Cost Analysis of Inpatient Stroke Treatment at PKU Muhammadiyah Yogyakarta Hospital Based on INA-CBG's Tariff in 2023

Ingenida Hadning (1) , Aulia Oktaviani (2)
(1) Muhammadiyah University of Yogyakarta , Indonesia
(2) Muhammadiyah University of Yogyakarta , Indonesia

Abstract

Stroke incidence in Yogyakarta Province is among the highest in Indonesia, frequently necessitating prolonged patient care and rehabilitation. The recent adjustment of INA-CBG's tariffs, as stipulated in Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023, has increased reimbursement rates for inpatient hemorrhagic stroke (Classes 1, 2, and 3) and ischemic stroke (Class 1). Despite these revisions, many hospitals report disparities between operational costs and the INA-CBG's reimbursement rates. This study represents the first dedicated evaluation of INA-CBG's tariffs, specifically concerning the 2023 ministerial regulation, for inpatient stroke management. We aimed to ascertain the financial discrepancies between the average actual costs of inpatient stroke treatment and the updated INA-CBG's tariffs at PKU Muhammadiyah Yogyakarta Hospital. Employing an observational design with a cross-sectional approach, we retrospectively collected data from inpatient stroke patients treated between January and September 2023. Data analysis involved descriptive statistics and a one-sample t-test. The findings reveal that, for most cases, the average actual costs incurred by the hospital were significantly lower than the corresponding INA-CBG's tariffs, indicating a consistent profit margin for the institution.

Full text article

Generated from XML file

References

1. Liu Y, Wang H, Bai B, Liu F, Chen Y, Wang Y, et al. Trends in Unhealthy Lifestyle Factors among Adults with Stroke in the United States between 1999 and 2018. J Clin Med. 2023;12(3):1223. DOI: 10.3390/jcm12031223; PMCID: PMC9917618; PMID: 36769871
2. Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132-44. DOI: 10.1177/17474930241308142; PMCID: PMC11786524; PMID: 39635884
3. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165. DOI: 10.1155/2018/3238165; PMCID: PMC6288566; PMID: 30598741.
4. Liu J, Xu A, Zhao Z, Ren B, Gao Z, Fang D, et al. Epidemiology and future trend predictions of ischemic stroke based on the global burden of disease study 1990-2021. Commun Med. 2025;5(1):273. DOI: 10.1038/s43856-025-00939-y; PMCID: PMC12229500; PMID: 40610700
5. Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, et al. Stroke in Asia. Cerebrovasc Dis Extra. 2024;14(1):58-75. DOI: 10.1159/000538928; PMCID: PMC11250668; PMID: 38657577
6. Health Research and Development Agency of the Ministry of Health of the Republic of Indonesia. Laporan Nasional Riskesdas 2018. Jakarta: Publishing Institute of Health Research and Development Agency, Ministry of Health of the Republic of Indonesia; 2019.
7. Fadhilah H, Permanasari VY. Economic Burden Bore by Patients and Families Because of Stroke: Policy Assessment. J Indones Health Policy Adm. 2020;5(3):91–5. DOI: 10.7454/ihpa.v5i3.3180
8. Rochmah TN, Rahmawati IT, Dahlui M, Budiarto W, Bilqis N. Economic Burden of Stroke Disease: A Systematic Review. Int J Environ Res Public Health. 2021;18(14):7552. DOI: 10.3390/ijerph18147552; PMCID: PMC8307880; PMID: 34299999
9. Alkayyis MY. Implementation of the National Health Insurance Programme in Achieving Universal Health Coverage in Indonesia. J Jaminan Kesehatan Nasional. 2024;4(2):85-95. DOI: 10.53756/jjkn.v4i2.197
10. Muslimah, Andayani TM, Pinzon R, Endarti D. Comparison of Real Costs against the Price of INA-CBG's Ischemic Stroke in Bethesda Hospital. J Manajemen Pelayanan Farmasi. 2017;7(2):105–14. DOI: 10.22146/jmpf.30289
11. Hadning I, Fathurrohmah F, Ridwan M, Rahajeng B, Utami P, Cahyaningsih I. Cost Analysis of Indonesia Case Based Groups (INA-CBGs) Tariff for Stroke Patients. J Manajemen Pelayanan Farmasi. 2020;10(2):137–44. DOI: 10.22146/jmpf.46720
12. Salman IPP, Haiga Y, Wahyuni S. Perbedaan Diagnosis Stroke Iskemik dan Stroke Hemoragik dengan Hasil Transcranial Doppler di RSUP Dr. M. Djamil Padang. Sci J. 2022;1(5):393–402. DOI: 10.56260/sciena.v1i5.72
13. Rahayu TG. The Analysis of Stroke Risk Factors and Stroke Types. Faletehan Health J. 2023;10(1):48–53. DOI: 10.33746/fhj.v10i01.410
14. Bereda G. Demographic Disparities in Stroke Occurrence: Insights From an Integrative Review of Emerging Trends. Brain Behav. 2025;15(8):e70575. DOI: 10.1002/brb3.70575; PMCID: PMC12321967; PMID: 40760721
15. Eng PC, Tan LLY, Kimball TN, Prapiadou S, Tan BYQ. Ischemic Stroke in Women: Understanding Sex-Specific Risk Factors, Treatment Considerations, and Outcomes. J Cardiovasc Dev Dis. 2024;11(12):382. DOI: 10.3390/jcdd11120382; PMCID: PMC11678625; PMID: 39728272
16. Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-95. DOI: 10.1161/circresaha.116.308398; PMCID: PMC5321635; PMID: 28154098
17. Wang J, Li Y, Yang GY, Jin K. Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions. Aging Dis. 2024;16(2):714-37. DOI: 10.14336/ad.2024.0124-1; PMCID: PMC11964428; PMID: 38607735
18. Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: A clinical update. World J Diabetes. 2017;8(6):235-48. DOI: 10.4239/wjd.v8.i6.235; PMCID: PMC5483423; PMID: 28694925
19. McFarlane SI, Sica DA, Sowers JR. Stroke in patients with diabetes and hypertension. J Clin Hypertens. 2005;7(5):286-92. DOI: 10.1111/j.1524-6175.2005.04379.x; PMCID: PMC8109587; PMID: 15886531
20. Xiong J, Wang JT, Lin S, Xie BY. Advances in hemiplegia rehabilitation: modern therapeutic interventions to enhance activities of daily living. Front Neurol. 2025;16:1555990. DOI: 10.3389/fneur.2025.1555990; PMCID: PMC11985468; PMID: 40224310
21. Chohan SA, Venkatesh PK, How CH. Long-term complications of stroke and secondary prevention: an overview for primary care physicians. Singapore Med J. 2019;60(12):616-20. DOI: 10.11622/smedj.2019158; PMCID: PMC7911065; PMID: 31889205
22. Poomalai G, Prabhakar S, Jagadesh NS. Functional Ability and Health Problems of Stroke Survivors: An Explorative Study. Cureus. 2023;15(1):e33375. DOI: 10.7759/cureus.33375; PMCID: PMC9898797; PMID: 36751244
23. Kurosaki M, Tosaka M, Ibe Y, Arii H, Tomono J, Tazawa M, et al. Functional Recovery after Rehabilitation in Patients with Post-stroke Severe Hemiplegia. Prog Rehabil Med. 2022;7:20220039. DOI: 10.2490/prm.20220039; PMCID: PMC9346303; PMID: 35975271
24. Carrizzo A, Izzo C, Oliveti M, Alfano A, Virtuoso N, Capunzo M, et al. The Main Determinants of Diabetes Mellitus Vascular Complications: Endothelial Dysfunction and Platelet Hyperaggregation. Int J Mol Sci. 2018;19(10):2968. DOI: 10.3390/ijms19102968; PMCID: PMC6212935; PMID: 30274207
25. Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci. 2016;351(4):380-6. DOI: 10.1016/j.amjms.2016.01.011; PMCID: PMC5298897; PMID: 27079344
26. Rubin GD. Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities. Radiology. 2017;282(2):333-47. DOI: 10.1148/radiol.2016160749

Authors

Ingenida Hadning
ingenida.hadning@umy.ac.id (Primary Contact)
Aulia Oktaviani
Author Biographies

Ingenida Hadning, Muhammadiyah University of Yogyakarta

Department of Pharmacy, Universitas Muhammadiyah Yogyakarta, Bantul, Special Region of Yogyakarta, Indonesia

Aulia Oktaviani, Muhammadiyah University of Yogyakarta

Department of Pharmacy, Universitas Muhammadiyah Yogyakarta, Bantul, Special Region of Yogyakarta, Indonesia

1.
Hadning I, Oktaviani A. Cost Analysis of Inpatient Stroke Treatment at PKU Muhammadiyah Yogyakarta Hospital Based on INA-CBG’s Tariff in 2023. Borneo J Pharm [Internet]. 2025Aug.30 [cited 2025Dec.5];8(3):305-12. Available from: https://journal.umpr.ac.id/index.php/bjop/article/view/7261

Article Details