Cost Disparities Between Hospital Expenditures and Reimbursement Schemes in Indonesia: A Study on Chemotherapy for Breast Cancer

Document Type : Research Articles

Authors

1 Faculty of Pharmacy, Universitas Mulawarman, Samarinda, Indonesia.

2 Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.

3 Sekolah Tinggi Ilmu Kesehatan Samarinda, Samarinda, Indonesia.

Abstract

Objective: Significant gaps exist between hospital-incurred medical costs and national health insurance reimbursement rates, challenging the sustainability and equity of breast cancer care in Indonesia. Fixed tariffs often fail to capture the complexities and financial burdens associated with chemotherapy. This study compares hospital-incurred medical costs with both INA-CBG and non-INA-CBG reimbursement rates for breast cancer chemotherapy, identifies the key cost components, and evaluates the appropriateness of current tariffs under the National Health Insurance (JKN) scheme. Methods: A retrospective cross-sectional study was conducted at a tertiary hospital in Surabaya, Indonesia, using data from breast cancer patients who underwent chemotherapy in 2021. Clinical and cost data were obtained from hospital billing records, electronic medical records, and BPJS Kesehatan claims. The Wilcoxon signed-rank test was used to compare hospital-incurred medical costs with reimbursement rates. Subgroup analyses by INA-CBG code and chemotherapy regimen were performed to assess variability in coverage. Results: A total of 80 patients were included, predominantly female (97.5%) and diagnosed with stage IV disease (64.1%). Most were categorized under INA-CBG code C-3-13-0 (93.75%). Overall, the median hospital-incurred medical costs significantly exceeded reimbursement rates: IDR 3,657,290 vs. IDR 1,161,000 for C-3-13-0 (p < 0.001) and IDR 3,964,189 vs. IDR 2,151,900 for C-4-13-I (p = 0.031). Key cost drivers were chemotherapy administration (57.93%), nursing care (14.04%), and handling of cytotoxic drugs (7.88%). Specific regimens, such as vinorelbine, showed significantly higher costs that were not adequately reimbursed. Conclusion: JKN tariffs for breast cancer chemotherapy substantially underestimate actual treatment costs. To improve financial sustainability and access, periodic tariff adjustments, adoption of activity-based costing, and consideration of hybrid payment models should be implemented to ensure equitable financing of oncology care in Indonesia.

Keywords

Main Subjects

Asian Pacific Journal of Cancer Prevention
Volume 27, Issue 3
March 2026
Pages 999-1005

Files

History

  • Receive Date: 23 July 2025
  • Revise Date: 27 October 2025
  • Accept Date: 25 February 2026

Share

How to cite

Statistics