Operational and Financial Barriers in KRIS Implementation: A Critical Review of Hospital Readiness and Equity in Indonesia

Abstract

The implementation of the Kamar Rawat Inap Standar (KRIS) policy marks a significant reform in Indonesia’s healthcare system, aiming to standardize inpatient services and improve equity. This review explores the operational and financial challenges hospitals face during KRIS implementation, particularly disparities between urban and rural facilities. A descriptive analytical approach was used to examine studies published between 2013 and 2023, focusing on hospital readiness, resource allocation, and financial sustainability. Findings indicate that urban hospitals are generally better equipped to comply with KRIS standards due to stronger infrastructure and more consistent funding. Conversely, rural hospitals face significant obstacles, including outdated facilities, limited financial capacity, and reliance on BPJS Kesehatan reimbursements. These disparities hinder equitable policy implementation. Despite these issues, the review identifies opportunities for improvement, such as targeted government support in the form of infrastructure investment, increased reimbursement rates, and workforce training. The review also considers the potential of digital health technologies—such as electronic medical records and health information systems—to improve hospital efficiency and reduce long-term costs. However, high initial investments remain a barrier, particularly for smaller institutions. This study concludes that while KRIS holds promise for enhancing service quality and equity, its success depends on addressing operational and financial disparities across hospital types and regions. A more context-sensitive and supportive implementation strategy is essential to achieve the policy’s intended outcomes.