Analysis of the Difference Between Hospital Actual Tariffs and INA-CBG Tariffs in Mild-Severity Cesarean Section Cases

Abstract

The INA-CBG payment system sets package tariffs based on diagnosis groups without accounting for the actual cost variations incurred by hospitals, potentially creating discrepancies with hospitals' actual tariffs, including in Sectio Caesarea (SC) delivery cases. This study aimed to analyze the difference between hospital actual tariffs and INA-CBG tariffs and to identify factors presumably contributing to this difference based on detailed service costs in mild severity level SC cases at RSU Faga Husada in 2025. The sample consisted of all BPJS inpatients undergoing mild severity level SC delivery without complications at RSU Faga Husada in 2025, totaling 72 cases, selected using a census technique. This quantitative study employed a cross-sectional design with retrospective data collection. Data were gathered through documentation studies of claims and patient billing records, then analyzed descriptively and tested using the Wilcoxon Signed Rank Test after the Kolmogorov-Smirnov normality test indicated non-normal data distribution. Based on the research results it was found that the total hospital actual tariff was Rp1,063,857,390.00, while the total INA-CBG tariff was Rp367,177,000.00, resulting in a difference of Rp696,680,390.00 (p=0.000). The surgical procedure component was the largest cost contributor, accounting for 80.26% of the total actual tariff.