Analysis Of Differences Between Actual Tariffs And Idrg Tariffs In Inpatient Bpjs Kesehatan Patients With Bronchopneumonia

Abstract

Health services for BPJS Kesehatan participants use a package-based payment system through the Indonesian Diagnosis Related Groups (iDRG), whereas hospitals incur actual costs based on the services provided. This study aimed to determine the differences between actual tariffs and iDRG tariffs, as well as the factors contributing to these differences, in claims for patients with Bronchopneumonia during the October–December 2025 period at South Buton Regency Hospital. The study employed a descriptive-analytical design with a quantitative approach. Saturated sampling, observation, and documentation study techniques were used. Univariate analysis was conducted using SPSS version 30.0 and Microsoft Excel. The results showed that 7 cases (26.9%) had a negative difference, while 19 cases (73.1%) had a positive difference. Among the 11 comparative cases, nursing costs were the dominant component in 9 patients (81.8%), contributing between 38.7% and 87.8%. Consultation costs were dominant in 2 patients (18.2%), with contributions of 21.9% and 24.3%, respectively. It was concluded that differences existed between the actual tariffs and iDRG tariffs. The primary factor contributing to these differences was nursing costs, followed by consultation costs.