scholarly journals Factors Affecting Work Performance among Nurses in Delivering Health Service for the National Health Insurance Patients at Dr. Moewardi Hospital, Surakarta

2018 ◽  
Vol 3 (1) ◽  
pp. 20-25
Author(s):  
Nureesa Doloh ◽  
◽  
Didik Tamtomo ◽  
Endang Sutisna Sulaeman ◽  
◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health ◽  
Work Performance ◽  
Factors Affecting

FACTORS AFFECTING DELAYINGPAYMENT OF NATIONAL HEALTH INSURANCE (BPJS KESEHATAN)PREMIUM AMONG PARTICIPANTS OF THE INFORMAL SECTOR IN BANYUMAS REGENCY

2019 ◽  
Vol 22 (11) ◽  
pp. 485-491
Author(s):  
Arih Diyaning Intiasari ◽  
Budi Aji ◽  
Siti Masfiah ◽  
Laksono Trisnantoro ◽  
Julita Hendrartini
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
Informal Sector ◽  
National Health ◽  
Factors Affecting

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.

scholarly journals Penganggaran dan Penerimaan Dana Kapitasi Program JKN di Daerah Terpencil Kabupaten Kepulauan Mentawai

2018 ◽  
pp. 92-101
Author(s):  
Desi Fitria Neti ◽  
Lukman Waris ◽  
Anni Yulianti
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Health Workers ◽  
National Health Insurance Program ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Right

Abstrak Program Jaminan Kesehatan Nasional (JKN) dilaksanakan atas hak setiap warga negara memperoleh layanan kesehatan, baik yang bertempat tinggal di perkotaan maupun di perdesaan termasuk di daerah terpencil perbatasan kepulauan. Pelaksana program JKN dilaksanakan oleh unit pelayanan kesehatan mulai dari pelayanan kesehatan di puskesmas sampai dengan pelayanan kesehatan rujukan di rumah sakit dengan pembayaran yang dilakukan oleh Badan Pelaksana Jaminan Sosial Kesehatan (BPJS) kepada unit pelaksana pelayanan kesehatan dengan mekanisme transfer berdasarkan sistem dana kapitasi. Penelitian ini bertujuan untuk mendeskripsikan dan menganalisis pelaksanaan penganggaran dan penerimaan dana kapitasi tenaga kesehatan program jaminan kesehatan nasional di daerah terpencil Puskesmas Mapaddegat Kabupaten Kepulauan Mentawai dengan mengunakan metode kualitatif. Pengumpulan informasi melalui observasi wawancara mendalam terhadap informan dan informan kunci dan Dokumentasi. Penelitian dilaksanakan bulan januari s/d juni 2017. Hasil penelitian menggambarkan bahwa pelaksanaan penganggaran dan penerima dana kapitasi tenaga kesehatan pada tahun 2014-2015 belum berjalan sesuai ketentuan pembayaran, tahun 2016 masih ditemukan permasalahan pembayaran norma kapitasi oleh BPJS Kesehatan sudah normatif namun belum sesuai dengan jumlah peserta yang terdaftar. Tahun 2017 penerimaan dana kapitasi sudah berjalan lebih baik dibuktikan dengan telah teradministrasi dan terdokumentasi semua bentuk pemanfaatan dan realisasi belanja pencairan dana kapitasi untuk seluruh petugas di puskesmas dan jaringannya. Kata kunci: Tenaga kesehatan, penganggaran, penerimaan dana kapitasi dan program JKN. Abstract The National Health Insurance Program (JKN) is implemented on the right of every citizen to receive health services in both urban and rural areas, including in remote border areas of the island. Implementing the JKN program is implemented by health care unit starting from health service at puskesmas to referral health service in hospital with payment made by BPJS to health service implementation unit with transfer mechanism based on capitation fund system. This study aims to describe and analyze the implementation of budgeting and receiving capitation funds health workers national health insurance program in remote areas Mapaddegat Puskesmas Mentawai Islands by using qualitative methods. Information gathering through in-depth interview observation of key informants and informants and Documentation. The study was conducted from January to June 2017. The results of this study illustrate that the implementation of budgeting and recipients of capitation funds of health personnel in 2014-2015 has not run according to payment terms, in 2016 still found the problem of payment of capitation norms by BPJS Health has been normative but not in accordance with number of registered participants according to the provisions. In 2017, the capitation of the capitation funds has been better implemented as proven by the administration and documentation of all forms of utilization and realization of capitation fund disbursement expenditure for all officers at the puskesmas and its network. Keywords: Health Manpower, policy, budgeting, admission of capitation funds and Health Insurance Program.

scholarly journals Analysis of Health Service Payment Utilization in National Health Insurance (JKN) by Premium-Aid-Recipient (PBI) Insurers

2018 ◽  
Vol 7 (1) ◽  
pp. 62-69
Author(s):  
Rian Arie Gustaman ◽  
Kamiel Roesman Bachtiar
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health

Abstrak Salah satu temuan dalam evaluasi pelaksanaan Jaminan Kesehatan Nasional (JKN) pada 2 tahun pertama adalah tingginya rasio klaim pada pelayanan rawat jalan tingkat lanjutan pada Fasilitas Kesehatan Tingkat Lanjutan (FKTL). Biaya pelayanan kesehatan rill per jiwa pada peserta Non PBI Mandiri adalah sebesar Rp282.139,00 jauh lebih besar dari rata - rata besaran Per Orang Per bulan sebesar Rp27.062,00. Rasio klaim pada pool Non PBI Mandiri adalah sebesar 1380%. Ini berbanding terbalik dengan peserta PBI yang pemanfaatan yankes masih jauh di bawah yang seharusnya dengan rasio klaim yang sangat rendah. Tujuan khusus dari penelitian ini adalah menganalisis pola pemanfaatan jaminan pembiayaan kesehatan era JKN pada peserta PBI untuk mengetahui gambaran   determinan   yang   mempengaruhinya dan   menghasilkan   rekomendasi terhadap perbaikan kebijakan pembiayaan kesehatan masyarakat sektor informal non miskin dan miskin yang diharapkan dapat mendukung upaya perluasan kepesertaan menuju kesehatan masyarakat semesta. Penelitian ini menggunakan penelitian pendekatan kualitatif. Hasil penelitian menunjukkan bahwa pengetahuan mengenai gambaran peresepsi masyarakat tentang program JKN dipengaruhi oleh tingkat pendidikan partisipan, keaktifan partisipan dalam mengikuti organisasi, serta adanya tindakan penyuluhan mengenai program JKN.

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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