scholarly journals PERAN BADAN PENYELENGGARA JAMINAN SOSIAL DALAM PENINGKATAN KEPESERTAAN PENERIMA BANTUAN IURAN DAERAH DI KOTA BLITAR DAN KOTA MALANG

2018 ◽  
Vol 21 (3) ◽  
pp. 199-210
Author(s):  
Rukmini Rukmini ◽  
Oktarina Oktarina
Keyword(s):  
Health Insurance ◽  
Local Government ◽  
National Health Insurance ◽  
National Health ◽  
Group Discussion ◽  
Universal Coverage ◽  
Local Health ◽  
District Health ◽  
Government District ◽  
One Year

BPJS is legal body of National Health Insurance providers to achieve Indonesia universal coverage. This study aims at identifying BPJS role to increase the number Recipient of Contribution Subsidy membership. This was observational study with cross sectional design. This study conducted in Blitar and Malang city. The data were collected by in-depth interview to some stakeholders such as: the chief of BPJS, the head of membership division, district health ofice. Meanwhile, focused group discussion were conducted to gathered the opinions of some stakeholders such as: district health ofice, BPJS, local government, district inancial management and asset agency, district planning and development agency, and social ofice. Result was BPJS had issued regulation to support the increased number of National Health Insurance as beneiciaries. Moreover, they implemented advocacy to deal with local government. District health ofice and other sectors in both Blitar and Malang had played role to integrate Local Health Insurance and SPM users to become district beneiciaries in BPJS. The member of beneiciaries in Blitar and Malang was the highest coverage. Nevertheless, the coverage centre beneiciaries were higher than the local one. Actually, there were many obstacles on local beneiciaries’ management but those could be overcome by coordination among BPJS, district health ofice as well as other sectors. BPJS had optimally played role to increase number of National Health Insurance memberships especially for the poor as local beneiciaries by supporting the integration of local health insurance and SPM users. Local beneiciaries membership was supposed to use close membership with one year payment. It means purchasing premium for one year based on the number of members registered in Memorandum of Understanding.  Abstrak BPJS merupakan badan hukum penyelenggara program Jaminan Kesehatan Nasional untuk mencapai universal coverage Indonesia. Penelitian bertujuan mengetahui peran BPJS dalam peningkatan kepesertaan PBI daerah. Studi kasus dilakukan secara kualitatif, di Kota Blitar dan Kota Malang pada tahun 2015. Pengumpulan data dengan wawancara mendalam Kepala BPJS, Kepala Bidang kepesertaan BPJS, Dinas Kesehatan dan focus group discussion (FGD) dengan Dinas Kesehatan, BPJS, Pemda, Badan Pengelolaan Keuangan dan Aset Daerah (BPKAD), Bappeda, dan Dinas Sosial. Analisis data secara deskriptif. Hasil menunjukkan bahwa BPJS telah menerbitkan peraturan untuk mendukung peningkatan kepesertaan JKN sebagai PBI Daerah dan melakukan berbagai proses mulai dari advokasi sampai perjanjian kerjasama dengan Pemerintah Daerah. Dinas Kesehatan dan lintas sektor terkait di Kota Blitar dan Kota Malang telah berperan dalam integrasi Jamkesda dan pengguna SPM menjadi PBI Daerah di BPJS sesuai dengan tugas pokok dan fungsinya. Peserta PBI di Kota Blitar dan Kota Malang merupakan jenis peserta dengan cakupan tertinggi di BPJS, tetapi cakupan PBI Pusat (APBN) lebih tinggi dari PBI Daerah (APBD). Berbagai kendala ditemui dalam pengelolaan PBI Daerah tetapi dapat diselesaikan dengan koordinasi yang baik antara BPJS, Dinas Kesehatan dan Lintas Sektor yang terlibat. BPJS telah berperan penuh dalam meningkatkan kepesertaan JKN khususnya bagi masyarakat miskin sebagai PBI di Daerah, dengan membantu melaksanakan integrasi kepesertaan Jamkesda dan pengguna SPM yang dilaksanakan Dinas Kesehatan. Kepesertaan PBID sebaiknya menggunakan close member ship yang berlaku satu tahun yaitu pembayaran premi selama 1 tahun sesuai dengan jumlah peserta yang terdaftar di perjanjian kerjasama.

How Single-payer Stacks Up: Evaluating Different Models of Universal Health Coverage on Cost, Access, and Quality

2018 ◽  
Vol 48 (3) ◽  
pp. 568-585 ◽  
Author(s):  
Ashley Fox ◽  
Roland Poirier
Keyword(s):  
United States ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Coverage ◽  
The United States ◽  
Health Coverage ◽  
Single Payer ◽  
Access And Quality ◽  
Universal Health

Described as “universal prepayment,” the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada’s system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.

scholarly journals Impact of insurance type on outcomes in cardiac arrest patients from 2004 to 2015: A nation-wide population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254622
Author(s):  
Si Jin Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Sung Woo Lee ◽  
Myung Ki ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Hospital Costs ◽  
Medical Aid ◽  
Insurance Type ◽  
Hospital Factors ◽  
One Year

Objectives There do not appear to be many studies which have examined the socio-economic burden and medical factors influencing the mortality and hospital costs incurred by patients with cardiac arrest in South Korea. We analyzed the differences in characteristics, medical factors, mortality, and costs between patients with national health insurance and those on a medical aid program. Methods We selected patients (≥20 years old) who experienced their first episode of cardiac arrest from 2004 to 2015 using data from the National Health Insurance Service database. We analyzed demographic characteristics, insurance type, urbanization of residential area, comorbidities, treatments, hospital costs, and mortality within 30 days and one year for each group. A multiple regression analysis was used to identify an association between insurance type and outcomes. Results Among the 487,442 patients with cardiac arrest, the medical aid group (13.3% of the total) had a higher proportion of females, rural residents, and patients treated in low-level hospitals. The patients in the medical aid group also reported a higher rate of non-shockable conditions; a high Charlson Comorbidity Index; and pre-existing comorbidities, such as hypertension, diabetes mellitus, and renal failure with a lower rate of providing a coronary angiography. The national health insurance group reported a lower one-year mortality rate (91.2%), compared to the medical aid group (94%), and a negative association with one-year mortality (Adjusted OR 0.74, 95% CI 0.71–0.76). While there was no significant difference in short-term costs between the two groups, the medical aid group reported lower long-term costs, despite a higher rate of readmission. Conclusions Medical aid coverage was an associated factor for one-year mortality, and may be the result of an insufficient delivery of long-term services as reflected by the lower long-term costs and higher readmission rates. There were differences of characteristics, comorbidities, medical and hospital factors and treatments in two groups. These differences in medical and hospital factors may display discrepancies by type of insurance in the delivery of services, especially in chronic healthcare services.

scholarly journals Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria

2019 ◽  
Vol 19 (3) ◽  
pp. 2356-2364
Author(s):  
Roland Nnaemeka Okoro ◽  
Chijioke Nmeka ◽  
Patrick O Erah
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Tertiary Hospital ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Amoxicillin Clavulanate ◽  
One Year

Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS).Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions.Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure.Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.Keywords: Antibiotics; national health insurance scheme; Nigeria; poly-pharmacy; prescription.

Predisposing Factors of the Head of Family with Bali ID Card to Join the National Health Insurance (JKN) Program: A Qualitative Study in Health Centre I North Denpasar

2016 ◽  
pp. 59
Author(s):  
Cokorda Istri Mita Pemayun ◽  
P.P. Januraga ◽  
N.M. Ayu Sri Ratna Sudewi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Central Government ◽  
Health Centre ◽  
Health Financing ◽  
Predisposing Factors ◽  
Local Health ◽  
Class Iii ◽  
The Government

Background and purpose: Since 2010, The Government of Bali has implemented local health financing (JKBM) to provide free health care services for Bali’s citizen, meanwhile, since 2014 the central government has started to implement the National Health Insurance program (JKN) based on participant’s monthly contribution. Although JKBM still available until 2017, there is a phenomenon of people who have Bali ID card turned into JKN. This article explores predisposing factors of the family head with Bali ID cards so that they switched into JKN scheme with relatively the same medical services and facilities.Methods: Interviews were conducted with purposively selected participants through the exit interview by using in-depth interview guide to 13 participants of JKN, three region leaders, three participants of JKBM and one public health central officer. Data were analyzed thematically and presented in a narrative form.Results: The interviews showed that participants who switched to JKN are concerned with sustainability and the quality of services in JKBM program. Participants perceived high vulnerability to disease from previous experience using JKBM program.Conclusion: Based on the consideration of participants to switch the membership becoming independent JKN Class III, it can be recommended improve the cooperation among stakeholders to enhance the socialization of JKN especially through the involvement of listed participants who already used JKN program.

scholarly journals Factors Of National Health Insurance, Factors Of Health Service And Factors Of Social Security Administrator Influence On The Satisfaction Of Independent BPJS Class One At Kertha Usada General Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 508-515
Author(s):  
Aditha Angga Pratama
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health ◽  
Universal Coverage ◽  
Simple Random Sampling ◽  
Dominant Factor ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional

Since 2004 Indonesia has campaigned for universal coverage as one of the improvements in health status. But until now there are still many Health insurance organizer (BPJS) participants who feel unsatisfied with the services they get, especially when Health insurance organizer participants are self-employed in class I inpatient services. The goal of this study is to identify the most dominant factor that can affect the satisfaction of Health insurance organizer participants' services in Kertha Usadha. The cross sectional survey research was conducted on 104 class 1 independent Health insurance organizer participants by simple random sampling. The selected Health insurance organizer participants were interviewed while in a state of hospitalization that was adjusted to the inclusion criteria of this study. The instrument used a structured questionnaire, with several related variables: characteristics, National Health Insurance factors, Health insurance organizer and health services. Variables were analyzed using Chi Square and then Logistic Regression with software. The results of this study found that 54.8% of B Health insurance organizer participants were satisfied with the services provided. While the results of multivariate analysis found that the factors influencing the satisfaction of Health insurance organizer participants were the National Health Insurance Factors that were good to moderate services (AOR: 1.2, 95% CI 0.8-1.43), good to less services (AOR: 3.4, 95% CI 1.5-7.53) and health service factors (AOR: 9.6, 95% CI 2.37-39.3). Health insurance organizer participant satisfaction is still low so it needs improvement in everything. So that later with increased satisfaction can improve the degree of public health

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