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INFLASI BIAYA MEDIS DAN ESKALASI BIAYA LAYANAN SEBAGAI RISIKO UTAMA ASURANSI KESEHATAN SWASTA DI INDONESIA: TINJAUAN LITERATUR
Nasywa Athiyah Zahra(1*), Nazhifa Nurul Azizah(2), Adzroo Atiiqoh Nur Nabiila(3), Riswandy Wasir(4), Cahya Arbitera(5), (1) Universitas Pembangunan Nasional "Veteran" Jakarta
(2) Universitas Pembangunan Nasional "Veteran" Jakarta
(3) Universitas Pembangunan Nasional "Veteran" Jakarta
(4) Universitas Pembangunan Nasional "Veteran" Jakarta
(5) Universitas Pembangunan Nasional "Veteran" Jakarta
(*) Corresponding Author
Abstract
Inflasi medis merupakan isu krusial dalam sistem pembiayaan kesehatan karena berkontribusi terhadap peningkatan biaya layanan serta beban klaim pada asuransi kesehatan swasta. Peningkatan ini dipengaruhi oleh berbagai faktor, seperti penuaan populasi, kemajuan teknologi medis, serta meningkatnya utilisasi layanan kesehatan. Penelitian ini bertujuan untuk menganalisis faktor-faktor pendorong inflasi medis serta mengevaluasi efektivitas strategi pengendalian biaya yang diterapkan dalam asuransi kesehatan. Metode yang digunakan berupa literature review dengan menelaah artikel ilmiah dari berbagai database seperti Google Scholar, PubMed, Garuda, Springer, The Lancet, dan ScienceDirect. Proses seleksi dilakukan berdasarkan kriteria inklusi dan eksluksi. Data dianalisis secara deskriptif kualitatif dengan mengelompokkan temuan ke dalam tema utama terkait inflasi medis, biaya klaim dan premi, serta strategi pengendalian biaya dan manajemen risiko. Hasil kajian menunjukkan bahwa inflasi medis merupakan determinan utama dalam eskalasi biaya layanan kesehatan yang berdampak pada peningkatan klaim dan premi, serta menimbulkan tekanan terhadap profitabilitas dan keberlanjutan sistem asuransi. Berbagai strategi seperti pengelolaan jaringan provider, manajemen utilisasi, dan strategic purchasing telah diterapkan, namun efektivitasnya masih terbatas akibat kendala implementasi dan kurangnya integrasi sistem. Di sisi lain, penerapan pendekatan managed care seperti kapitasi, cost-sharing, dan kontrak selektif menunjukkan potensi dalam meningkatkan efisiensi, meskipun masih menghadapi tantangan dalam pelaksanaan dan pengawasannya. Oleh karena itu, inflasi medis perlu dipahami sebagai risiko sistemik yang memerlukan pendekatan manajemen yang lebih komprehensif dan terintegrasi. Penguatan pemanfaatan data dan teknologi, peningkatan kolaborasi antar pihak asuransi dan penyedia layanan kesehatan, serta pengembangan kebijakan berbasis nilai menjadi langkah strategis guna meningkatkan efisiensi tanpa mengorbankan mutu layanan kesehatan, sekaligus menjaga keberlanjutan sistem asuransi dalam jangka panjang.
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DOI: https://doi.org/10.31596/jkm.v14i2.3259
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