scholarly journals RECONSTRUCTION NATIONAL SOCIAL SATISFACTION SYSTEM FOR HEALTH FIELD IN THE AUTONOMY REGION WITH VALUE OF WELFARE

2018 ◽  
Vol 1 (1) ◽  
pp. 101
Author(s):  
Gunarto Gunarto
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Government Regulation ◽  
Health Sector ◽  
Social Security System ◽  
Security System ◽  
Research Approach ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

Objectives to be achieved in this research To understand and analyze the National Social Security System Construction of Health Sector in the current positive law, to understand and analyze the weaknesses of the National Social Security System in the Field of Health today and to analyze and reconstruct the National Social Security System for Health Based on the value of welfare Research is expected to have both theoretical and practical uses that researchers use is socio legal research, this research approach is chosen to see how far the effectiveness of law in the prosperity of the community especially in health insurance coverage, here the law is not only seen in terms of its effectiveness but Also related to non-legal factors such as institutions related to the welfare of the community. The Legal System of the Health Insurance Program with the participation of BPJS is still very weak both in terms of the legal substance component, in providing equitable welfare in obtaining health services through the Health Insurance Program with. Strengthening Components of Legal Substances by changing Article 39 Paragraphs (1), (3) and (4) of Presidential Regulation No. 12 of 2013, Strengthening Legal Structure Components by Strengthening FKTP I on the regulation of Government Regulation, Strengthening Legal Culture Component by developing Culture of community law through continuous education to the community so that the community, the Government is not responsible for providing funds for Beneficiaries of Contribution (PBI).

PERLINDUNGAN HUKUM BAGI RSUD DR. MOEWARDI SURAKARTA TERHADAP KETERLAMBATAN PEMBAYARAN KLAIM OLEH BPJS KESEHATAN

2020 ◽  
Vol 8 (1) ◽  
pp. 42
Author(s):  
Asna Zamharira ◽  
Arief Suryono
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Research Method ◽  
Legal Protection ◽  
Secondary Data ◽  
Primary Data ◽  
Cooperation Agreement ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

<p>Abstract<br />This articles aims to find out how legal protection for health facilities is towards late payment of claims by BPJS Health. The research method used in writing this law is a normative juridical research method that is research that uses secondary data or literature that is supported by primary data in the field as supporting data. Analysis of data using qualitative analysis. The results of the study revealed that health services in implementing the Health Insurance program between RSUD Dr. Moewardi Surakarta with BPJS Health is based on a collaboration agreement between RSUD Dr. Moewardi Surakarta with BPJS Kesehatan about Advanced Level Referral Health Services for Participants in the Health Insurance Program, one of which is the contents of a cooperation agreement regarding the payment system of claims. The claim system is carried out by referring to the agreement. In the system of claims there were still obstacles that is the delay in the payment of claims by BPJS Kesehatan to the hospital. As a form of legal protection, to resolve the problem of late payment of claims made in accordance with the cooperation agreement and Perpres No. 82 Tahun 2018 concerning Health Insurance. The Government and BPJS Kesehatan are expected to be able to make claims payments in accordance with the terms or agreed cooperation agreements.<br />Keywords: Cooperation agreement; Claim; BPJS Kesehatan; Hospital.</p><p>Abstrak<br />Artikel ini bertujuan untuk mengetahui bagaimana perlindungan hukum bagi fasilitas kesehatan tehadap keterlambatan pembayaran klaim oleh BPJS Kesehatan. Metode penelitian yang digunakan dalam penulisan hukum ini adalah metode penelitian yuridis normatif yaitu penelitian yang menggunakan bahan-bahan hukum sekunder atau kepustakaan yang ditunjang dengan data primer di lapangan sebagai data pendukung. Data diolah dan dianalisis secara kualitatif. Hasil penelitian diketahui bahwa pelayanan kesehatan dalam melaksanakan program Jaminan Kesehatan antara RSUD DR. Moewardi  Surakarta dengan BPJS Kesehatan didasarkan pada perjanjian kejasama antara RSUD Dr. Moewardi Surakarta dengan BPJS Kesehatan tentang Pelayanan Kesehatan Rujukan Tingkat Lanjutan bagi Peserta Program Jaminan Kesehatan yang salah satu isi perjanjiannya mengenai sistem pembayaran klaim. Sistem pembayaran klaim dilakukan dengan berpedoman pada perjanjian kerjasama. Dalam sistem klaim masih ditemui hambatan yaitu terjadinya keterlambatan pembayaran klaim oleh BPJS Kesehatan kepada rumah sakit. Sebagai bentuk perlindungan hukum, untuk penyelesaian permasalahan keterlambatan pembayaran klaim dilakukan sesuai dengan perjanjian kerjasama dan Perpres No. 82 Tahun 2018 tentang Jaminan Kesehatan. Pemerintah dan BPJS Kesehatan diharapkan dapat melaksanan pembayaran klaim sesuai dengan ketentuan atau perjanjian kerjasama yang telah disepakati.<br />Kata Kunci: Perjanjian Kerjasam; Klaim; BPJS Kesehatan; Rumah Sakit.</p>

scholarly journals Legal Issues in The Implementation of National Social Security System on Labour in Indonesia

2018 ◽  
Vol 54 ◽  
pp. 03019
Author(s):  
Tedi Sudrajat ◽  
Siti Kunarti ◽  
Abdul Aziz Nasihuddin
Keyword(s):  
Social Security ◽  
Social Insurance ◽  
Health And Safety ◽  
Legal Protection ◽  
Social Security System ◽  
Security System ◽  
Safety Assurance ◽  
The Social ◽  
The Government ◽  
Social Security Benefits

The Social Security System in Indonesia has been regulated by the government, and the program is managed by an agency called Social Insurance Administration Organization (BPJS). Associated with the existence of social security functions for workers, its practice presents a gap between what is expected and what is regulated. For this reason, it is therefore necessary to examine, firstly, what kind of legal protection of workers is covered by this national social security system managed in BPJS program and, secondly, what constraints are encountered in its implementation. This research is Juridical Normative one, with normative qualitative data analysis. The research finds that the social security is correlated not only with the welfare of employees who are assessed by the level of wages provided by the organization, rather it is also correlated with other factors in the form of health and safety assurance. In the broader context, social welfare is measured not only when the person is at work and gets social security benefits, rather the measure of his welfare is also applicable when the worker is not working and/or when they retire. On the basis of these, the social security program is an integral aspect of social security to which the government should give a legal protection.

scholarly journals The Law Enforcement Of The Employees Social Security System In Indonesia: A Game Theory Perspective

2019 ◽  
Vol 2 (2) ◽  
pp. 165-174
Author(s):  
Randy Amsyari ◽  
Fajrin Satria Dwi Kesumah
Keyword(s):  
Game Theory ◽  
Nash Equilibrium ◽  
Law Enforcement ◽  
Social Security ◽  
Social Security System ◽  
Security System ◽  
The Other ◽  
Subgame Perfection ◽  
The Law ◽  
The Government

Insurance for the workers means a guarantee of safety for their works on the workplaces. It is necessarily crucial as workers need such a policy that can protect them from the loss. Indonesian government declare a policy that enact the act about National Social Security System (SJSN). The companies are the subject of this regulation, despite the fact at the initial implementation of this law enforcement brought to the pros and cons. Hence, the regulation also regulates for those who betray the policy will have to pay some certain amount of fine which in turn can harden them. The companies on the other side have a choice either to register or not their workers to SJSN as they still consider the premium they have to pay. This study aims to analyze the payoffs for both government and companies to be better off from the law enforcement. Game theory perspective is applied for the methodology of the study, particularly Subgame Perfection Nash Equilibrium (SPNE) and Bayesian Nash Equilibrium (BNE). The results present that in condition of an effective law enforcement at p, the firms will be beneficial from the SJSN policy by registering their workers and pay the premium, because if they do not pay the premium they have to pay additional amount of fine. On the other hand, if the policy is not effective with 1-p, the firms will have an advantage by not registering their employees to the SJSN as the law enforcement is not effective. Also, the government does not necessarily conduct an investigation as the cost is higher than the return that they will get.

scholarly journals Medico-economic impact of enhanced rehabilitation after surgery: an exhaustive, nation-wide claims study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frédéric Bizard ◽  
Thierry Boudemaghe ◽  
Laurent Delaunay ◽  
Lucas Léger ◽  
Karem Slim
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Cost Reduction ◽  
Average Length ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Social ◽  
The Mean ◽  
Medico Economic ◽  
The Cost

Abstract Background Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. Methods Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. Results The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million). Conclusions Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.

Effect of Health Insurance Program in Social Security in Kailali District, Nepal

2020 ◽  
Vol 4 (3) ◽  
pp. 01-05
Author(s):  
Saraswati Kumari Joshi ◽  
Durga Kumari Joshi ◽  
Sita Kumari Joshi ◽  
Nisha Adhikari ◽  
Shristi Joshi ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Insurance Program ◽  
Health Insurance Program

Long-term sickness and invalidity benefits: Forecasting and other actuarial problems

1987 ◽  
Vol 114 (3) ◽  
pp. 467-550 ◽  
Author(s):  
S. Haberman
Keyword(s):  
Social Security ◽  
Social Security System ◽  
Security System ◽  
Social Security Systems ◽  
Security Systems ◽  
Insurance Benefit ◽  
Disability Claim ◽  
The Government ◽  
The Uk

It is proposed to discuss the actuarial problems associated with the management of long-term sickness and invalidity benefits. The emphasis is on benefits provided by social security schemes (with particular reference to National Insurance benefit in the UK), but the main points are relevant to private sector benefits including permanent health insurance (PHI).The plan of the paper is as follows. We describe in Section 2 the nature of long-term invalidity benefit provided by the British social security system and then consider in Section 3 the problems associated with defining disability. A discussion of the differences between the incidence of morbidity and the making of an insurance claim leads to consideration of selection and moral hazard (Section 4). We then examine in Section 5 the methodology for analysing costs and estimating future costs with particular reference to the development within the Government Actuary's Department (GAD) of a model based on an incidence and survivorship approach to invalidity benefit and the debate aroused by CMI Report No. 7 on the same topic5. The paper then presents an analysis of recent trends in disability claim rates (Section 6) and incidence and termination rates (Sections 7 and 8) based on invalidity benefit within the British social security system, as well as PHI and the experience of other countries. Attempts are then made in Section 9 to explain these trends and the upward trend in financial costs for disability benefits experienced by many social security systems. The paper concludes with an examination of two areas of current interest, viz. sex differences in morbidity rates and claim rates (Section 10) and the relationship between claim rates and the prevailing level of unemployment (Section 11).

Proficiency of Personnel: Key to Effective and Efficient Procurement

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Razel P. Tayo
Keyword(s):  
Social Security ◽  
Data Gathering ◽  
Secondary Data ◽  
Social Security System ◽  
Structured Interview ◽  
Government Procurement ◽  
Security System ◽  
Primary Data ◽  
Procurement Reform ◽  
The Government

Effective and efficient procurement system results in the best value for money and transparency. The study assessed the adherence of the Northern Mindanao Division of Social Security System to procurement policies provided in Republic Act No. 9184 – The Government Procurement Reform Act (GPRA) and its revised Implementing Rules and Regulation. Specifically, this answered the query on how adherent is the procurement procedure of Northern Mindanao Division of Social Security System to procurement policies. The study employed a descriptive research design utilizing a combination of document analysis, observation, and interview as data gathering tools. The data were obtained using a researcher-made checklist designed to assess adherence to procurement policies and analyzed using a descriptive statistics. Primary data were validated through a semi-structured interview and triangulated through observation or from available secondary data. Results showed the respondents were not fully adherent because of the inadequacy of technical expertise. There were areas of its existing procurement processes that needed to be corrected or re-engineered. Among the salient areas that should be improved are the professionalizing of all procurement personnel and amending its internal rules and policies to come-up with adherent, modernized, standardized and regulated procurement activities that are compliant with the core principles anchored by GPRA, namely: transparency, accountability, equity, efficiency and economy. Keywords - Social Science, procurement, Government Procurement Reform Act (GPRA), Shopping, Small Value Procurement, PhilGEPS, descriptive design, Philippines

scholarly journals Analysis of The Implementation of The Health Insurance System in Indonesia

2021 ◽  
Author(s):  
S.H. Budiarsih
Keyword(s):  
Social Security ◽  
Social Security System ◽  
Patent Law ◽  
Living Environment ◽  
The State ◽  
Security System ◽  
The People ◽  
Pros And Cons ◽  
The Government ◽  
The Right

The state constitution of the 1945 Constitution mentioned that everyone has the right to live a prosperous life born and inward, residing, and getting a healthy and healthy living environment and entitled to health services. Under the Constitution and the Act, the Government makes efforts to ensure poor people's access to health service. However, in its implementation, various problems cause pros and cons, especially related to financing mechanisms and systems. Although, the birth of the BPJS Law is certainly inseparable from the patent law, namely Law number 40 of 2004 concerning the National Social Security System. For efforts to fulfill the rights of the community in the field of health that cannot be fully accommodated by the state, the government should evaluate the BPJS Law and Law No. 40 of 2004 on the National Social security system. The two laws currently implemented should be based on the 1945 Constitution and not harm the people

scholarly journals Catastrophic Health Expenditure: An Experience from Health Insurance Program in Nepal

2019 ◽  
Vol 3 (5) ◽  
pp. 327-336 ◽  
Author(s):  
Deepak Raj Paudel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Expenditure ◽  
Health Care Expenditure ◽  
Catastrophic Health Expenditure ◽  
Health Concern ◽  
Government Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

High expenditure due to health care is a noted public health concern in Nepal and such expenditure is expected to reduce through the access to health insurance. This study determines the factors affecting household’s catastrophic health care expenditure in Kailali district, where the government health insurance program was first piloted in Nepal. A cross-sectional survey was conducted from January to February 2018 among 1048 households (6480 individuals) after 21 months of the execution of the social health insurance program.  For the sample selection, wards were selected in the first stage followed by the selection of the households. Overall, 17.8% of the households reported catastrophic health expenditure using a threshold of more than 10% of out-of-pocket payment to total household expenditure. The study found that households without having health insurance, low economic status, and head with low level of education were more likely to face catastrophic spending. The findings suggest a policy guideline in the ongoing national health insurance debate in Nepal. The government health insurance program is currently at expansion stage, so, increase in insurance coverage, could financially help vulnerable households by reducing catastrophic health expenditure.

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