Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 5;19(7):e0305835.
doi: 10.1371/journal.pone.0305835. eCollection 2024.

Hospital services utilisation and cost before and after COVID-19 hospital treatment: Evidence from Indonesia

Muhammad Fikru Rizal  1   2 , Firdaus Hafidz  1 , Gilbert Renardi Kusila  1 , Wan Aisyiah  3 , Dedy Revelino  3 , Erzan Dhanalvin  3 , Ayunda Oktavia  3 , Ilyasa  3 , Citra Jaya  3 , Benjamin Saut  3 , Mahlil Ruby  3
Affiliations

Hospital services utilisation and cost before and after COVID-19 hospital treatment: Evidence from Indonesia

Muhammad Fikru Rizal et al. PLoS One. .

Abstract

Objective: To estimate hospital services utilisation and cost among the Indonesian population enrolled in the National Health Insurance (NHI) program before and after COVID-19 hospital treatment.

Methods: 28,159 Indonesian NHI enrolees treated with laboratory-confirmed COVID-19 in hospitals between May and August 2020 were compared to 8,995 individuals never diagnosed with COVID-19 in 2020. A difference-in-difference approach is used to contrast the monthly all-cause utilisation rate and total claims of hospital services between these two groups. A period of nine months before and three to six months after hospital treatment were included in the analysis.

Results: A substantial short-term increase in hospital services utilisation and cost before and after COVID-19 treatment was observed. Using the fifth month before treatment as the reference period, we observed an increased outpatient visits rate in 1-3 calendar months before and up to 2-4 months after treatment (p<0.001) among the COVID-19 group compared to the comparison group. We also found a higher admissions rate in 1-2 months before and one month after treatment (p<0.001). Consequently, increased hospital costs were observed in 1-3 calendar months before and 1-4 calendar months after the treatment (p<0.001). The elevated hospital resource utilisation was more prominent among individuals older than 40. Overall, no substantial increase in hospital outpatient visits, admissions, and costs beyond four months after and five months before COVID-19 treatment.

Conclusion: Individuals with COVID-19 who required hospital treatment had considerably higher healthcare resource utilisation in the short-term, before and after the treatment. These findings indicated that the total cost of treating COVID-19 patients might include the pre- and post-acute period.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Observation period for COVID-19 and comparison group.
Fig 2
Fig 2. Study participants flow.
Fig 3
Fig 3. Difference-in-difference estimates of hospital outpatient visit rate of COVID-19 group compared to comparison group.
Note: The outcome is the number of inpatient stays per 100 individuals per month. The horizontal axis represented months relative to COVID-19 hospital treatment. Lines represented the estimated difference between the COVID-19 and comparison groups, controlling for demographic characteristics. Shaded areas represented the 95% Confidence Intervals.
Fig 4
Fig 4. Difference-in-difference estimates of hospital inpatient rate of COVID-19 group compared to comparison group.
Note: The outcome variable is the number of inpatient stays per 100 individuals per month. The horizontal axis represented months relative to COVID-19 hospital treatment. Lines represented the estimated difference between the COVID-19 and comparison groups, controlling for demographic characteristics. Shaded areas represented the 95% Confidence Intervals. Estimates for the month during laboratory-confirmed COVID-19 in hospital treatment were omitted because almost all individuals in the COVID-19 group had at least one hospital encounter.
See this image and copyright information in PMC

References

    1. Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus (COVID-19). StatPearls. Treasure Island (FL); 2023. - PubMed
    1. Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al.. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2021;93(3):1449–58. Epub 2020/08/14. doi: 10.1002/jmv.26424 . - DOI - PMC - PubMed
    1. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al.. Coronavirus Disease 2019 Case Surveillance—United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759–65. Epub 2020/06/20. doi: 10.15585/mmwr.mm6924e2 . - DOI - PMC - PubMed
    1. Surendra H, Elyazar IR, Djaafara BA, Ekawati LL, Saraswati K, Adrian V, et al.. Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study. Lancet Reg Health West Pac. 2021;9:100108. Epub 2021/03/09. doi: 10.1016/j.lanwpc.2021.100108 . - DOI - PMC - PubMed
    1. Surendra H, Paramita D, Arista NN, Putri AI, Siregar AA, Puspaningrum E, et al.. Geographical variations and district-level factors associated with COVID-19 mortality in Indonesia: a nationwide ecological study. BMC Public Health. 2023;23(1):103. Epub 2023/01/15. doi: 10.1186/s12889-023-15015-0 . - DOI - PMC - PubMed