Implementation of a Business Intelligence System for Analysis of SIMRS Real Cost Variances against INA-CBG Rates and Identifying Clinical Inefficiencies

Abstract

This research aims to design a Business Intelligence (BI) System as a strategic solution to the cost control challenges in hospitals within the National Health Insurance (JKN) system. This BI system integrates real cost data from the Hospital Management Information System (SIMRS) (Medicine, Lab, Radiology) with INA-CBG claim rate data through a structured Extract, Transform, Load (ETL) process. The results of implementation and data analysis for 8 months on 17,059 cases showed critical findings. Hospitals experienced a total financial loss of IDR 58.14 billion, it was found that 79.32% (13,531 cases) had real costs that exceeded the INA-CBG rate. The diagnosis of 'Viral & Other Non-Bacterial Infections (Mild)' (code A-4-13-I) was the largest source of financial loss. This inefficiency is caused by a disproportionate composition of supporting costs, with drug costs (64.9%) and laboratory costs (25.1%) being the primary drivers, indicating potential overutilization or practices that are not aligned with the clinical needs of "minor" diagnoses. This BI system also provides interactive visualizations, monitoring profitability, and mapping cost patterns per diagnosis. Drill-down functionality generates actionable insights for improving operational efficiency.