Abstract
The implementation of the National Health Insurance (JKN) program aims to provide equitable access to healthcare for all Indonesians. The JKN financing system uses a prospective payment model based on INA-CBGs tariffs. However, studies indicate discrepancies between the unit cost incurred by hospitals and the INA-CBGs tariffs, potentially causing financial losses for hospitals. This study aims to review the literature on the comparison between unit costs, INA-CBGs tariffs, and hospital tariffs, as well as analyze the Cost Recovery Rate (CRR) indicator. Seventeen studies were reviewed, covering various types of services. Findings show that most services, especially outpatient services such as hemodialysis and surgeries, have unit costs higher than INA-CBGs tariffs. This study recommends strengthening hospital efficiency strategies by calculating unit costs using the Activity-Based Costing (ABC) method integrated with clinical pathways. BPJS Kesehatan should also evaluate the INA-CBGs tariff structure to align payments with actual service costs.