FINANCIAL SUSTAINABILITY RUMAH SAKIT DI ERA UNIVERSAL HEALTH COVERAGE: SYSTEMATIC LITERATURE REVIEW

Abstrak

Keberlanjutan finansial rumah sakit merupakan isu krusial dalam ekosistem Universal Health Coverage (UHC), mengingat ketimpangan antara tuntutan perluasan akses layanan dan kapasitas fiskal fasilitas kesehatan semakin melebar. Data empiris menunjukkan bahwa sebagian besar rumah sakit peserta JKN mengalami tekanan finansial serius, dengan dampak yang mencakup penurunan kualitas layanan, keterbatasan pengadaan obat dan alat medis, hingga ancaman terhadap keberlangsungan operasional fasilitas (Laila et al., 2025; Imansyah, 2025). Kajian ini bertujuan memetakan faktor-faktor penentu financial sustainability rumah sakit serta strategi yang terbukti efektif dalam menjaganya di tengah tekanan sistem pembiayaan berbasis casemix. Penelitian menggunakan pendekatan Systematic Literature Review (SLR) dengan panduan Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Penelusuran dilakukan pada lima basis data elektronik, yakni PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, dan Garuda, menghasilkan 20 artikel yang memenuhi kriteria inklusi. Sintesis naratif tematik mengidentifikasi empat faktor utama yang secara simultan memengaruhi keberlanjutan finansial rumah sakit, yaitu ketidaksesuaian tarif INA-CBGs dengan biaya aktual layanan, akumulasi pending claim akibat lemahnya pengelolaan clinical coding, inefisiensi pemanfaatan sumber daya operasional, serta dampak sistem pembayaran prospektif terhadap mutu pelayanan. Strategi yang terbukti efektif meliputi penerapan metode Activity-Based Costing, diversifikasi sumber pendapatan, penguatan kompetensi clinical coder, peningkatan kualitas layanan sebagai instrumen finansial jangka panjang, serta optimalisasi aset (asset optimization) melalui maksimalisasi utilisasi peralatan medis, manajemen aset berbasis data, dan monetisasi aset yang kurang dimanfaatkan. Disimpulkan bahwa keberlanjutan finansial rumah sakit di era UHC tidak dapat diselesaikan melalui pendekatan tunggal, melainkan membutuhkan pengelolaan terintegrasi yang mencakup kebijakan tarif, efisiensi operasional, manajemen klaim, optimalisasi aset, dan peningkatan mutu pelayanan secara bersamaan.

Hospital financial sustainability represents a critical issue within the Universal Health Coverage (UHC) ecosystem, as the gap between expanding service access demands and the fiscal capacity of healthcare facilities continues to widen. Empirical evidence indicates that a significant proportion of hospitals participating in the national health insurance scheme face serious financial pressures, with consequences including deteriorating service quality, limited procurement of medicines and medical equipment, and threats to the operational continuity of facilities (Laila et al., 2025; Imansyah, 2025). This study aims to map the key determinants of hospital financial sustainability and identify proven strategies for maintaining it amid pressures from casemix-based financing systems. A Systematic Literature Review (SLR) approach guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement was employed. A systematic search across five electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and Garuda, yielded 20 articles meeting the inclusion criteria. Thematic narrative synthesis identified four principal factors simultaneously influencing hospital financial sustainability: the disparity between INA-CBGs tariffs and actual service costs, accumulating pending claims resulting from inadequate clinical coding management, inefficient utilization of operational resources, and the impact of prospective payment systems on service quality. Effective strategies identified include implementing Activity-Based Costing methods, diversifying revenue sources, strengthening clinical coder competencies, enhancing service quality as a long-term financial instrument, and asset optimization through maximizing medical equipment utilization, data-driven asset management, and monetization of underutilized assets. It is concluded that hospital financial sustainability in the UHC era cannot be addressed through a singular approach but requires integrated management encompassing tariff policy, operational efficiency, claims management, asset optimization, and service quality improvement simultaneously.