Nadiyatul Ghina, Vieri Koerniawan, Erica Grace Simanjuntak, Sapto Wahyu Indratno
Increasing claims costs borne by the National Health Insurance (NHI) have caused financial disruptions in the provision of equitable and quality health insurance services to the public. This study aims to identify significant factors that affect claim burden to support efforts to control claim costs in the future. Employing a Generalized Linear Models (GLM) approach, this study developed a claims costs model classified by hospital type, given the different rates for each type. The results show that factors such as geography, membership segment, membership class, and length of stay significantly affect the claims burden. The findings are expected to provide insights for NHI in designing preventive strategies to manage claims burden more effectively. © 2026 Author(s).
Universitas Negeri Padang, Prof. Dr. Hamka Street, West Sumatera, Padang, 25132, Indonesia; Institut Teknologi Bandung, Ganesha Street No. 10, West Java, Bandung, 40132, Indonesia
