Analysis of typhoid fever clinical pathway implementation in the era of national health insurance in Indonesia

Starting in November 2016, pricing policy for private hospital in Indonesia was specifically set in a fixed tariff called INA-CBGs (Indonesian Case Base Groups). PMI Hospital which was affected by INA-CBGs regulation built Clinical Pathway for Typhoid fever in order to cope with the challenge. It admitted 705 cases in less than a year in 2016 yet it was claimed that the reimbursement for each case was still lower than the hospital cost. Study aimed to explore variation of medical practices based on Clinical Pathway considering INA-CBGs 2016 pricing policy. Cases included in the study were 156 cases with homogenous severity level chosen from October 2016 to March 2017. Historical data was taken from hospital information system including medical record and billing details. Data was processed using ClinPath V.2.0 tools developed by Faculty of Public Health Universitas Indonesia resulting in distribution of variation. Variation resulted in Length of Stay was (4.27 days) and it was expected to be 4-5 days in clinical pathway while not all patients utilized the same procedure within one period of care. There were also non-value added diagnosis such as Complete Urine (0.01) and Electrolyte test (0.01) included. Consumption of antibiotic (0.28) which consisted of 25 different trade names from different structures resulted in various tariff of services. Variation drives medical cost resulted in tariff increment. Typhidot test can be taken into consideration and the use of later generation of antibiotics are recommended considering affordability and availability.