scholarly journals SOCIAL HEALTH INSURANCE LITERACY: LESSON LEARNED FROM SOCIAL INSURANCE FOR MATERNITY CARE BY NATIONAL HEALTH INSURANCE PROGRAMME

2019 ◽  
Vol 7 (1) ◽  
pp. 25
Author(s):  
Choirun Nisa' ◽  
Intan Nina Sari
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Maternity Care ◽  
Social Insurance ◽  
Post Partum ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Insurance Literacy ◽  
The Government

Background: Health insurance is a right for all Indonesian citizens. To provide this, the Indonesian government must provide health services that are equitable, fair, and affordable for all levels of society. Before National Health Insurance (JKN) was established, the government launched Social Insurance for Maternity Care or Jaminan Persalinan (Jampersal) as a special health facility for pre-pregnant to post-partum mothers. The JKN program will run well if it is accompanied with good health service literacy of the community.Aims: This study aims to analyze the relationship of social health insurance literacy with the utilization of Jampersal and predict the response towards JKN utilization based on Jampersal mothers. These responses can be used as an input for JKN improvement.Methods: This research is a descriptive study that focuses on the experience of the subjects. The study does so by analyzing Jampersal users’ response and utilizing it for the improvement of JKN. The respondents of this study are Jampersal and non-Jampersal mothers consisting of 75 pregnant and post-partum mothers.Results: The results show that the number of Jampersal users (47%) were less than non Jampersal (53%) with a ratio of 2:3. In addition, literacy about Jampersal of Jampersal mothers' was higher (28 out of 30 people - 93.33%) compared to non Jampersal mothers (29 out of 45 people - 64.44%).Conclusions: This study concludes that there is a lack of promotion of government programs, especially social health insurance. What needs to be done to improve participation and use of social health insurance is to encourage primary healthcare centers to promote the programs. Intervention policy, especially by educating the communities, is necessary for the improvement of JKN literacy.                                                                                                                                                          Keywords: Literacy, Participation, Social health insurance.

scholarly journals DOES MORAL HAZARD OCCOUR IN THE IMPLEMENTATION OF SOCIAL HEALTH INSURANCE? EVIDENCE FROM PUBLIC HOSPITALS IN A RURAL PROVINCE OF INDONESIA

2020 ◽  
Vol 5 (1) ◽  
pp. 24
Author(s):  
Rizanda Machmud ◽  
Syafrawati Syafrawati ◽  
Prof. Syed Mohamed Aljunid ◽  
Rima Semiarty
Keyword(s):  
Health Insurance ◽  
Moral Hazard ◽  
National Health Insurance ◽  
National Health ◽  
Medical Records ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Severity Level ◽  
Discharge Status

Indonesia is now encountering moral hazard problems in the implementation of social health insurance. BPJS, as the administrator of Indonesia’s National Health Insurance, reported that there was an increase in deficit in the 4 years of the implementation of National Health Insurance from US$ 228 million in 2014 to US$ 470 million in 2016. Despite efforts conducted to overcome the problem, no evidence-based predictor that might be significantly associated with moral hazard in a rural province hospital in Indonesia. The purpose of this research is to identify the incidence of moral hazard in the implementation of National Health Insurance in Indonesia. Data consisting of 180 medical records obtained from three public hospitals in rural province of Indonesia were selected as samples in this study. These medical records were reviewed by Independent Senior Coder (ISC) who had more than 5 years experiences as a coder. The indicators of moral hazard in this study were upcoding, readmission, and possible unnecessary admission. Logistic regression was used to explore determinant of moral hazard from patient, coder, and physician side. The results show that rate of moral hazard cases for upcoding is 10%, readmission is 2.8%, and possible unnecessary admission is 18.9%. It can be seen from multivariate analysis that discharge status, severity level and LOS have a significant relationship with moral hazard. Illness severity level, Discharge against Medical Advice, and higher Length of Stay are risk factors for moral hazard incidence.

scholarly journals An Audit of Knowledge and Attitude Regarding Implementation of the National Health Insurance (JKN) in BPK RI

2019 ◽  
Vol 6 (5) ◽  
pp. 50
Author(s):  
Hari Suhud
Keyword(s):  
Health Insurance ◽  
Human Resources ◽  
National Health Insurance ◽  
National Health ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Card ◽  
Knowledge And Attitude ◽  
The Republic ◽  
Unfavorable Attitude

This study aims to evaluate the knowledge and attitude of Human Resource Bureau employees regarding implementation of National Health Insurance (JKN) in The Audit Board of the Republic of Indonesia (known as BPK RI). The study is carried out by quantitative method through the distribution of questionnaires. Based on the data obtained from the results of research on 155 respondents in terms of knowledge and attitude, it can be concluded as follows: 1. the level of knowledge of employees at Human Resources Bureau in BPK RI mostly have low knowledge about the National Health Insurance (JKN) (58.1%). The results are exposed to employees who have never used Social Health Insurance/BPJS Health card with a large enough score (36.1%), and the rest are employees who have used the card; 2. the attitude of employees at Human Resources Bureau in BPK RI has a favorable attitude towards the positive statement (84.5%), as for the attitude of employees to negative statements obtained the opposite result, that most respondents have unfavorable attitude (76.1%). The results were distributed to respondents who had never used Social Health/ BPJS Health card with similar percentages.

scholarly journals Hubungan Pengetahuan Dengan Motivasi Menggunakan Jaminan Kesehatan Nasional (JKN) Di Puskesmas Panarung

2020 ◽  
Vol 6 (1) ◽  
pp. 138-142
Author(s):  
Rizka Ovany ◽  
Hermanto Hermanto ◽  
Titus Suprianto
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Social Health Insurance ◽  
Sampling Technique ◽  
Correlation Study ◽  
P Value ◽  
Strong Motivation ◽  
Insurance Mechanism ◽  
The Government

The National Health Insurance (JKN) is carried out with a social health insurance mechanism that is mandatory to meet the basic health needs of the community that pays contributions or is paid by the Government. This is not well understood by many families so there are still families who have not used national health insurance on the grounds that they rarely get sick and do not use it when they seek treatment. This study aims to see the relationship of knowledge with motivation in using JKN. This type of correlation study with a purposive sampling technique, data collection using questionnaires in the form of closed statements as many as 11 items about national health insurance knowledge (JKN), and as many as 15 items of questions. Motivational measurements were given to 35 respondents. The statistical test uses the Rho Spearmen Test (Rank). From 35 respondents, there were 22 respondents (62.9%) lacking knowledge with 16 respondents (45.7%) moderate motivation and 6 respondents (17.1%) strong motivation while 9 respondents had sufficient knowledge level (9 respondents) 25.7%) with the strong motivation of 6 respondents (17.1%) and a moderate motivation of 3 respondents (8.6%) while respondents who have a good level of knowledge amounted to 4 respondents (11.4%) with the strong motivation of 4 respondents (11.4%) and moderate motivation (0%). With the analysis test resultsusing the Rho Spearmen (Rank obtained P-Value 0.002 (0.002 <0.05).

scholarly journals Kepercayaan Publik (Public Trust) Terhadap E-Government : Studi Kasus Penggunaan E-Mobile BPJS Kesehatan Di Kota Makassar

2020 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
Sitti Mirsa Sirajuddin ◽  
A . Atrianingsi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Mobile Applications ◽  
Mobile Application ◽  
Public Trust ◽  
The Public ◽  
The Government ◽  
Quantitative Descriptive ◽  
High Level

The general objective of the study was to analyze the level of public trust (citizen trust) of e-government based health insurance services, namely the e-mobile National Health Insurance (JKN) BPJS in Makassar City.The design of this research is a quantitative descriptive type. The population in this study were people who used the National Health Insurance (JKN) e-mobile application with 167 respondents. Data collection was carried out using a questionnaire instrument. Data analysis uses multiple linear regression.The results showed that first there was a high level of public trust in JKN e-mobile applications. This means that the application gives satisfaction to the community and is considered beneficial for them. Secondly, the level of public trust is high in the government, where the public considers the government to be serious in providing health insurance services.Tujuan umum penelitian adalah untuk menganalisis tingkat kepercayaan publik (citizen trust) terhadap pelayanan jaminan kesehatan berbasis e-government yaitu e-mobile Jaminan Kesehatan Nasional (JKN) BPJS Kesehatan di Kota Makassar. Desain penelitian ini adalah kuantitatif tipe deskriptif. Populasi dalam penelitian ini adalah masyarakat yang menggunakan aplikasi e-mobile Jaminan Kesehatan Nasional (JKN) dengan jumlah responden sebanyak 383 orang. Pengumpulan data dilakukan dengan menggunakan instrument kuesioner. Analisis data menggunakan regresi linear berganda. Hasil penelitian menunjukkan bahwa, pertama terdapat tingkat kepercayaan tinggi masyarakat terhadap aplikasi e-mobile JKN. Hal ini berarti aplikasi memberi kepuasan kepada masyarakat dan dianggap bermanfaat bagi mereka. Kedua tingkat kepercayaan publik tinggi terhadap pemerintah tinggi, dimana masyarakat menilai pemerintah serius dalam memberikan pelayanan jaminan kesehatan.

Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

2019 ◽  
Vol 39 (9/10) ◽  
pp. 752-772
Author(s):  
Bishwajit Nayak ◽  
Som Sekhar Bhattacharyya ◽  
Bala Krishnamoorthy
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Digital Technology ◽  
Social Health Insurance ◽  
Social Health ◽  
Strategic Choices ◽  
Content Type ◽  
Study Results ◽  
The Government ◽  
Health Insurers

Purpose Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

The Scheme of National Health Insurance considered in relation to the Valuations of Approved Societies as at 31 December 1918

1923 ◽  
Vol 54 (2) ◽  
pp. 150-203
Author(s):  
P. N. Harvey
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Financial Structure ◽  
General Interest ◽  
Main Theme ◽  
Main Subject ◽  
The Government ◽  
Technical Features ◽  
Made In

The scheme of National Health Insurance, apart from its general interest to the student of social questions, presents many technical features of special interest to the actuary, and it has been suggested that the completion of the first valuations of approved societies, i.e., the societies administering the monetary benefits of the system, affords an opportunity for discussion of the scientific problems to which these features give rise. With the Government Actuary's consent, I therefore submit in the following paper an examination of some of the more important points of actuarial interest which have emerged in the course of the valuation work. Before approaching the main theme of the paper, however, I have described briefly certain factors, such as the principal alterations made in the financial structure of the scheme by the Act of 1918, a knowledge of which is essential to an understanding of the later part of the paper. These preliminary remarks are placed in Part I, the main subject being dealt with in Part II.

scholarly journals Fraud in Healthcare Service

2018 ◽  
Vol 54 ◽  
pp. 03015
Author(s):  
Dara Pustika Sukma ◽  
Adi Sulistiyono ◽  
Widodo Tresno Novianto
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health ◽  
Healthcare Service ◽  
Social Insurance ◽  
Empirical Method ◽  
Professional Organization ◽  
Social Insurance System ◽  
Central Java

In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.

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