Evaluation of BPJS Financing Efficiency and Characteristics of Outpatient ENT Patients In 2023 – 2025 Based on INA CBGs Rates at RS X Surabaya
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Andie Roesbiantoro
Rizka Dany Effendi
Budhi Setianto
Agus Aan Adriansyah
Yauwan Tobing Lukiyono
Nikmatus Sa'adah
Abstract
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.
Downloads
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2026 Andie Roesbiantoro, Rizka Dany Effendi, Budhi Setianto, Agus Aan Adriansyah, Yauwan Tobing Lukiyono, Nikmatus Sa'adah
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Andi Roesbiantoro, Budhi Setianto, Agus Aan Adriansyah, Rizka Dany Afina, Diah Retno Kusumawati,
N. S. (2025). Evaluation of INA-CBGs Tariffs in BPJS Outpatients as an Effort to Control Quality
and Costs at the ENT Polylinic of Surabaya Islamic Hospital Andi. Jurnal Ilmiah Kesehatan, 18,
316–323.
Azhari, A. A., Panjaitan, Z. N., Putri, N. A., Soleha, E., & Maysandy, L. (2020). Sosialisasi Pelaksanaan
Sistem INA-CBGs di Pelayanan Kesehatan. Jurnal Abdidas, 1(3), 149–156.
Elhuriyah, E., & Lendrawati, L. (2025). Analisis Tarif Layanan BPJS Kesehatan: Studi Kasus Pada
Poliklinik Saraf Rumah Sakit X. JEMSI (Jurnal Ekonomi, Manajemen, Dan Akuntansi), 11(6),
5656–5665. https://doi.org/10.35870/jemsi.v11i6.5286
Firman, F. (2024). Analisis Pembiayaan berdasarkan Lama Rawat Pasien BPJS Diabetes Melitus Tipe II
Komplikasi Sirkulasi Perifer di RSU PKU Muhammadiyah Bantul. Jurnal Ekonomi Kesehatan
Indonesia, 9(1). https://doi.org/10.7454/eki.v9i1.1119
Irdhina Putri Batrisyia, Fadli Robby Amsriza, M. R. F. (2024). Analisis Trend Kunjungan dan Pola
Pembiayaan Pasien Poliklinik Bedah Sebelum dan Sesudah Implementasi Jaminan Kesehatan
Nasional (JKN) di RS AMC Muhammadiyah Yogyakarta. MANUJU: MALAHAYATI NURSING
JOURNAL, 2(8), 306–312.
Kementerian Kesehatan Republik Indonesia. (2022). Panduan Layanan Peserta Jaminan Kesehatan
Nasional Kartu Indonesia Sehat (JKN-KIS). Riskedas 2018,3, 103-111. Kemenkes 2022, 3, 103–
111.
Nasel, F. A., Arimbi, D., & Makbul, A. (2025). Keseimbangan antara Efisiensi Biaya dan Hak Pasien
dalam Studi Kebijakan Pembatasan Obat dalam BPJS Kesehatan. Jurnal Ilmu Hukum, Humaniora
Dan Politik, 5(6), 5324–5332. https://doi.org/10.38035/jihhp.v5i6.5693
Nilmawati, Y., Yanie, A., & Saputera, M. M. A. (2025). Analisis Selisih Biaya Riil Dan Tarif Paket INA-
CBG’s Dengan Faktor-Faktor Yang Mempengaruhi Biaya Pada Pasien JKN Rawat Inap Di Klinik
Utama Setara Barito Kuala. Jurnal Farmasi SYIFA, 3(1), 17–21.
https://doi.org/10.63004/jfs.v3i1.604
Nita Perlita. (2020). Pengaruh Sistem Akuntansi terhadap Efisensi Pengelolaan Klaim Jaminan Sosial di
Indonesia. Jurnal Ilmu Dan Riset Akuntansi :, 5(7), 201–208.
Nuurjannah, N. Y. (2021). IMPLEMENTASI KEBIJAKAN JAMINAN KESEHATAN NASIONAL (
JKN ) DI RUMAH SAKIT UMUM DAERAH ( RSUD ) KOTA BANDUNG PENDAHULUAN
Berdasarkan Undang-Undang Nomor 36 Tahun 2009 Tentang Kesehatan Pasal 5 daya di bidang
kesehatan . aman , bermutu , dan terjangkau . ( 3. Jurnal Ilmiah Administrasi Pemerintahan
Daerah (JIAPD), Vol 13(2), 63–77.
Peraturan Menteri Kesehatan NO.26 Tahun. (2021). Peraturan Menteri Kesehatan Republik Indonesia
Nomor 26 Tahun 2021. Peraturan Menteri Kesehatan Republik Indonesia Nomor 26 Tahun 2021,
26, 10–17.
Purba, Y. T., Sinaga, A. G., & Simbolon, P. H. (2023). Analisis kebijakan program jaminan kesehatan
nasional (JKN) terhadap akses pelayanan kebidanan. Prosiding Seminar Nasional Bukit
Pengharapan, 26–30.
Rita, M., Situmorang, M., Aprileony, J., Sekolah, E., Ilmu, T., Lancang, A., & Dumai, K. (2025).
Implementasi Kebijakan Program Jaminan Kesehatan (JKN) dalam Meningkatkan Akses
Pelayanan Kesehatan. Jurnal Administrasi Pemerintahan Desa, 07(01), 1–18.
https://doi.org/10.33086/jhs.v19i03.8838 286
Andie Roesbiantoro - 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 / JOURNAL OF HEALTH SCIENCE – VOLUME 19 NOMOR 03 (2026) E-ISSN: 2477-3948
Roesbianto, A., Setianto, B., Adriansyah, A. A., Setiyowati, Bistara, D. N., & Sa’adah, N. (2022).
Description Of Characteristics , Diagnosis And Financing Of BPJS Patients. Medical Technology
and Public Health Journal, 6(2), 169–176.
Roesbiantoro, A., Setianto, B., Adriansyah, A. A., Lukiyono, T., Afina, R. D., & Karmila, H. N. (2022).
Campaign To Increase The Knowledge Of Health Cadres In Efforts To Prevent Hearing Loss
Risks In Commemoration Of World Hearing Day. Proceeding SNPM Unusa, 2(3).
Syesharini, R. A., Putri, Z. M., & Ananda, Y. (2020). Perbandingan Biaya Rawat Jalan Poliklinik Jantung
Dengan Realisasi Klaim BPJS. Jurnal Kesehatan Medika Saintika, 11(2), 253–257.
Wijaya, S. H., & Winoto, H. T. (2025). Penelaahan Efisiensi Unit Pelayanan Rawat Jalan Berdasarkan
Kinerja Dokter dan Waktu Tunggu Pelayanan Pasien: Studi Kasus di RS UNAIR. Jurnal Ilmu
Manajemen Terapan, 6(6), 374–389.
Wilis, P. A. (2025). Analisis Perbandingan Biaya dan Penggunaan Obat Antara Pasien BPJS Kesehatan
dan Non-BPJS Kesehatan Periode Januari-Desember 2022 di Klinik Pratama X Kot