Latar Belakang: Skizofrenia merupakan gangguan mental kronis yang menimbulkan beban signifikan terhadap sistem pembiayaan kesehatan, terutama dalam program Jaminan Kesehatan Nasional (JKN). Penyakit ini memerlukan perawatan jangka panjang dan rawan kekambuhan, sehingga berkontribusi terhadap tingginya angka kunjungan dan pembiayaan di fasilitas kesehatan, khususnya pada layanan rujukan. Tujuan: Mengetahui besarnya biaya pelayanan kesehatan peserta JKN dengan skizofrenia dan faktor-faktor yang berhubungan dengan biaya tersebut. Metode: Penelitian kuantitatif dengan desain cross-sectional menggunakan data sekunder BPJS Kesehatan tahun 2024. Sampel terdiri dari 1.597 peserta aktif JKN dengan diagnosis skizofrenia selama satu tahun. Analisis dilakukan secara univariat dan bivariat menggunakan SPSS versi 25. Hasil: Total biaya pelayanan mencapai Rp16.896.391.354. Rata-rata biaya rawat jalan Rp314.929 dan rawat inap Rp5.050.107. Biaya signifikan dipengaruhi oleh usia, hubungan keluarga, kelas hak rawat, segmentasi peserta, wilayah kepesertaan, jenis dan kepemilikan FKTP/FKRTL, kunjungan ke FKTP, dan tipe FKRTL. Kesimpulan: Skizofrenia memberikan beban biaya tinggi pada JKN. Diperlukan pembiayaan berbasis kebutuhan serta penguatan layanan jiwa di tingkat primer dan komunitas untuk efisiensi sistem.

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Background: Schizophrenia is a chronic mental disorder that poses a significant burden on the healthcare financing system, particularly within Indonesia’s National Health Insurance (JKN) program. The condition requires longterm care and is prone to relapse, contributing to high healthcare utilization and costs, especially at referral level facilities. Objective: To determine the total healthcare costs for JKN participants diagnosed with schizophrenia and to identify factors associated with those costs. Methods: This quantitative study employed a cross sectional design using secondary data from BPJS Kesehatan (Indonesia’s Social Health Insurance) for the year 2024. The sample consisted of 1.597 active JKN participants diagnosed with schizophrenia over a 12 month period. Data were analyzed using univariate and bivariate techniques in SPSS version 25. Results: The total healthcare cost amounted to IDR 16.896.391.354. The average outpatient cost was IDR 314.929, while the average inpatient cost was IDR 5.050.107. Factors significantly associated with higher costs included age, family relationship status, treatment class, participant segmentation, region of enrollment, type and ownership of primary and referral healthcare facilities (FKTP/FKRTL), number of visits to primary care, and type of referral facility. Conclusion: Schizophrenia places a substantial financial burden on the JKN system. A need-based financing approach and strengthened mental health services at the primary and community levels are essential to improving efficiency and sustainability.