Analysis of Factors Causing Differences in BPJS Health Claims for Inpatient Care

Abstract

Background: Differences in BPJS Health claims refer to discrepancies between actual hospital service costs and reimbursement based on INA-CBGs tariffs, which may affect hospital financial performance. Several factors, including human resources, work methods, information systems, document completeness, and financing, are associated with these discrepancies. Objective: This study aimed to analyze the relationship between the 5M factors (Man, Method, Machine, Material, and Money) and BPJS Health claim discrepancies in inpatient services at Ja'far Medika General Hospital, Karanganyar. Methods: This quantitative study used a cross-sectional design with a correlational analytical approach. The sample consisted of 60 respondents, representing the entire population, selected using total sampling. Data were collected using questionnaires and document checklists and analyzed using univariate analysis and Kendall's Tau-b correlation test. Results: The Man (τ=0.810), Material (τ=0.786), Method (τ=0.776), Machine (τ=0.774), and Money (τ=0.714) factors showed positive and statistically significant relationships with BPJS Health claim discrepancies (p=0.000). Conclusion: All 5M factors were significantly associated with BPJS Health claim discrepancies in inpatient services, with the Man factor showing the strongest relationship.