Analisis Financial Losses Akibat Under-reporting Kasus Tuberkulosis di Klinik Swasta Kota Denpasar: Pendekatan Economic Burden dari Perspektif Provider

Abstract

Abstract
Tuberculosis under-reporting in private healthcare facilities creates substantial economic burden that has not been systematically quantified in Indonesia, despite private sector handling 47% of TB cases in Denpasar with discrepancy rate reaching 29.1% between Tuberculosis Information System (SITB) and BPJS Healthcare P-Care. This study aimed to analyze and quantify financial losses due to TB under-reporting in Denpasar private clinics using economic burden approach from provider perspective. Descriptive quantitative study with single case study design and mixed-method approach was conducted at Klinik Pratama Karya Prima during August-December 2025. Data collection included comprehensive economic surveys, in-depth interviews with 5 key informants, SITB data extraction (2022-2024), financial document audits, and 16-hour time-motion study observation. Bottom-up costing analysis was applied to calculate cost components including direct medical costs, direct non-medical costs, indirect costs, and hidden costs. The study revealed significant financial losses of Rp 1,419,500 per unreported TB suspected case, with total annual cost of Rp 1,510,000 while revenue only Rp 90,500 per case (16.7-fold gap). Main cost components included diagnostic examinations (52%), hidden costs (19.9%), and staff time allocation (18.2%). Projection for 147 private clinics in Denpasar reached Rp 17.42 billion annually with estimated 3,260 TB cases systematically unreported. The massive gap between capitation payment system and actual cost requirements demonstrates fundamental misalignment justifying urgent investment in integrated reporting systems and improved incentive mechanisms to optimize TB program economic efficiency in private sector.


Abstrak
Under-reporting tuberkulosis di fasilitas kesehatan swasta menimbulkan beban ekonomi substansial yang belum dikuantifikasi secara sistematis di Indonesia, padahal sektor swasta menangani 47% kasus TB di Kota Denpasar dengan discrepancy rate mencapai 29,1% antara Sistem Informasi Tuberkulosis (SITB) dan P-Care BPJS Kesehatan. Penelitian ini bertujuan menganalisis dan mengkuantifikasi kerugian finansial akibat under-reporting kasus TB di klinik swasta Kota Denpasar menggunakan pendekatan economic burden dari perspektif provider. Penelitian deskriptif kuantitatif dengan rancangan studi kasus tunggal dan pendekatan mixed-method dilaksanakan di Klinik Pratama Karya Prima periode Agustus-Desember 2025. Pengumpulan data meliputi survei ekonomi komprehensif, wawancara mendalam dengan 5 narasumber kunci, ekstraksi data SITB (2022-2024), audit dokumen keuangan, dan time-motion study selama 16 jam observasi. Analisis bottom-up costing diterapkan untuk menghitung komponen biaya meliputi direct medical costs, direct non-medical costs, indirect costs, dan hidden costs. Penelitian mengungkap kerugian finansial signifikan sebesar Rp 1.419.500 per kasus terduga TB yang tidak dilaporkan, dengan total biaya tahunan Rp 1.510.000 sementara pendapatan hanya Rp 90.500 per kasus (kesenjangan 16,7 kali lipat). Komponen biaya utama meliputi pemeriksaan diagnostik (52%), biaya tersembunyi (19,9%), dan alokasi waktu staf (18,2%). Proyeksi untuk 147 klinik swasta di Denpasar mencapai Rp 17,42 miliar per tahun dengan estimasi 3.260 kasus TB tidak dilaporkan secara sistematis. Kesenjangan massive antara sistem pembiayaan kapitasi dengan kebutuhan biaya aktual menunjukkan ketidaksesuaian mendasar yang membenarkan investasi mendesak dalam sistem pelaporan terintegrasi dan mekanisme insentif yang diperbaiki untuk mengoptimalkan efisiensi ekonomi program TB di sektor swasta.