Predicting the cost of COVID-19 treatment and its drivers in Indonesia: analysis of claims data of COVID-19 in 2020-2021

Ryan R. Nugraha, Mutia A. Pratiwi (), Ruli Endepe Al-Faizin, Ardian Budi Permana, Ery Setiawan, Yuli Farianty, Kalsum Komaryani and Hasbullah Thabrany
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Ryan R. Nugraha: USAID Health Financing Activity/ThinkWell, LLC
Mutia A. Pratiwi: USAID Health Financing Activity/ThinkWell, LLC
Ruli Endepe Al-Faizin: USAID Health Financing Activity/ThinkWell, LLC
Ardian Budi Permana: Ministry of Health
Ery Setiawan: USAID Health Financing Activity/ThinkWell, LLC
Yuli Farianty: Ministry of Health
Kalsum Komaryani: Ministry of Health
Hasbullah Thabrany: USAID Health Financing Activity/ThinkWell, LLC

Health Economics Review, 2022, vol. 12, issue 1, 1-10

Abstract: Abstract Background Recent Coronavirus Disease-19 (COVID-19) pandemic shows that health system, particularly hospital care, takes the highest toll on COVID-19. As hospital gets to manage the surge of COVID-19 cases, it is important to standardize treatment standard and package for COVID-19. Until recently, in Indonesia, COVID-19 curative package in hospital is paid using a retrospective payment system (claims system) using a per-diem rate. Quantifying standard cost using an established retrospective claims dataset is important as a basis for standard formulation for COVID-19 package treatment, should COVID-19 be accommodated into the benefit package for Universal Health Coverage (UHC) under the National Health Insurance. Methods We estimated a standard cost for COVID-19 treatment using provider’s perspective. The analysis was conducted retrospectively using established national COVID-19 claims dataset during January 2020 until 2021. Utilizing individual-or-patient level analysis, claims profile were broken down per-patient, yielding descriptive clinical and care-related profile. Estimate of price and charge were measured in average. Moreover, indicators were regressed to the total charged price (in logarithmic scale) so as to find the predictors of cost. Results Based on the analysis of 102,065 total claims data received by MOH in 2020-2021, there is an average claim payment for COVID-19 in the amount of IDR 74,52 million (USD$ 5175). Significant difference exists in hospital tariffs or price to the existing claims data, indicating profit for hospital within its role in managing COVID-19 cases. Claim amount predictors were found to be associated with change of claim amount, including high level of severity, hospital class, intensive care room occupancy and ventilator usage, as well as mortality. Conclusion As COVID-19 pandemic shifts towards an endemic, countries including Indonesia need to reflect on the existing payment system and move towards a more sustainable payment mechanism for COVID-19. The COVID-19 payment system needs to be integrated into the existing national health insurance allowing bundled payment to become more sustainable, which can be achieved by comprehensively formulating the bundled payment package for COVID-19.

Keywords: Claim payment; Retrospective payment; Medical cost; COVID-19; Indonesia (search for similar items in EconPapers)
Date: 2022
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DOI: 10.1186/s13561-022-00392-w

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