<![CDATA[The INA-CBGs payment system in the National Health Insurance (JKN) program requires hospitals to improve cost efficiency through quality and cost containment. This study aims to analyze the implementation of the Clinical Pathway (CP) for diabetic ulcers, calculate the unit cost of care, and evaluate the Cost Recovery Rate (CRR) at XYZ Hospital, Central Java, using the Activity-Based Costing (ABC) method. A descriptive quantitative study with a cross-sectional design was conducted on all inpatients with a single diagnosis of diabetic ulcer without comorbidities from October to December 2024. Data were collected through activity-based CP observation, medical record review, and hospital financial reports. This study shows that the CP for diabetic ulcers is mostly implemented according to protocol, with mandatory actions concentrated in the first three days of hospitalization. However, variations in length of stay (LOS) and clinical interventions persist based on patient needs. CP optimization and LOS control are crucial, as they strongly correlate with cost efficiency and service quality under the INA-CBGs scheme. Patients without surgery had 558.5 minutes of activity and a unit cost of IDR 1,974,120 (70% direct, 30% overhead; CRR 222%), while those with debridement had 1,051 minutes and a unit cost of IDR 5,275,858 (79% direct, 21% overhead; CRR 83%). INA-CBGs groups different interventions under the same case category, causing payment disparities and risking hospital financial sustainability. The study recommends revisiting INA-CBGs tariffs, enforcing disciplined CP implementation, and optimizing activity-based cost management to maintain efficiency and healthcare quality.]]>
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