ANALYSIS OF TARIFF POLICY AND THE EFFICIENCY OF BPJS HEALTHCARE FINANCING ON THE SUSTAINABILITY OF HOSPITALS AND PATIENT SATISFACTION IN INDONESIA

Abstrak

The National Health Insurance Program (JKN) managed by BPJS Kesehatan has been using the INA-CBGs tariff system for efficient healthcare financing since 2014. This system groups diagnoses and medical procedures to determine inpatient service package rates. A literature study using a mixed methods approach and Systematic Literature Review of 25 journals between 2013 and 2025 was conducted to analyze the suitability of INA-CBGs rates with the actual costs of hospital services, their impact on hospital financial conditions, and the influence of rate policies on service quality and JKN participant satisfaction. The results showed that INA-CBG rates were, on average, 9–15% lower than actual costs, triggering financial pressure and bankruptcy risks for hospitals, especially those with less effective financial management. Hospitals that implement efficient management and Activity-Based Costing systems can reduce losses and maintain service quality. In addition, tariff disparities also have an impact on declining service quality and patient satisfaction due to limited facilities and different treatment between BPJS and general patients. As of October 2025, the INA-CBGs tariff system will be replaced by the iDRG system to improve accountability, transparency, and financing efficiency. In conclusion, reformulating tariff policies based on real costs and service quality, increasing claim transparency, strengthening hospital financial management, and improving service quality monitoring are essential for the JKN to be sustainable, efficient, and equitable in supporting Universal Health Coverage in Indonesia.