Background: This assessment aims to analyze service performance and hospital efficiency by comparing Case Mix (CM) and Case Mix Index (CMI), of Health Social Security Agency (BPJS-Kesehatan) claims data for 2017 – 2019. There are almost 2000 provider general hospitals with various types from throughout all of 5 regions in Indonesia.

Results: The major findings shows the value of outpatient CM is increasing in almost all hospitals as well as for inpatient care, although there are variations in several regions. Most of the outpatient CM was found continuously increasing each year and observed highest in type C hospitals except for regions 1 in which type B hospitals showed the highest CM value. As CMI is heavily influenced by hospital’s capacity, type A hospitals had the highest CMI than type B, C and D hospitals. Most of outpatient CMI increased, except for type D hospital in regions 1, 2 and 3. The inpatient CMI for class A hospitals in 2017 and 2018 were the highest than type B, C and D hospitals, nevertheless type B hospitals had highest CMI in 2019. In 2019 CMI tends to decrease in all class A hospitals. Based on the findings, many hospitals need to improve their service performance quality due to efficiency and reflect inadequate resources used.

Conclusion: CM and CMI is a reflection of the type of care a patient receives, the complexity of their cases and cost of care. Hospitals need to regularly monitor these indicators and unfortunately this has never been done in many hospitals. In the future, hospitals need conducting analysis to optimize their capacity as type B Referral Hospitals and make service cost efficiency both for inpatient and outpatient.

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Mrs. Anni Yulianti