Mutiara Nurtandhee, (2023) – Estimasi Biaya Gagal Ginjal | 84 Jurnal Jaminan Kesehatan Nasional, Volume 3 Number 2, (December, 2023). Page 84 - 101 DOI : 10.53756/jjkn.v3i2.104 ISSN : 2798-6705 (online) ISSN : 2798-7183 (print) Estimasi Biaya Pelayanan Kesehatan sebagai Upaya Pencegahan Defisit Dana Jaminan Sosial untuk Penyakit Gagal Ginjal Mutiara Nurtandhee 1 1 Program Studi Sains Aktuaria, Institut Teknologi Sumatera, e-mail: nurtandhee@gmail.com. Abstract: Not all medical expenses were paid promptly in 2018, which resulted in a deficit for BPJS Kesehatan. If DJS cannot meet the costs of health services, it will have an impact on other people who need care. Kidney failure is one of the catastrophic diseases with the highest costs, costing up to 6.5 trillion rupiah in 2021, an increase of 190% compared to 2020. This is also due to the increase in the number of sufferers, followed by an increase in cases of kidney failure. Some of the procedures include CAPD, hemodialysis, and organ transplantation, which can cost up to hundreds of millions of rupiah per patient. This research aims to forecast the prevalence rate of kidney failure in Indonesia for 2023–2025 using the Exponential Smoothing method and the literature study method. The results showed that people aged >45 years were more likely to get kidney failure. Compared to women, the prevalence for men is higher, which serves as a warning to the community to maintain a healthy lifestyle. Following the hypothesis, the total cost of kidney failure will increase with the increase in hemodialysis patients and cases. The total cost of treatment is expected to be between 2.4 and 3 trillion rupiah in 2023-2025. It is known that the cost containment scheme has succeeded in overcoming the problem of cost control in several countries. The United States uses cost sharing as a cost control scheme for the treatment of ESRD (End-Stage Kidney Disease). Therefore, Indonesia can also implement a cost-sharing scheme that is based on the forecasting results of kidney failure costs. This scheme is appropriate to overcome the problem of controlling insurance costs. Keywords: Kidney Failure; Social Security Fund; Exponential Smoothing Abstrak: Pada tahun 2018, BPJS Kesehatan mengalami defisit sehingga biaya pengobatan tidak semua dibayar tepat waktu. DJS yang tidak dapat memenuhi biaya pelayanan kesehatan akan berdampak terhadap masyarakat lain yang membutuhkan perawatan. Penyakit gagal ginjal merupakan salah satu penyakit katastropik dengan biaya tertinggi, menghabiskan biaya hingga 6,5 triliun rupiah pada tahun 2021, meningkat 190% dibandingkan tahun 2020. Hal tersebut juga disebabkan karena meningkatnya jumlah penderita yang diikuti dengan peningkatan kasus gagal ginjal. Beberapa tindakan di antaranya adalah CAPD, hemodialisis, dan transpalantasi organ yang dapat menghabiskan biaya hingga ratusan juta rupiah per pasien. Tujuan penelitian ini adalah melakukan peramalan angka prevalensi gagal ginjal di Indonesia untuk tahun 2023-2025