Quality of mental health care among insured patients in an Indonesian psychiatric hospital

Abstract

Background This study aimed to assess the quality of inpatient psychiatric care for patients covered by the National Health Insurance (NHI) programme at the Indonesian Psychiatric Hospital in Makassar. Methods We conducted a retrospective secondary data analysis using electronic claim (e-claim) data from Indonesia's NHI system for the 2019-2020 period, applying the Donabedian framework to evaluate the structure, process, and outcome components of psychiatric inpatient care quality. Descriptive statistical analyses including frequency distributions, cross-tabulations, and summary measures (means, standard deviations) were applied across framework dimensions. Unadjusted odds ratios (ORs) with 95% CIs and chi-square tests were conducted to evaluate associations between prolonged LOS (>42 days) and financial loss; all associations are unadjusted and descriptive. Results Quality assessment under Indonesia's NHI demonstrated persistent structural challenges in psychiatric inpatient care. Thirty-day readmission rates were 7.2% (113 of 1,571 unique patients) in 2019 and 5.5% (34 of 614 unique patients) in 2020, indicating gaps in continuity of care and suboptimal transition processes. Nearly half of total admissions exceeded 42 days, reflecting substantial clinical complexity and prolonged stabilisation needs. Financial evaluations showed that hospital tariffs consistently exceeded INA-CBGs reimbursement across all length of stay categories, generating universal financial losses. Prolonged stays (>42 days) accounted for approximately 80% of total loss-incurring admissions and produced the largest mean deficits, highlighting significant misalignment between the prospective payment system and the true resource requirements of psychiatric care. Conclusions This study identifies a dual challenge in Indonesian psychiatric inpatient care: structural misalignment between INA-CBGs reimbursement and actual care costs, compounded by service-delivery factors inherent to severe and relapsing psychiatric illness. Addressing these challenges requires both tariff reform and investment in integrated clinical pathways and post-discharge community support to ensure financial sustainability and high-quality mental healthcare within Indonesia's NHI system.