groups. The most common cases are other minor chronic diseases. Total hospital costs increased from IDR 256,479,954 in 2023 to IDR 369,708,595 in 2025 with the largest cost component coming from consultations and medicines. Although the rate of INA-CBGs is still higher than the cost of hospitals, the difference in profits has decreased significantly. This study concludes that it is necessary to strengthen service efficiency, control costs, and optimize service management to maintain the financial sustainability of hospitals.