Cost Analysis of Caesarean Section at Hospital X, Indonesia: An Activity Based Costing Analysis for the Clinical Pathway

Abstract

Since the national health insurance launched in 2014, the hospital claimed the cost of health services through the Indonesian-Case Base Groups’ (INA-CBGs) rate but there was a negative cost variance between the INA-CBGs rate and the hospital tariff. The study aimed to analyse and compare the unit cost of the caesarean section (c-section) between the hospital tariff, the INA-CBGs rate, the clinical pathway tariff, and the actual unit cost. Materials and methods: The research was a cross-sectional study that compared the unit cost of the caesarean section (c-section) between the hospital tariff, the INA-CBGs rate, the clinical pathway tariff, and the actual unit cost. The population was the bills of all patients who undertreatment c-section in September 2021 at Hospital X. The data were analysed using descriptive statistic and calculated the cost variance between four different tariffs. Results: The comparison in ascending order starting from the highest to the lowest unit cost of c-section service was the hospital tariff, the INA-CBGs rate, the unit cost of actual health service, and the clinical pathway tariffs. The actual unit cost reflected the hospital activities that did not adhere to the clinical pathway, so it might cause a negative cost variance and loss for the hospital. Conclusion: The unit cost of c-section based on clinical pathway using the ABC method was lower than the INA-CBGs tariff. The hospital should implement the clinical pathway for all health service activity to reduce cost variance and to improve efficient health service quality.