The Hidden Costs of Inpatient Glaucoma Treatment: Out-of-Pocket Burden at a Tertiary Care Hospital in Yogyakarta

Abstract

Introduction and Objective: Glaucoma requires lifelong care, generating out-of-pocket (OOP) costs despite insurance coverage. This study assessed OOP expenditure among hospitalized glaucoma patients covered by Indonesia’s National Health Insurance (JKN). Methods: A hospital-based cross-sectional study included 40 purposively selected glaucoma inpatients from December 2024 to February 2025. Self-reported data were collected through structured interviews. Multiple linear regression examined associations between sociodemographic and cost-related factors and total OOP expenditure. Results: Participants’ mean age was 56 years, with a male-to-female ratio of 1:1.9; 52.5% were unemployed and received subsidized JKN contributions. Mean OOP expenditure per hospitalization was IDR 640,090, comprising direct non-medical expenses (92%) and indirect costs (8%). Transportation (mean IDR 352,670; 61% of direct non-medical costs), meals for accompanying relatives (mean IDR 184,125; 32%), and indirect costs (mean IDR 50,375) were significantly associated with total OOP expenditure (all p < 0.001). The model explained 84.3% of expenditure variance (R² = 0.843). Conclusion: Transportation and meals for accompanying relatives dominated direct non-medical OOP costs, highlighting the need to strengthen financial protection for patients and their households.