Analysis of the cost recovery rate for inpatient services under the national health insurance scheme at hospital X in Yogyakarta

Diska Arliena Hafni; Seto Satriyo Bayu Aji; Monika Andriani

doi:10.18196/jai.v26i1.23520

Authors

Diska Arliena Hafni Department of Accounting, Faculty of Economics Social Sciences and Humanities, Universitas 'Aisyiyah Yogyakarta, Special Region of Yogyakarta
Seto Satriyo Bayu Aji Department of Accounting, Faculty of Economics Social Sciences and Humanities, Universitas 'Aisyiyah Yogyakarta, Special Region of Yogyakarta
Monika Andriani Department of Accounting, Faculty of Economics Social Sciences and Humanities, Universitas 'Aisyiyah Yogyakarta, Special Region of Yogyakarta

DOI:

https://doi.org/10.18196/jai.v26i1.23520

Keywords:

Cost Recovery Rate, Inpatient Services, NHI Patients

Abstract

Research aims: This study aims to analyze the cost recovery rate of inpatients under the National Health Insurance (NHI) program at Hospital X in Yogyakarta.
Design/Methodology/Approach: This study employed an explanatory sequential mixed-methods design using a case study approach. The cases to be examined involved NHI inpatient patients in the Respiratory, Cardiology, and Obstetrics-Gynecology departments. Data will be analyzed using the Cost Recovery Rate (CRR) formula.
Research findings: The CRR for inpatient NHI patients at the Respiratory Clinic shows a CRR value of 143%, while the CRR values for the Cardiology, Obstetrics, and Gynecology Clinics are 95% and 80%, respectively. Cross subsidization from clinics with positive CRR values can be implemented to ensure that the hospital's Revenue from Social Security Agency for Health (SSAH) claims remains positive overall.
Theoretical contribution/ Originality: This research has made a valuable contribution to the accounting literature on hospital entities, a field that remains significantly underexplored.
Practitioner/Policy implication: The findings of this research can serve as a valuable asset for hospitals and the government in formulating policies that promote the enhancement of equitable and sustainable healthcare services for stakeholders.
Research limitation/Implication: The limitation of this study is that it only examined the CRR values of inpatient NHI patients in a single hospital, focusing exclusively on inpatients in the NHI Respiratory, Cardiology, and Obstetrics and Gynecology departments.

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