A Diagnostic Related Group and Its Effect on Hospital Costs: findings from Indonesia

Presenter: Ni Mas Ratna Sudewi, PT Askes (Persero) Indonesia

Abstract

The use of a diagnostic related group (DRG) system for hospital payment is internationally invasive. In 2007 Indonesia introduced this system (known as INA-DRG) for paying the third class government owned hospital. Following up on this policy, a new standard tariff of INA-DRG has been developed, and has been signed by the Ministry of Health. This represented a profound policy change of the sort being considered by policy-makers, hospitals, and insurers including PT Askes (Persero) Indonesa. We use 1.230 hospitalization cases data to analyze the financial effects of INA-DRG system. The data were taken in September up to December 2007 from four government owned hospitals in three provinces (Jakarta, Jogjakarta, and Bali). We compare and contrast tariff per diseases diagnosis between the standard tariff of INA-DRG and the tariff that was generated from medical claim on the previous payment system (e.g., fee for service mixed with package tariff). As the previous payment system are made base on costs per treatment, we aggregrated several treatments into specific diseases diagnosis, and then calculated the total treatments costs for the respective diseases diagnosis. Combine with utulization data, a simulation was carried out as to figure out the effect of implementing INA-DRG on future medical costs. The result indicates that PT Askes (Persero), base on the standard tariff of INA-DRG, has paid hospitals on average 8.47% higher than the hospital claim. Among the 10 most frequent of diseases diagnosis, we find that six (and four) of them have tariff an average lower (and higher) than the standard tarif of INA-DRG. The six of the diseases diagnoses inlcude Dengue Hemorhagic Fever (-42%), Liveborn Infants According to Place of Birth (-62%), Diarrhoea & Gastroenteritis of Presumed Infectious Origin (-66%), Typoid Fever (-53%), Acute Appendicitis (-50%), and Unspecified Injury of Head (-64%). Whilst the four of the disease diagnosis are Unspecified Delivery by Caesarean Section (+28%), Tuberculosis of Lung without Mention of Bacteriological (+53%), Unspecified Single Spontaneous Delivery (+11%) and Other Abortions (+242%). Our findings suggest that the implementation of INA-DRG would have a significant financial implications for both insurer (PT. Askes) and hospitals.

Authors: Ni Mas Ratna Sudewi, Budi Hidayat, I. Gede Subawa, Umbu Marisi, Suzanna Zadli Razak, Mira Anggraini, Ambar Wati, Andi Afdal, Togar Siallagan

Session: Poster
Time: -
Room: No.3 Hall