Navigating Financial Uncertainty: Hospital Cost Strategies During the Initial COVID-19 Outbreak in Indonesia
DOI:
https://doi.org/10.18196/jati.v8i2.23871Keywords:
COVID-19, Hospital Cost, Hospital Strategies, Regulation, IndonesiaAbstract
The COVID-19 pandemic revealed fundamental weaknesses in healthcare financing systems, particularly in developing countries like Indonesia. Public hospitals faced significant challenges in sustaining operations due to changes in reimbursement policies and the increasing complexity of services, while simultaneously relying on government funding. The absence of a stable and adaptive payment mechanism during the pandemic led to prolonged financial uncertainty. This study examines the financial strategies public hospitals adopt to maintain operational continuity amid changes in the reimbursement scheme for COVID-19 patients. The research was conducted at Universitas Airlangga Hospital using 547 COVID-19 patient claim records and interviews with the hospital's financial manager, which were analyzed through descriptive methods. The findings indicate that hospitals utilized strategies based on internal resources, such as cost reallocation, improved coordination, and integration between medical service units and financial departments, in response to external regulatory pressures. Collaboration between clinical and administrative teams improved cost control and operational resilience during the transition period of payment systems. This study emphasizes the importance of utilizing internal hospital capabilities, including financial systems, governance structures, and interdepartmental synergy, in dealing with policy uncertainty. Hospitals needs to develop responsive and forward-looking financial strategies to cope with public health crises. For policymakers, the findings highlight the urgency of designing reimbursement systems that are responsive, transparent, and based on hospitals' actual needs and the sustainability of healthcare services in the future.
References
Alawy, G., Wicaksono, A., & Suharyanto, A. (2021). Correlation Between Mobility and COVID-19 Cases in Surabaya City, Indonesia. Civil and Environmental Science, 004(02), 154–162. https://doi.org/10.21776/ub.civense.2021.00402.5
Altman., S. H. (2012). The Lessons of Medicare’s Prospective Payment System Show that the Bundled Payment Program Faces Challenges. Health Affairs, 31(9). https://doi.org/10.1377/hlthaff.2012.0323
Ambarriani, A. S. (2014). Hospital financial performance in the Indonesian national health insurance era. Review of Integrative Business and Economics Research, 4(1), 121–133.
Ambarwati, W. (2021). Pembiayaan Pasien COVID-19 dan Dampak Keuangan terhadap Rumah Sakit yang Melayani Pasien COVID-19 di Indonesia Analisis Periode Maret 2020 – Desember 2020. Jurnal Ekonomi Kesehatan Indonesia, 6(1). https://doi.org/10.7454/eki.v6i1.4881
Aulia, D., Ayu, S. F., & Nasution, N. H. (2017). Analysis of Hospital Efforts to Cover Deviation of INA-CBGs Claim using Activities Base Costing Method in Private Hospital. Jurnal Ekonomi Kesehatan Indonesia, 1(4), 159–166.
Barney, J. (1991). Firm resources and sustained competitive advantage. Journal of Management, 17(1). https://doi.org/10.1177/014920639101700108
Carbonara, N., Pellegrino, R., Luca, C. D. (2024). Resilience of hospitals in an age of disruptions: a systematic literature review on resources and capabilities. Health Systems, 13(3), 192-228. https://doi.org/10.1080/20476965.2024.2365144
Citra Mutiarahati, N. L., Ani, L. S., Suarjana, K., Januraga, P. P., Manuaba, I. B. G. F., Lesmana, C. B. J., & Indrayathi, P. A. (2023). Hospital financial control strategy in the COVID-19 Pandemic era. Public Health and Preventive Medicine Archive, 11(1), 63–70. https://doi.org/10.53638/phpma.2023.v11.i1.p06
Decree of the Minister of Health of the Republic of Indonesia 59/2014 (2014). Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan.
Decree of the Minister of Health of the Republic of Indonesia 59/2016 (2016). Pembebasan Biaya Pasien Penyakit Infeksi Emerging Tertentu.
Decree of the Minister of Health of the Republic of Indonesia HK.01.07/MENKES/1112/2022 (2022). Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Corona Virus Disease 2019 (COVID-19)
Decree of the Minister of Health of the Republic of Indonesia HK.01.07/MENKES/238/2020 (2020). Petunjuk Teknis Klaim Penggantian Biaya Perawatan Pasien Penyakit Infeksi Emerging Tertentu bagi Rumah Sakit yang Menyelenggarakan Pelayanan Coronavirus Disease 2019 (COVID-19).
Decree of the Minister of Health of the Republic of Indonesia HK.01.07/MENKES/4344/2021 (2021). Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Corona Virus Disease 2019 (covid-19) bagi Rumah Sakit Penyelenggara Pelayanan Corona Virus Disease 2019 (covid-19).
Decree of the Minister of Health of the Republic of Indonesia HK.01.07/MENKES/5673/2021 (2021). Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Corona Virus Disease 2019 (covid-19).
Filip, R., Puscaselu, R. G., Anchidin-Norocel, L., Dimian, M., Savage, W. K. (2022). Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. Journal of Personalized Medicine, 12(8). https://doi.org/10.3390/jpm12081295
Gandjour, A. (2021). How many intensive care beds are justifiable for hospital pandemic preparedness? A cost-effectiveness analysis for COVID-19 in Germany. Applied Health Economics and Health Policy, 19, 181-190. https://doi.org/10.1007/s40258-020-00632-2
Hafidz, F., Kusila, G. R., Nadhira, F., Daniel, D., Baros, W. A., Revelino, D., Dhanalvin, E., Saut, B., Jaya, C., Oktavia, A. (2022). Utilization and expenditure of Indonesia National Health Insurance before and during COVID-19 pandemic in Indonesia: a descriptive study. BKM Public Health & Community Medicine, 38(7), 219-226. https://doi.org/bkm.v38i7.4964
Halim, I. J., Manggala, S. K., Kaunang, W. F. P. (2025). The economic burden on private hospitals in treating ICU vs non-ICU patients: Investigating the financial gap between Indonesian case base groups (INA-CBG) rates and hospital billing. Proceedings Book of ICE on IMERI, 1-9.
Handayani, L., Suharmiati, S., & Pratiwi, N. L. (2018). Hospital Unit Cost and INA_CBGs Tariff: Is the Hospital Health Services Paid Fair? Buletin Penelitian Sistem Kesehatan, 21(4), 219–227. https://doi.org/https://doi.org/10.22435/hsr.v21i4.45
Hiller, M., Bracht, H., & Schroeder, S. (2022). One year with the COVID-19 pandemic − Lessons learnt? Intersectoral collaboration measures established during the crisis could benefit capacity and patient flow management in daily clinical practice. Journal of Health Organization and Management, 36(2), 141–148. https://doi.org/10.1108/JHOM-06-2021-0211
Holshue, M. L., DeBolt, C., Lindquist, S., Lofy, K. H., Wiesman, J., Bruce, H., Spitters, C., Ericson, K., Wilkerson, S., Tural, A., Diaz, G., Cohn, A., Fox, L., Patel, A., Gerber, S. I., & Kim, L. (2019). First Case of 2019 Novel Coronavirus in the United States. The New England Journal of Medicine, 382(10), 929–936. https://doi.org/10.1056/NEJMoa2001191
Jatnika, V. V., Soewondo, P., & Muliawati, M. (2021). Strategy in Anticipating The Hospital’s Financial Condition During The COVID-19 Pandemic: A Systematic Review. Jurnal Ilmiah Akuntansi Dan Keuangan, 04(02), 597–609. https://doi.org/10.32670/fairvalue.v4i2.651
Kwon, S., & Kim, E. (2022). Sustainable health financing for COVID-19 preparedness and response in Asia and the Pacific. Asian Economic Policy Review, 17, 140-156. https://doi.org/10.1111/aepr.12360
Lee, J., Lee, D., Kwon, O. (2024). Cost-effectiveness of hospital-based treatment compared with community treatment centres: an analysis of Korea National Health Insurance claims data. BMJ Open, 14(e079232). https://doi.org/10.1136/ bmjopen-2023-079232
Letter of Minister of Finance (2020). Satuan Biaya Penggantian Atas Biaya Perawatan Pasien Penyakit Infeksi Emerging Tertentu Bagi Rumah Sakit yang Menyelenggaran Pelayanan Coronavirus Disease 2019 (Covid-19).
Li, X., Zhang, Y., Zhang, X., Li, X., Lin, X., Han, Y. (2022). Effect of fee-for-service, diagnosis-related-group, and mixed payment systems on physicians’ medical service behavior: experimental evidence. BMC Health Services Research, 22:870, 1-12. https://doi.org/10.1186/s12913-022-08218-5
Lippi, A., Price, D. J., Benelli, R., Lippi, G. (2022). Is limiting COVID-19 outside hospitals cost-effective? Cost-effectiveness analysis of the Italian special care continuity units (USCA). National Accounting Review, 4(4), 428-447. https://doi.org/10.3934/NAR.2022024
Marques, I., Serrasqueiro, Z., & Nogueira, F. (2021). Managers’ competences in private hospitals for investment decisions during the COVID-19 pandemic. Sustainability (Switzerland), 13(4), 1–14. https://doi.org/10.3390/su13041757
Moolla, I., & Hiilamo, H. (2023). Health system characteristics and COVID-19 performance in high-income countries. BMC Health Services Research, 23:244, 1-14. https://doi.org/10.1186/s12913-023-09206-z
Monica, R. D., Firdaus, F. M., Lestari, I. P., Suryati, Y., Rohmayani, D., & Hendrati, A. (2021). Analisis Perbedaan Tarif Riil Rumah Sakit dengan Tarif Ina-CBG’s Berdasarkan Kelengkapan Medis Pasien Rawat Inap pada Kasus Persalinan Sectio Caesarea guna Pengendalian Biaya Rumah Sakit TNI AU Dr. M. Salamun Bandung. Jurnal Manajemen Informasi Kesehatan Indonesia, 9(1), 96. https://doi.org/10.33560/jmiki.v9i1.289
Nojomi M., Banihashemi AT., Ahangar A. (2021). Covid-19 and Reimbursement Mechanisms in Medical Economics: Retrospective(ffs) or Prospective(drg) Payment Healthcare Systems, Which One?. American Journal of Biomedical Science & Research, 14(2). http://dx.doi.org/10.34297/AJBSR.2021.14.001973
Organisation for Economic Cooperation and Development. (2021). OECD Economic Surveys: Indonesia. https://doi.org/https://doi.org/10.1787/fd7e6249-en
Ratcliffe, R. (2020). First coronavirus cases confirmed in Indonesia amid fears nation is ill-prepared for an outbreak. The Guardian.
Rokhmah, D., Ridzkyanto, R. P., Khoiron, K. (2020). Analysis of Government Budgeting for Health: Case Study of COVID-19 in East Java Province, Indonesia. Kesmas, 15(5), 54-59. https://doi.org/10.21109/kesmas.v15i2.3986
Roosa, M. (2021). RSUA Raih Predikat RS Terbaik Penanganan Covid-19 di Jawa Timur. Suara Surabaya. https://www.suarasurabaya.net/kelanakota/2021/rsua-raih-predikat-rs-terbaik-penanganan-covid-19-di-jawa-timur/
Rusdi, M. S., Yusvina, Dillasamola, D., Efendi, M. R. (2023). Cost-effectiveness analysis of COVID-19 treatment for hospitalized patients: a healthcare provider perspective in Batam, Indonesia. Journal of Public Health and Development, 21(2), 282-294. https://doi.org/10.55131/jphd/2023/210223
Satibi, S., Andayani, T. M., Endarti, D., Suwantara, I. P. T., Wintariani, N. P., & Agustini, N. P. D. (2019). Comparison of real cost versus the Indonesian Case Base Groups (INA-CBGs) tariff rates among patients of high-incidence cancers under the national health insurance scheme. Asian Pacific Journal of Cancer Prevention, 20(1), 117–122. https://doi.org/10.31557/APJCP.2019.20.1.117
Social Security Administering Body for Health. (2019). Regulation of the Social Security Administering Body for Health Number 1 of 2019 concerning the Revocation of Regulation Number 1 of 2018 on Emergency Assessment and Reimbursement Procedures for Emergency Services. Jakarta: BPJS Kesehatan.
Teece, D. J. (2007). Explicating dynamic capabilities: the nature and microfoundations of (sustainable) enterprise performance. Strategic Management Journal, 28(13), 1319-1350. https://doi.org/10.1002/smj.640
Thabrany, H. (2014). National Health Insurance. In Raja Grafindo Persada.
Vianna, E. C. da C., Pestana, L. C., Meireles, I. B., Rafael, R. de M. R., Marziale, M. H. P., Faria, M. G. de A., & Gallasch, C. H. (2022). Management of resources in a federal emergency hospital during the COVID-19 pandemic. Revista Brasileira de Enfermagem, 75(Suppl 1), 1–8. https://doi.org/10.1590/0034-7167-2021-0149
Waters, H. R., & Hussey, P. (2004). Pricing health services for purchasers—a review of methods and experiences. Health Policy, 70(2), 175–184. https://doi.org/10.1016/j.healthpol.2004.04.012
Yulius, S. K., Soewondo, P., & Carolinsia, B. (2022). Hospital Financial Strategy in Response to COVID-19: A Systematic Review. Journal of Health Policy and Management, 7(1), 81–93. https://doi.org/10.26911/thejhpm.2022.07.01.08
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jati: Jurnal Akuntansi Terapan Indonesia

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright Agreement and License
In order to be accepted and published by Jati: Jurnal Akuntansi Terapan Indonesia, author(s) submitting the article manuscript should complete all the review stages. By submitting the manuscript, the author(s) agreed to the following terms:
The copyright of received articles shall be assigned to Jati: Jurnal Akuntansi Terapan Indonesia as the publisher of the journal. The intended copyright includes the rights to publish articles in various forms (including reprints). Jati: Jurnal Akuntansi Terapan Indonesia maintain the publishing rights to the published articles. Authors are permitted to disseminate published articles by sharing the link/DOI of the article at Jati: Jurnal Akuntansi Terapan Indonesia. Author are allowed to use their articles for any legal purposes deemed necessary without written permission from Jati: Jurnal Akuntansi Terapan Indonesia with an acknowledgment of initial publication to this journal
License
All articles published in Jati: Jurnal Akuntansi Terapan Indonesia are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC-BY-NC).