Background The COVID-19 pandemic imposed a major socioeconomic and financial burden on healthcare systems worldwide. Its rapid spread required extensive diagnostic and therapeutic interventions, increasing treatment costs significantly.Aims This study evaluated the economic burden of COVID-19 treatment in Southeast Sulawesi, Indonesia, from the perspective of healthcare providers and Indonesia’s national health insurance system (BPJS Kesehatan). It also assessed the gap between actual treatment costs and reimbursement claims and identified the main cost drivers.Methods A retrospective observational study with a cross-sectional design was conducted using data from COVID-19 patients admitted to two referral hospitals between 2020 and 2022. Direct medical costs were estimated using a bottom-up microcosting approach. Differences between hospital tariffs and BPJS Kesehatan reimbursement claims were analyzed, and sensitivity analysis was performed to determine the most influential cost components.Results The average hospital tariff per patient was USD 1,919. A substantial discrepancy was found between hospital tariffs and BPJS Kesehatan reimbursement, with a gap of USD 3,280. Accommodation costs (USD 1,298) and pharmaceutical services (USD 390) were identified as the main cost drivers, contributing considerably to overall costs and showing high sensitivity to changes in resource utilization.Conclusion COVID-19 treatment imposes a high-cost burden, with a mismatch between actual costs and BPJS Kesehatan reimbursement under the INA-CBGs system. We need to re-evaluate reimbursement schemes to better align with actual costs and minimize the cost gap. Cost-control efforts should prioritize the main cost drivers. These findings highlight the need for more efficient and sustainable healthcare financing strategies.
Sabarudin et al. (Thu,) studied this question.