The Difference in Length of Stay, Quality of Life, and Cost Effectiveness of Care for Geriatric Patients in Acute Care for Elderly Dr. Cipto Mangunkusumo National Hospital Before and After National Health Insurance Program Implementation

Abstract

Geriatric population with special characteristics tend to have longer average length of stay. The aim of the study is to evaluate the implementation of NHIP (national health insurance program) system according to length of stay, quality adjusted life days (QALD) and cost effectiveness of care in Cipto Mangunkusumo National Hospital (CMNH). This is a retrospective cohort study with historical control. The subjects were geriatric patients with geriatrics giants on July to December 2013 (non NHIP) and January to June 2014 (NHIP). We used independent t-test to compare two means of length of stay and QALD. The characteristics were similar between 100 subjects in non NHIP group and 125 subjects in NHIP group. The median of age was 70 (60-86) dan 68 (60-85) years old respectively. There was no significant difference between length of stay in non NHIP, median 12(2-76) days and NHIP group, median 12(2-59) days, p= 0.974. As for QALD, there was also no significant difference between non NHIP, median 0.812 (-3.1–24.37) and NHIP group, median 0.000 (-7.37–22.43), p= 0.256. The median cost spent was Rp 19.961.000 (Rp2.57–Rp100 millions) in non NHIP and Rp 20.832.000 (Rp3.067-Rp100 millions) in NHIP group. Incremental cost effectiveness ratio (ICER) scheme showed NHIP is more expensive Rp1.500.000 to have 0.91 shorter days than non NHIP system. For QALD, the cost was cheaper Rp3.484.887 to have 0,25 QALD lower than non NHIP. There was no significant difference in length of stay and quality of life of patients who admitted in CMNH with CGA approach before and after NHIP implementation.