Tarif Retribusi Pelayanan Kesehatan pada Unit Pengobatan Penyakit ParuParu

The Pulmonary Care Unit (UPP) is a specialized department in hospitals that focuses on the diagnosis, treatment, and rehabilitation of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), tuberculosis, and lung cancer. In Indonesia, the cost of medical services rendered by the UPP is regulated through a system called Tarif Retribusi Pelayanan Kesehatan (RP). This page explains the principles behind RP, outlines the main categories of services, provides a sample tariff schedule, and offers guidance for patients on how bills are calculated and what rights they have.

1. Legal and Regulatory Background

The RP system is anchored in several national regulations:

1. Law No. 44/2009 on Hospital Services establishes that hospitals must publish clear, standardized tariffs for each type of service.
2. Ministerial Regulation No. 33/2018 defines the methodology for calculating tariffs based on the cost of labor, equipment, medicines, and overhead.
3. Health Insurance Law (Law No. 24/2017) mandates that the tariff for services covered by the national health insurance (BPJS Kesehatan) must be transparent and the same across public and private facilities.

The Ministry of Health regularly updates the tariff tables, usually at the beginning of each fiscal year. Hospitals are required to adopt the latest version and display the rates in patient information folders, on their websites, and at the reception desk.

2. Main Service Categories in the Pulmonary Care Unit

Services are grouped according to the complexity of care required. Below is a brief description of each category.

2.1 OutPatient Consultation

• General Respiratory Consultation initial assessment, medical history, and basic examination.
• Specialist FollowUp detailed review of chronic conditions or postprocedure monitoring.

2.2 Diagnostic Procedures

• Chest Radiography (Xray) standard imaging for evaluating lung fields.
• HighResolution CT Scan (HRCT) detailed imaging for interstitial lung disease.
• Spirometry and Pulmonary Function Tests (PFT) measurement of lung volumes and airflow.
• Bronchoscopy endoscopic examination of the airway, often with biopsy.

2.3 Therapeutic Interventions

• Inhalation Therapy administration of bronchodilators or steroids via nebulizer.
• Oxygen Therapy supplemental oxygen delivered through nasal cannula or mask.
• Pulmonary Rehabilitation supervised exercise, education, and counseling.

2.4 InPatient Care

• General Ward Stay daily bed charge, nursing care, and basic monitoring.
• Intensive Care Unit (ICU) advanced monitoring, mechanical ventilation, and specialist nursing.
• Surgical Procedures includes thoracotomy, videoassisted thoracoscopic surgery (VATS), and lung resection.

3. Sample Tariff Table (2025 Revision)

Service	Reference Code	Rp (Indonesian Rupiah)	BPJS Kesehatan Rate	Notes
General Respiratory Consultation (outpatient)	R01	90,000	80,000	Includes basic lab test (CBC)
Specialist FollowUp Consultation	R02	150,000	130,000	Extended evaluation up to 30 minutes
Chest Xray (PA view)	D01	70,000	60,000	Digital image provided
HRCT Scan full lungs	D02	1,200,000	1,050,000	Includes radiologist report
Spirometry (pre and postbronchodilator)	D03	120,000	100,000	Standard PFT panel
Bronchoscopy with biopsy	P01	2,500,000	2,200,000	Includes pathology fee
Inhalation Therapy (per session)	T01	45,000	40,000	Nebulizer with medication
Oxygen Therapy 5 L/min, 24 hrs	T02	850,000	750,000	Cylinder + flow regulator
General Ward per day	I01	500,000	450,000	Includes meals and basic nursing
ICU per day	I02	3,500,000	3,200,000	Ventilator and intensive monitoring
VATS Lung Biopsy	S01	7,800,000	7,300,000	Surgical fee + anesthesia

Note: The BPJS Kesehatan Rate column reflects the amount reimbursed to the hospital when the patient is covered by the national health insurance scheme. Patients who pay outofpocket are billed the full Rp amount unless a discount policy applies.

4. How the Bill is Calculated

1. Service Identification Each service performed is recorded with its reference code (e.g., R01, D02).
2. Quantity Determination The number of units (e.g., number of Xray exposures, days of ICU stay) is logged.
3. Tariff Application The base tariff from the table above is multiplied by the quantity.
4. Additional Charges Includes medicines, consumables, and any supplementary procedures not covered by the standard tariff.
5. Insurance Adjustment If the patient uses BPJS Kesehatan, the hospital applies the lower BPJS rate and submits a claim. The patient may still be responsible for a copayment if the service exceeds the insured ceiling.
6. Final Invoice A detailed statement is printed, showing each line item, quantity, unit price, subtotal, and total amount payable.

5. Patient Rights and Transparency

Under Indonesian health law, patients have the following protections:

• Right to Information Before any procedure, the patient must receive a written estimate that details the expected tariff.
• Right to Choose Patients may select a provider (public or private) based on the disclosed tariffs.
• Right to Appeal If a patient believes a charge is incorrect, they can submit a written complaint to the hospitals grievance committee within 30 days of billing.
• Right to Confidentiality All billing records are kept confidential and can only be accessed by authorized personnel.

6. Common Issues and How to Address Them

6.1 Unexpected CoPayments

Even when a service is covered by BPJS, a copayment may appear if the hospitals tariff exceeds the national ceiling. Patients should verify the ceiling rates online or at the BPJS office and ask the hospital for a justification.

6.2 Duplicate Charges

Occasionally, a service (e.g., a chest Xray) may be entered twice due to administrative error. Request a detailed breakdown and, if needed, file a correction request with the billing department.

6.3 Lack of Itemized Receipts

Some facilities provide a lumpsum receipt. Patients have the right to ask for an itemized version, which facilitates verification and insurance reimbursement.

7. Future Directions for Tariff Management

Efforts are underway to modernize the RP system:

• Digital Billing Platforms Integration of electronic health records (EHR) with realtime tariff lookup reduces manual errors.
• Standardized Coding Adoption of the International Classification of Diseases (ICD10) and Indonesias own procedure coding aims to harmonize billing across institutions.
• PatientCentric Portals Online portals where patients can view their upcoming charges, track insurance claims, and download statements.

8. Conclusion

The Tarif Retribusi Pelayanan Kesehatan for the Pulmonary Care Unit is a transparent, regulated set of fees designed to balance the costs of sophisticated respiratory care with the need for affordable access. By adhering to national regulations, publishing clear tariff tables, and providing patients with detailed billing information, hospitals can maintain trust and ensure that patients receive the care they need without financial surprise.

Patients are encouraged to ask questions, review the tariff schedule before procedures, and keep copies of all invoices. When the system works as intended, both the healthcare provider and the patient benefit from a fair, predictable, and accountable payment process.