Strategic Efforts of X Hospital towards Universal Health Coverage 2019

With the change in payment system from retrospective to prospective for National Health Insurance (NHI) patients, X Hospital must perform strategic efforts for managing the acceptance of service cost (46%) and facility cost (54%) for every Indonesia Case-Based Group (INA-CBG) payment. This study aimed to describe the difference in service cost and facility cost acceptance based on the hospital's billing and INA-CBG payment plus additional costs for patients with wards of an upgraded class, and it also describes X Hospital's strategic efforts toward universal health coverage (UHC). This study has an observational-descriptive design, and it collects quantitative and qualitative data. For this purpose, a total of 432 hospital bills and INA-CBG payments for NHI inpatients in January-February 2016 are collected, and in-depth interviews with several participants from the management, service providers, and administration are conducted. The results show that the total payment acceptance of INA-CBG plus additional costs is lower than the hospital's billing. The total service cost acceptance increased by IDR 99,034,017.00. The highest increase came from the internist ward and the highest decrease, from the obstetric ward. The total facility cost acceptance decreased by IDR 279,521,491.00. All wards showed a decrease, with the highest decrease coming from the internist ward. The proportion of service and facility costs must be balanced with behavior management of healthcare providers, arrangement of clinical pathways, optimization of various costs without reducing the quality of care, providing the hospital's formulary and ensuring usage of drugs and medical devices, and using the hospital management and information system to improve efficiency. By doing so, X Hospital will become ready to provide high-quality healthcare services under UHC.