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INDONESIA
Jurnal Ekonomi Kesehatan Indonesia
Published by Universitas Indonesia
ISSN : 25278878     EISSN : 25983849     DOI : https://doi.org/10.7454/eki
Core Subject : Economy, Health, Science,
Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Health Professions Medicine & Pharmacology Public Health
This journal encompasses original research articles, case studies, conceptual fields, review-based studies (very limited, it will be strictly selected), and protocols. The journal publishes research from various topics in health economics, including but is not limited to the following topics: Economic Evaluation Health Financing Health Policy Health Insurance Pharmacoeconomics Health Technology Assessment (HTA) Tobacco Control Jaminan Kesehatan Nasional (JKN) Health and Econometric Article published in Jurnal Ekonomi Kesehatan Indonesia are determined through the blind review process conducted by the editor and reviewers. They provide evaluation and constructive suggestions for the authors. Prior to be accepted, they considers several factors such as whether the manuscript format is in accordance with the manuscript template and writing guidelines for authors, the relevance of the article with scopes, and its contribution to the development of health economics evaluation and accounting practices as well as the health policy.
Arjuna Subject : Ilmu Sosial - Kesehatan (Ilmu Sosial)
Articles 7 Documents
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Search results for , issue "Vol. 10, No. 2" : 7 Documents clear
Analisis Perbandingan Biaya dan Penggunaan Obat Antara Pasien BPJS Kesehatan dan Non-BPJS Kesehatan Periode Januari-Desember 2022 di Klinik Pratama X Kota Bandung Wilis, Phebe Ariella; Padmasawitri, Tjokorde Istri Armina; Qanaah, Syifa Fitrah
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Abstract

Primary healthcare facilities may have two sources of drug funding: capitation funds for drugs prescribed to patients under the Social Security Administering Agency (BPJS Kesehatan), and out-of-pocket payments from non-BPJS Kesehatan patients. Analyzing drug utilization patterns and financing is essential to ensure the efficient use of these funding sources. This study aims to analyze drug costs and utilization among BPJS Kesehatan patients compared to non-BPJS Kesehatan patients at Primary Clinic X in Bandung City from January to December 2022.This study used a retrospective cross-sectional design with data collected from electronic medical records and pharmacy transactions. Descriptive analysis was employed to compare the number and cost of prescriptions. In contrast, inferential analysis (t-test and ANOVA) was used to assess differences in drug costs across patient occupational groups. Of 6,846 patients, 1,964 were BPJS Kesehatan participants and 4,882 were non-BPJS Kesehatan patients. More drugs were prescribed to non-BPJS Kesehatan patients, but the average cost per prescription was higher among BPJS Kesehatan patients (Rp37,424.23 vs. Rp 32,341.87; p= 0.003). The average monthly proportion of capitation funds used for drugs was 27.89%. The retiree group had the highest average prescription cost (Rp56,337), while students had the lowest (Rp28,078), with significant differences among occupational categories (p< 0.05). At the study site, the average drug cost for BPJS Kesehatan patients was higher than for non-BPJS Kesehatan patients due to the dominance of elderly patients with chronic diseases. These findings highlight the impact of an aging population and rising chronic disease prevalence on increased drug costs, which pose a challenge for capitation fund management.
Cost-Benefit Analysis Program Percontohan Pengendalian Rabies Berbasis One Health di Wilayah Sanur, Denpasar Selatan Ni Wayan, Marheni; I Nyoman, Sutarsa; Subrata, Made
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Rabies continues to pose a significant public health challenge in Bali Province, Indonesia. The Dharma Program, a rabies control initiative based on the One Health approach, has been implemented in multiple areas of the province. Sustaining and expanding this program requires an economic evaluation that compares the cost burden of rabies under scenarios with and without program implementation. This study was conducted in two pilot villages: Sanur Kaja (SKJ) and Sanur Kauh (SKH). Cost data were obtained from activity reports, published literature, and structured interviews with program managers. Benefit values were estimated using scenario modeling, which included treatment costs, post-exposure prophylaxis (PEP) expenses, costs for examining suspected rabid dogs, and vaccination costs for rabies-transmitting animals. The analysis utilized net present value (NPV) and benefit-cost ratio (BCR) as economic indicators. In both villages, the program achieved economic efficiency under conditions of high incidence of bites from rabies-transmitting animals (RTA), as indicated by positive NPV and BCR values greater than one in the third year. Specifically, Sanur Kaja reported an NPV of IDR 21.3 million and a BCR of 1.19, while Sanur Kauh (SKH) reported an NPV of IDR 28.8 million and a BCR of 1.43. Under scenarios of low RTA incidence, both villages experienced negative NPV and BCR values below one, although the magnitude of these losses declined annually. Key variables affecting program financing included the proportion of dogs sterilized, rabies vaccination costs, PEP prices, and changes in RTA incidence. The Dharma Program has demonstrated potential economic efficiency, with positive NPV and BCR achieved from the third year. The continuously improving NPV values and initial investments in dog sterilization and community education contributed to reducing long-term vaccination costs. However, since the analysis remains internal and has not been compared with alternative programs, further comparative studies are required.
Utilization Review pada Jaminan Kesehatan Nasional: Implementasi, Tantangan dan Komponen Essensial Ulandari, Luh Putu Sinthya; Indrayathi, Putu Ayu
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Abstract

Indonesia has implemented the National Health Insurance (JKN) program since 2014; however, various forms of fraud continue to be found. According to regulations, BPJS Kesehatan, as the national social security agency, is required to conduct Utilization Review (UR) as an effort to control costs and improve the quality of healthcare services. The effectiveness of UR remains questionable due to several implementation challenges. This study aims to explore the implementation of UR, identify its challenges, and examine the essential components required for its effective implementation. The study was conducted in August 2023 using a qualitative approach through in-depth interviews. Samples were selected purposively and consisted of five key informants. Data were analyzed using thematic analysis. The results showed that all respondents had good knowledge of the UR concept. BPJS Kesehatan applies a retrospective method. The UR results vary, including trends or patterns of patient visits, the ten most frequent Case Base Groups (CBG), the ten most common procedures, and the ten cases with the highest funding for outpatient and inpatient services. BPJS Kesehatan also formulates recommendations based on the UR results. However, strong commitment from healthcare providers is required to implement improvements. The challenges faced by BPJS Kesehatan include limited time for conducting UR, the large number of healthcare facilities to be assessed, as well as conflicts and misunderstandings with patients. Regarding essential components, three key aspects are needed: human resources, technology, and standardized UR procedures.
Clinical Pathway Sebagai Solusi Keberlanjutan JKN di Indonesia: Systematic Review Septiana, Septiana; Soekiswati, Siti; Ichsan, Burhannudin
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Abstract

The National Health Insurance (JKN) program is threatened with a deficit and potential default in 2026 due to inefficiency and the risk of fraud in healthcare facilities. In the context of JKN, which uses a package system (INA-CBG), Clinical Pathway (CP) is a strategic instrument within the JKN system that has dual benefits for both Payers (BPJS Kesehatan) and Providers (Hospitals). For BPJS Kesehatan, CP primarily functions to ensure service quality and prevent undertreatment fraud, the practice of reducing services to benefit hospitals. This prevention ultimately achieves cost efficiency in the JKN program by avoiding payment of complication claims and readmissions arising from substandard services. On the hospital side, CP helps control real cost effectiveness (cost) to maintain efficiency. High CP compliance can reduce inefficiencies (e.g., resource overutilization), thereby reducing the gap in hospital losses under the INA-CBG package system. This indirectly reduces the incentive for hospitals to commit fraud. This study aims to synthesize comprehensive evidence regarding the impact of CP compliance on cost efficiency (Hospital Cost) from a provider perspective and its impact on the sustainability of JKN. The method used was a Systematic Review based on the PRISMA framework, analyzing 28 articles from hospitals in Indonesia (2016-2025) that discussed the impact of CP on costs and/or Length of Stay (LOS) as well as the quality of clinical services. During the snowballing and abstract screening stages, we also found that compliance was an important variable measured by the studies we reviewed. The results show that the level of CP compliance in Indonesia remains low; 80% of hospitals have compliance below 50%, which triggers service variations and the risk of fraud. CP compliance is consistently positively correlated with reduced Hospital Costs (thus increasing internal hospital efficiency) and accelerated LOS. In addition to cost efficiency, CP has also been shown to improve the quality of clinical services by reducing complications (SSI: Surgical Site Infection) and reducing the risk of readmissions. In conclusion, CP is an essential dual solution; improving CP compliance is a fundamental key to balancing hospital cost efficiency without sacrificing quality, while simultaneously safeguarding the financial sustainability of the JKN Program from the burden of unnecessary complication claims.
Cost of Illness Analysis in Total Knee Replacement at Public Hospital Jenderal Ahmad Yani, Lampung, Indonesia Alia, Dina Fatma; Endarti, Dwi; Andayani, Tri Murti
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Abstract

Total knee replacement (TKR) is one of the most economical and frequently successful orthopedic procedures. Cost-of-illness studies of TKR in Indonesia are scarce and lack an analysis of the relationship between characteristics and costs. This study aims to examine the cost-of-illness of TKR from a social perspective and explore the relationship between the characteristics and the cost of TKR. This is an observational cross-sectional study of all patients who underwent TKR from 1st January 2022-31 st December 2023. The characteristics were collected from the medical records. Cost of illness was conducted from a social perspective with a bottom-up approach. Hospital cost on the JKN ECLAIM System was obtained as direct medical cost. Direct non-medical and indirect costs were collected through a phone interview with the patient or caregiver. Indirect cost was defined as income loss from the patient and caregiver. The relationship between characteristics and cost was analyzed bivariately using the Mann–Whitney U test and Kruskal–Wallis test. Of a total 54 patient were obtained. Median direct medical cost was 51,769,675 IDR; direct non-medical cost was 850,000 IDR; and indirect cost was 750,000 IDR. None of the characteristics had a direct relationship with medical cost. Age (p = 0.043), Caregiver (p <0.001), and distance traveled (p <0.001) were known as characteristic related to direct non-medical costs. Indirect cost was related to age (p = 0.053) and employment status (p = 0.005). This study only examined the cost of TKR in the hospital. Costs of post-surgery recovery steps, including costs for revisit consultations, wound care, and physiotherapy, need to be carried out in the future.
Analisis Perbedaan Biaya Satuan Sectio Caesarea Tanpa Penyulit dengan Tarif INA-CBGs di Rumah Sakit Swasta Tipe D (X) di Ternate Tahun 2022 Hani, Ummu, MARS; Soewondo, Prastuti
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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Cesarean section unit cost is an important component for hospital’s management to implement strategic efficiency steps in the future, especially for Rumah Sakit X which 90% of patients are Jaminan Kesehatan Nasional’s participant. Geographically, this hospital is one of hospitals which serve delivery and labor services in Ternate Island that can accommodate references from nearby islands. This resulting in high caesarean section rate, 55 % of all deliveries. The low JKN rate for caesarean section forced management to know the detailed cost component, so the efficiency strategies and the continuity of hospital services could be more increased. This research through quantitative strategy, processing caesarean section patients’ secunder data, interviewing staff, and looking through hospital’s financial statements. We analyzed every Caesarean sections in 2022 using Activity Based Costing. The total cost for caesarean section is 6.659.302 IDR. The difference from INA-CBGs are 1.569.376 IDR for 3rd class, 754.976 IDR for 2nd class, and 59.524 IDR for 1st class. Efficiency efforts than had been done was reducing the length of stay and using consumables with lower price. Expansion of caesarean section was suggested with cooperation with midwives and first degree health care in order to minimize the hospital referrence.
Unraveling the Drivers of Inequality in Maternal Healthcare Utilization in Indonesia: A Decomposition Analysis Wahyuningsih, Wji; Siregar, Kemal N; Nurhakiki, Syifa
Jurnal Ekonomi Kesehatan Indonesia Vol. 10, No. 2
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This study assessed socioeconomic inequalities in maternal healthcare utilization in Indonesia and identifies key factors driving these inequalities. We used data from 2013 and 2023 Indonesian Health Surveys, comprised of a total unweighted sample of 15,638 and 9,923 women aged 15-49 in the 2013 and 2023, respectively. Concentration index (CI) measured wealth-based inequality, and decomposition analysis identified primary drivers of inequalities in maternal healthcare access. Overall maternal healthcare service utilization has increased, but significant inequalities persist. Antenatal care showed minimal improvement, with the CI rising from 0.059 to 0.079, indicating a persistent higher socioeconomic distribution. Facility-based deliveries improved, with the CI decreasing from 0.115 to 0.039. Cesarean section inequality, though reduced, remains high, with CI declining from 0.299 to 0.158. Decomposition analysis revealed that socioeconomic status, women’s education, and geographic location were the primary drivers of inequalities in maternal healthcare utilization. While Indonesia has made progress in increasing facility-based deliveries, especially among the poorest women, inequalities persist in antenatal care and cesarean section. Pro-poor policies must address these multidimensional barriers by improving access to education, particularly for women, and implementing region-specific interventions, especially in eastern Indonesia, which lags in healthcare development.

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