Analisis Implementasi Clinical Pathway terhadap Efisiensi Klaim INA-CBG’s dan Pengendalian Biaya Farmasi Pasien Bedah di RSU Asy Syifa Sambi: Mixed Method

Problems: Asy Syifa Sambi Hospital faced severe financial challenges due to shrinking margins on INA-CBG claims for surgical cases, resulting in an average monthly deficit of IDR 47,079,303 during January-August 2025. A cost anomaly occurred in the pharmacy unit, where the decrease in patient volume was not proportional to the reduction in drug costs (patients decreased by 53.5%, while expenses decreased by only 16.3%), indicating high clinical prescribing variability amid tax burdens since August 2024. Objective: To analyze clinician compliance and the impact of Clinical Pathway (CP) implementation on INA-CBG’s claim efficiency and pharmacy cost control, and to comprehensively explore the supporting and inhibiting factors of its implementation. Methods: This study employed a mixed-methods, explanatory sequential design. Quantitative data were collected through medical records and billing audits (January–November 2025) for Appendectomy, Excision, Hemorrhoidectomy, and Hernioplasty cases. Qualitative data were collected through in-depth interviews with specialists, nurses, and the quality team to provide context for the quantitative findings. Results: CP implementation showed high clinical compliance (84%–94%), exceeding national standards. The application of CP significantly increased claim efficiency by 25.3% in Appendectomy cases and reduced pharmacy costs, with efficiency reaching 37.8%. Qualitatively, the success was driven by increased discipline and team communication, despite administrative barriers in manual documentation. CP was proven effective in accelerating patient recovery (Length of Stay) and serving as a financial risk mitigation instrument.