scholarly journals Analisis Peran Pemerintah Daerah terhadap Ketersediaan Fasilitas Kesehatan pada Pelaksanaan Jaminan Kesehatan Nasional di Provinsi Bengkulu

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Yandrizal Yandrizal ◽  
Desri Suryani
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Local Governments ◽  
Access To Health Care ◽  
Health Facilities ◽  
Health Centers ◽  
Quality Health ◽  
Motorcycle Taxi

AbstrakProgram Jaminan Kesehatan Nasional bertujuan mempermudah masyarakat untuk mengakses pelayanan kesehatan yang bermutu. Bagaimana ketersediaan fasilitas kesehatan, maka perlu dilakukan analisis peran pemerintah daerah terhadap ketersediaan fasilitas kesehatan. Metode penelitian ini adalah analisis formatif yaitu bertujuan menilai peran pemerintah daerah terhadap kebijakan yang sedang dilaksanakan, dan bagaimana pemikiran memodifikasi untuk pengembangan sehingga membawa perbaikan. Hasil yang didapat ialah pada pertengahan tahun 2014 Fasilitas Kesehatan Tingkat Pertama (FKTP) yang bekerja sama dengan Badan Penyelenggara Jaminan Sosial (BPJS) kesehatan sebanyak 229 unit, masih kurang sebanyak 361 unit untuk mencapai kebutuhan tahun 2019. Akses ke pelayanan kesehatan sebagaian masyarakat masih menjadi kendala geografis, waktu paling lama dari menuju puskesmas 90 sd 120 menit, biaya Rp. 200.000,- menggunakan ojek. Rasio fasilitas pelayaan rujukan tertinggi di Kota Bengkulu 1,88 per 100.000 penduduk dan terendah Kabupaten Rejang Lebong 0,40 per 100.000. Ratio dokter spesialis tertinggi 3.61 per 100.000 penduduk dengan rerata biaya rawat inap Rp. 3.595.000,- per pasien, terendah 0,55 per 100.000 pendudukan dengan rerata biaya rawat inap Rp.1.000.000,-. Pemenuhan tenaga terutama dokter umum, dokter gigi di puskesmas sulit terwujud mengingat formasi CPNS sangat kecil. Apabila dilakukan kontrak, Pemerintah Kabupaten/kota tidak mampu.Kata Kunci: kebijakan pemerintah daerah, fasilitas kesehatan, kebijakan jaminan kesehatan nasional.AbstractThe National Health Insurance Scheme aims to facilitate the public's access to quality health services. How does the availability of health facilities, it is necessary to analyze the role of local governments on the availability of health facilities. Methods: formative analysis, assessing the role of local governments on the policies that are being implemented, and how to modify the thinking for development so as to bring improvement. Results: Mid-2014 FKTP in collaboration with the Social Security Agency (BPJS) health as much as 229 units, 361 units are still lacking to achieve the requirements in 2019. Access to health care is still a society in part to geographical constraints, the longest time of the leading health centers 90 up to 120 minutes, costs IDR. 200.000, - use a motorcycle taxi. The ratio of the highest referral ministry facility in the city of Bengkulu 1.88 per 100,000 population, and the lowest Rejang Lebong 0.40 per 100,000. The highest ratio of specialists per 100,000 population is 3.61 with an average cost of hospitalization IDR. 3.595.000,- per patient, the lowest of 0.55 per 100,000 of the occupation with an average hospitalization cost IDR 1.000.000,-. Fulfillment power especially general practitioners, dentists at health centers employess difficult to achieve given the very small formations, if the contract is done district/city can not afford.Keywords: role of local government, availability of health facilities, the national health insurance policy

Cases of Dispute and Pending Claims in Hospitals in the Era of National Health Insurance

2022 ◽  
Vol 2 (1) ◽  
pp. 32-38
Author(s):  
Mrs. Yastori
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance System ◽  
Quality Health ◽  
Icd 10 ◽  
Data Collection Technique ◽  
Observation Method

Background: Indonesia began to implement a National Health Insurance System based on the National Social Security System in 2014 with the support of government regulations which states that Indonesia requires every citizen to have access to comprehensive and quality health services so that can continue their life through the National Health Insurance. Pending and dispute claims are problems that often occur in the era of national health insurance that can affect hospital budget allocation and planning policies, increasing the high cost burden for hospitals which will affect the quality of health services provided. The purpose of this study was to determine pending cases and dispute claims in hospitals in the Era of National Health Insurance.Methods: The study used a descriptive method with a qualitative approach. The data collection technique used is the observation method, namely directly to the e-claim file at several hospitals. 15 e-claim files taken in total from April – July 2021.Results: Obtained 13 cases of pending claims and 2 cases of dispute claims. Cases pending claims are caused by not complying with the code with evidence or resources, not in accordance with medical clinical practice guidelines and the rules of the health insurance provider.Conclusions: In coding, it is necessary to match the theory on the ICD-10, update the ICD-10. It is necessary to understand the rules and provisions made by the insurer and the related guidelines and rules. Please be aware of every latest code update.

scholarly journals DRUG COST ANALYSIS ON NATIONAL HEALTH INSURANCE ERA IN HEALTH SUPPORT FACILITIES

2017 ◽  
Vol 10 (2) ◽  
pp. 119
Author(s):  
Satibi Satibi ◽  
Dewa Ayu Putu Satrya Dewi ◽  
Atika Dalili Akhmad ◽  
Novita Kaswindiarti ◽  
Dyah Ayu Puspandari
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
Drug Cost ◽  
National Health ◽  
Health Facilities ◽  
Drug Costs ◽  
Average Percentage ◽  
Primary Health

Objective: In national health insurance (JKN) era, pharmacy can play roles in the form of behind refer pharmacies, or networking pharmacy and clinic pharmacy pratama. Behind refer pharmacies drug cost can be claimed directly to BPJS, meanwhile for the other type of pharmacy have to negotiation first with the primary health care. Drug cost variations in the JKN era affect the profitability of the business pharmacies. This research aims to the drug percentage charges against capitation and variety of drug costs.Methods: This research is analytic observational cross-sectional. This research uses secondary data from a JKN prescription patient. This research was conducted on 6 affiliated pharmacies, 6 networking pharmacies, and 7 clinical pharmacy pratama in DIY. The sampling in this research is by purposive with 8.430 prescriptions. Data drug costs JKN era was analyzed by descriptive statistics and comparative test (Kruskal Wallis test).Results: The result showed that average percentage of drug costs for capitation fee in the networking pharmacy is 13.58% and primary health care is 15.91%. Pharmacy in JKN era has drug cost variations (p=0.000). Drug cost in JKN era depends on the pattern of play roles with the health facilities and BPJS. The average percentage of drug costs against capitation health facilities in networking pharmacy is lower than clinical pharmacy pratama.Conclusions: Drug costs in an era of JKN depending on the pattern of cooperation with health facilities pharmacies and BPJS. The average percentage of the cost of drugs to the pharmacy capitation health facilities in networking lower than clinic pharmacy pratama. Differences in drug costs JKN era influenced by the long days of drug administration, the number of prescription sheets, margin.Keywords: Drug cost analysis, National health insurance (JKN), Pharmacy, Primary health care, Capitation.

scholarly journals BACK-REFERRAL PROGRAM IN THE ERA OF NATIONAL HEALTH INSURANCE AT BALUNG DISTRICT GENERAL HOSPITAL OF JEMBER IN 2017

2019 ◽  
Vol 7 (1) ◽  
pp. 33
Author(s):  
Christyana Sandra
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
General Hospital ◽  
National Health Insurance ◽  
National Health ◽  
Access To Health Care ◽  
Neurological Diseases ◽  
District General Hospital ◽  
Stable Conditions ◽  
Number Of Patients

Background: In 2014, National Health Insurance Program (BPJS Kesehatan) implemented Back-Referral Program (BRP) to facilitate access to health care for patients with chronic diseases in stable conditions. However, the program did not run well at District General Hospital of Balung which had the lowest back-referral program (6 participants) in 2015-2016.Aim: The study aims to examine the BRP at Balung District General Hospital of Jember in 2017.Methods: This study is designed as qualitative case study. The informants consisted of head of treasury verification, secretary of JKN service controlling, officers of local government’s free care scheme, coordinator of internal and neurological disease, specialists in internal and neurological diseases, officers of Social Security Agency for Health, officers of patient eligibility verification, and participants of Back-Referral Program. The study was conducted from October to December 2017.Results: Results show that the attendance of BPJS Kesehatan officers has no contribution to the services of BPJS Kesehatan in the hospital. Participants also find it difficult to follow the steps of BRP due to unavailability of drugs at primary healthcare centers. Moreover, neurologists have not written any referral recommendation since 2016, so there was no patient admittance.Conclusions: The BRP at Balung District General Hospital did not achieve its target (<5 cases/week). In the contrary, the average number of patients referred to the hospital was 86 patients per week. Balung District General Hospital should implement Standard Operating Procedure for letters signed by responsible physician for patients and evaluate the BRP. Keywords: National Health Insurance, Back-referral program, Hospital, Social security.

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