Analysis of Hemodialysis Unit Costs Using the Double Distribution Approach to Enhance Hospital Profitability: A Case Study at YARSI Hospital in Jakarta, Indonesia
Abstract
Chronic Kidney Disease (CKD) represents a major and growing health challenge globally and in Indonesia, with the number of patients requiring hemodialysis increasing sharply in recent years. This surge in demand places significant financial pressure on healthcare institutions, necessitating precise cost management to maintain service quality and hospital sustainability. This study aims to calculate the actual unit cost of hemodialysis at YARSI Hospital using the Double Distribution (DD) method, which provides a transparent allocation of both direct and indirect costs. Employing a quantitative descriptive case study design, data were collected from hospital financial records and service documentation for 16,789 hemodialysis sessions conducted during 2024. The DD method was applied in two stages: distributing overhead costs to intermediate cost centers, and subsequently distributing intermediate costs such as those related to pharmacy, laboratory, and medical personnel to final service centers. The analysis revealed that the unit cost of Single-Use hemodialysis was IDR 1,927,643, while Re-Use hemodialysis was IDR 1,956,284. The minimal difference between the two systems indicates that high utilization volume significantly influences cost efficiency. These findings confirm that the DD method enables hospitals to obtain a more accurate understanding of cost structures, thereby supporting evidence-based decision-making in pricing and resource management. In conclusion, implementing the Double Distribution approach can enhance cost transparency, optimize efficiency, and guide hospitals in establishing rational service rates without compromising care quality. Future research should involve multi-hospital comparisons to strengthen the generalizability of cost-efficiency models in hemodialysis services.
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References
[1] World Health Organization, Global Report on Kidney Health, Geneva: WHO, 2023.
[2] J. Bowe et al., “Global, regional, and national burden of CKD,” Lancet Kidney Dis., vol. 10, no. 2, pp. 115–126, 2023.
[3] M. R. Hill et al., “Chronic kidney disease trends in Southeast Asia,” BMC Nephrol., vol. 24, no. 72, pp. 1–12, 2023.
[4] Ministry of Health Indonesia, National Health Profile 2024, Jakarta: Kemenkes RI, 2024.
[5] S. Pranata et al., “Health financing reform under the JKN scheme,” Health Policy Plan., vol. 38, no. 3, pp. 401–412, 2023.
[6] BPJS Kesehatan, Statistical Report 2024: National Health Insurance Coverage, Jakarta, 2024.
[7] K. Tanaka et al., “Economic burden of dialysis therapies,” Clin. Nephrol., vol. 101, no. 6, pp. 389–398, 2022.
[8] J. Kim et al., “Cost structures in renal replacement therapy,” Health Econ. Rev., vol. 14, no. 28, pp. 1–9, 2023.
[9] Y. Agada-Amade et al., “Cost-benefit analysis of hemodialysis in Abuja,” Health Econ. Rev., vol. 14, no. 47, 2024.
[10] H. Sari et al., “Hospital tariff setting under the JKN system,” Indones. Health Econ. J., vol. 8, no. 1, pp. 22–35, 2023.
[11] A. Nurmansyah et al., “Analysis of basic hospital pricing using DD,” BIO Web Conf., vol. 152, 01012, 2025.
[12] N. Bahaswan and F. Pribadi, “Inefficiency determinants in dialysis services,” Med. J., vol. 9, pp. 55–63, 2022.
[13] M. Febriani, “Unit cost analysis for hemodialysis under INA-CBGs,” Med. J. Bangka, vol. 1, 2022.
[14] L. Chen et al., “Comparative evaluation of costing methods in hospital management,” J. Health Econ., vol. 82, 102754, 2023.
[15] T. M. Hani, Hospital Tariff Calculation Using Double Distribution, Yogyakarta: Deepublish, 2019.
[16] P. Sarnianto and Y. Anggriani, “Comparative cost analysis in hemodialysis,” J. Ilm. Kedokt., vol. 6, no. 2, pp. 27–30, 2021.
[17] V. S. Vinawaty et al., “Hemodialysis service costs in the JKN era,” MPP KI J., vol. 2, 2022.
[18] R. Jiménez-Ramírez et al., “Direct costs of hemodialysis in the Dominican Republic,” Rev. Colomb. Nefrol., vol. 10, no. 3, pp. 207–215, 2023.
[19] M. Ranasinghe et al., “Economic assessment of dialysis in developing countries,” BMC Nephrol., vol. 12, no. 42, 2023.
[20] A. Sharma et al., “Cost optimization in hospital service delivery,” Front. Public Health, vol. 12, 2024.
[21] N. Budi et al., “Tariff adjustment strategies in Indonesian hospitals,” Int. Health Policy J., vol. 9, no. 2, 2024.
[22] L. Mulyani et al., “Application of ABC method in healthcare service costing,” Econ. Health J., vol. 7, pp. 44–53, 2021.
[23] S. Bahar et al., “Challenges in implementing accurate cost methods in hospitals,” Health Syst. Rev., vol. 18, no. 4, pp. 209–218, 2023.
[24] E. Marvia, “Cost analysis with ABC in PKU Muhammadiyah Hospital,” Med. J., vol. 12, 2022.
[25] R. Martínez-Paulino et al., “Direct cost evaluation in dialysis centers,” Health Serv. Res., vol. 59, no. 1, pp. 90–103, 2024.
[26] A. Thabrany, “Determining hospital tariffs: an updated framework,” Indones. J. Hosp. Manage., vol. 5, no. 2, pp. 77–89, 2022.
[27] J. Zhao et al., “Advanced costing methods in hospital performance analysis,” Healthcare Fin. Rev., vol. 40, no. 3, pp. 112–125, 2023.
[28] T. M. Hani, Hospital Tariff Calculation Using Double Distribution, Yogyakarta: Deepublish, 2019.
[29] N. Bahaswan and F. Pribadi, “Inefficiency determinants in dialysis services,” Med. J., vol. 9, pp. 55–63, 2022.
[30] M. Febriani, “Unit cost analysis for hemodialysis under INA-CBGs,” Med. J. Bangka, vol. 1, 2022.
[31] A. Nurmansyah et al., “Analysis of basic hospital pricing using DD,” BIO Web Conf., vol. 152, 01012, 2025.
[32] R. Jiménez-Ramírez et al., “Direct costs of hemodialysis in the Dominican Republic,” Rev. Colomb. Nefrol., vol. 10, no. 3, pp. 207–215, 2023.
[33] L. Chen et al., “Comparative evaluation of costing methods in hospital management,” J. Health Econ., vol. 82, 102754, 2023.
[34] A. Sharma et al., “Cost optimization in hospital service delivery,” Front. Public Health, vol. 12, 2024.
[35] E. Marvia, “Cost analysis using ABC approach in hospital services,” Med. J., vol. 12, pp. 45–53, 2022.
[36] J. Zhao et al., “Advanced costing methods in hospital performance analysis,” Healthcare Fin. Rev., vol. 40, no. 3, pp. 112–125, 2023.
[37] World Health Organization, Health Systems Efficiency Toolkit, Geneva: WHO, 2023.
[38] A. Nurmansyah et al., “Analysis of basic hospital pricing using DD,” BIO Web Conf., vol. 152, 01012, 2025.
[39] L. Chen et al., “Comparative evaluation of costing methods in hospital management,” J. Health Econ., vol. 82, 102754, 2023.
[40] R. Jiménez-Ramírez et al., “Direct costs of hemodialysis in the Dominican Republic,” Rev. Colomb. Nefrol., vol. 10, no. 3, pp. 207–215, 2023.
[41] Y. Agada-Amade et al., “Cost-benefit analysis of hemodialysis in patients with end-stage kidney disease in Abuja,” Health Econ. Rev., vol. 14, no. 47, 2024.
[42] M. Febriani, “Unit cost analysis for hemodialysis under INA-CBGs,” Med. J. Bangka, vol. 1, 2022.
[43] V. S. Vinawaty et al., “Hemodialysis service costs for chronic kidney failure patients in the JKN era,” MPP KI J., vol. 2, 2022.
[44] N. Bahaswan and F. Pribadi, “Inefficiency determinants in dialysis services,” Med. J., vol. 9, pp. 55–63, 2022.
[45] M. Ranasinghe et al., “Economic assessment of dialysis in developing countries,” BMC Nephrol., vol. 24, no. 72, 2023.
[46] K. Tanaka et al., “Economic burden of dialysis therapies,” Clin. Nephrol., vol. 101, no. 6, pp. 389–398, 2022.
[47] A. Sharma et al., “Cost optimization in hospital service delivery,” Front. Public Health, vol. 12, 2024.
[48] J. Zhao et al., “Advanced costing methods in hospital performance analysis,” Healthcare Fin. Rev., vol. 40, no. 3, pp. 112–125, 2023.
[49] World Health Organization, Health Systems Efficiency Toolkit, Geneva: WHO, 2023.
[50] E. Marvia, “Cost analysis with ABC in PKU Muhammadiyah Hospital,” Med. J., vol. 12, pp. 45–53, 2022.
[51] S. Bahar et al., “Challenges in implementing accurate cost methods in hospitals,” Health Syst. Rev., vol. 18, no. 4, pp. 209–218, 2023.
[52] P. Sarnianto and Y. Anggriani, “Comparative analysis of hemodialysis costs in Bogor Regency,” J. Ilm. Kedokt., vol. 6, no. 2, pp. 27–30, 2021.
[53] L. Mulyani et al., “Application of ABC method in healthcare service costing,” Econ. Health J., vol. 7, pp. 44–53, 2021.
[54] A. Thabrany, “Determining hospital tariffs: an updated framework,” Indones. J. Hosp. Manage., vol. 5, no. 2, pp. 77–89, 2022.
[55] H. Sari et al., “Hospital tariff setting under the JKN system,” Indones. Health Econ. J., vol. 8, no. 1, pp. 22–35, 2023.
[56] J. Bowe et al., “Big data and AI in hospital cost analytics,” Front. Health Inform., vol. 7, 2024.
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Copyright (c) 2025 Wendi Pradiyatmoko, Hulmansyah, Laura Mayanda, Dicky Budiman, Misbahul Munir, Danial Rasyid
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