Presentation (CTI)

OBJECTIVES: The way health care for occupational injury claims is financed in Indonesia, generally following a fee-for-service model, produces large variations in costs with inefficiencies that differ across regions in Indonesia. This study investigates the cost consequences of utilizing a fee-for-service model for occupational health care, while investigating potential interventions to balance cost containment with quality of service.
METHODS: A retrospective study of occupational injury cases in Indonesia from 2015 to 2022, we assess diagnosis codes, treatment costs, and region associated cost variability. A machine learning algorithm is utilized to cluster diagnoses to reduce variability, and stochastic frontier analysis is used to assess cost efficiencies. To assess cost trends, we utilized a difference-in-differences approach to compare high vs. low reimbursement dependency groups.
RESULTS: Average costs for outpatient cases were $743 with substantial variability associated, including a maximum for traumatic amputation of $6,256. There were also differences across regions, with an average of $5,726 in Papua. The diagnostic grouping achieved a 20% reduction in variability, while the estimated increase in costs was highest for regions characterized by high reimbursement dependency where average cost increased to $2,246.
CONCLUSIONS: Occupational injury health care costs associated with a fee-for-service model are associated with substantial variability and inefficiencies across regions. Policy development should transition to standardized tariffs informed by regional cost patterns and diagnostic profiles, to achieve sustainable and equitable health care financing. Therefore, further research is needed to evaluate the impact of this strategy on long-term cost containment and patient outcomes.