Ethical Aspects of Restrictions on the Use of Albumin in Cancer Patients That Use National Health Insurance in Indonesia

Link of Video Abstract: https://youtu.be/5YcW57q5ujU Introduction: The use of albumin is an important part of cancer therapy, and in some cases is used as a variable to assess a patient's prognosis. For cancer patients who use financing through national health insurance, regulations are currently in place for efficient use with restrictions on giving human albumin to a maximum of 3 bottles per patient arrival period, with albumin levels that can only be given to patients with albumin levels below 2.5. The amount above this must be borne by the hospital. This research was conducted to assess and analyze the administration of albumin to cancer patients, especially to patients who are funded by national health insurance. Method: This was a cohort study that uses a sampling technique in the form of total sampling for cancer patients hospitalized. This study included cancer patients age >18 years, who had albumin serum level on admission less than 2.5 g/dL and received albumin therapy during in-patient care. Data were tabulated and analyzed according to the rules of quantitative statistics. Results: More than half of the patients in this study were female (57.1%) and over 60 years old (53.6%). The types of cancer in this study varied, with renal and uterine cancer accounting for 5 patients each (17.8%), colorectal and cervical cancer, 3 patients (10.7%), sarcoma and pancreatic cancer, 2 patients (7.145). Of the 28 cases of cancer patients with hypoalbuminemia who required albumin, 10.7% were subsidized by hospitals with amounts varying between 1 and 4 bottles. Conclusion: Health insurance which leads to financing of contributions assisted by the government with the concept of mutual cooperation is in accordance with the concept of health service ethics. The efficiency process carried out should not encourage hospitals, doctors and health workers to violate patient service standards by creating moral hazard conditions. A re-evaluation of restrictions and the determination of controlled top-ups needs to be carried out to avoid a more widespread moral hazard condition.