ANALYSIS OF HOSPITAL MANAGEMENT PERCEPTION TOWARDS DIFFERENCE BETWEEN REAL RATE OF HOSPITAL AND RATE OF INACBGS IN HEMODIALYSIS SERVICES: A STUDY QUALITATIVE AT PERTAMINA HOSPITAL PANGKALAN BRANDAN

Abstract

This study analyzes the perception of hospital management at Pertamina Hospital Pangkalan Brandan regarding the discrepancy between actual hospital costs and INA-CBGs reimbursement rates for hemodialysis services. The research was prompted by concerns over the financial gap that may impact service sustainability and quality for chronic kidney disease patients. A qualitative case study approach was used, involving in-depth interviews with key informants such as the hospital director, head of finance, medical personnel, and administrative staff. Findings revealed a significant disparity between real costs—ranging from IDR 1,200,000 to IDR 1,600,000 per hemodialysis session—and INA-CBGs reimbursements of only IDR 850,000 to IDR 950,000. The largest cost components were medications, disposable medical equipment, and human resources. This discrepancy places operational burdens on the hospital, which are managed through efficiency measures and cross-subsidies. Informants emphasized that INA-CBGs tariffs do not adequately reflect the clinical complexity of patients, particularly those with comorbidities or frequent dialysis needs. The study recommends revising the INA-CBGs scheme by aligning reimbursement rates with clinical realities and involving hospitals in policy development. In conclusion, reforming the INA-CBGs tariff system is essential to maintaining the financial viability and quality of hemodialysis services in Indonesian hospitals.