scholarly journals BPJS Kesehatan dalam Perspektif Hukum Islam (Studi Fatwa Majelis Ulama Indonesia dan Fatwa Nahdlatul Ulama)

2018 ◽  
pp. 141
Author(s):  
Mughni Labib
Keyword(s):  
Health Insurance ◽  
Qualitative Study ◽  
Social Security ◽  
National Health Insurance ◽  
Islamic Law ◽  
Formal Aspect ◽  
Islamic Jurisprudence ◽  
Nahdlatul Ulama ◽  
Sociological Approaches ◽  
Social Security Agency

This paper elaborates the fatwa of the Healthcare and Social Security Agency (BPJS Kesehatan) issued by the Indonesian Ulema Council (MUI) and Nahdlatul Ulama (NU), Indonesia’s largest Muslim organization. The MUI and NU declared their own fatwa on BPJS Kesehatan. The MUI labeled that BPJS Kesehatan contravened Islamic law, whereas the NU promoted that the national health insurance aligns with the law. These two fatwas trigger polemic in the country. A qualitative study was designed by employing usul al-fiqh (Islamic jurisprudence) and sociological approaches. The study used documentation and interviews to collect data concerning the MUI and NU fatwas on BPJS Kesehatan. The interactive model of Miles & Huberman was adopted to analyze the data. The results reveal that the issuance of the MUI and NU contradictory fatwas against BPJS Kesehatan was due to the use of different Islamic sources (dalil) and overlooks in drafting the edicts. The MUI emphasized more on several elements involved in the health insurance that were inconsistent with sharia law such as riba (interest), gharar (uncertainty), and maisir (gambling). Conversely, the NU highlighted a formal aspect stipulating that BPJS Kesehatan represented a social agency that benefited lots of people. This study also points out that some factors causing the variety of fatwas on BPJS Kesehatan between the MUI and NU covered the understanding and application of the dalil in relation to the edict formulation and the influence of socio-political atmospheres at the time of fatwa issuance.

scholarly journals Revealing the Legal Protection of Patients Social Security Administration Agency of Health in Sanglah and Balimed Hospitals Denpasar

2020 ◽  
Vol 7 (2) ◽  
pp. 102-110
Author(s):  
RA Tuty Kuswardhani ◽  
I Nyoman Budiana
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Legal Protection ◽  
The Elderly ◽  
National Formulary ◽  
Social Security Administration ◽  
Curative Therapy ◽  
The Social

Social Security Administration Agency of Health has a National National Health Insurance formulary, but in reality patients do not get drugs according to the National Health Insurance National Formulary. Therefore, the aims of this study are to determine the legal protection of patients of the Social Security Administration Agency of Health for the elderly in curative therapy in hospitals according to the national formulary of National Health Insurance at Sanglah Hospital and Balimed Hospital, and to know the responsibilities undertaken by the Social Security Administration Agency of Health in fulfilling its obligations for patients the Agency for the Implementation of the Social Health Insurance of the elderly in curative therapy in accordance with the national formulary of the National Health Insurance. This study uses a participatory observational (empirical-observational) empirical legal research method. Sampling with purposive sampling and data collection techniques using triangulation techniques. In principle, legal protection must refer to legal certainty, fairness and benefits for the population participating in the Social Security Administration Agency of Health for the elderly so that it is not impressed that Balimed Hospital and Sanglah General Hospital and the Social Security Administration Agency of Health make a service to consumers who are not good. The legal responsibility that should be obtained by the participants of the Social Security Administration Agency of Health for the elderly in Balimed Hospital and Sanglah Hospital Denpasar which is currently not maximally received by patients participating in the Social Security Administration Agency of Health for the elderly at Balimed Hospital and Sanglah Hospital.

scholarly journals Upaya Pencegahan Perbedaan Diagnosis Klinis Dan Diagnosis Asuransi Dengan Diberlakukan Program Jaminan Kesehatan Nasional (JKN) Dalam Pelayanan Bpjs Kesehatan Studi Di Rsud Kota Semarang

2016 ◽  
Vol 4 (2) ◽  
pp. 84-90
Author(s):  
Faik Agiwahyuanto ◽  
Sudiro Sudiro ◽  
Inge Hartini
Keyword(s):  
Qualitative Study ◽  
Social Security ◽  
Medical Treatment ◽  
Emergency Room ◽  
Medical Record ◽  
Clinical Pathway ◽  
Public Hospital ◽  
Medical Service ◽  
Hospital Director ◽  
Social Security Agency

Percentage of clinical and insurance diagnosis differences at Semarang City Public Hospital tended to increase. If this condition remained, it would lead to upcoding (fraud). The aim of this study was to explain a process of clinical and insurance diagnosis at a hospital in the implementation of Healthcare and Social Security Agency (Health BPJS). This was a qualitative study. Main informants consisted of doctors at an emergency room, surgeons, and internists. Informants for triangulation purpose consisted of a Hospital Director, a hospital verifier, and a head of Medical Record Unit. Data were analysed using content analysis.The results of this research showed that there were any differences in clinical and insurance diagnosis at Semarang City Public Hospital. The cause of these differences was due to differences in diagnosis and medical treatment between medical service standard of doctors at the hospital and a standard of INA-CBGs. To prevent the differences of clinical and insurance diagnosis, the Semarang City Public Hospital had formed an internal verifier team of the hospital and a Clinical Micro System team. A medical committee had a role to minimise the occurrence of upcoding by multiplying kinds of Clinical Pathway as a reference for doctors in diagnosing and determining kinds of treatments for patients.The differences of clinical and insurance diagnosis must be equated to prevent the occurrence of upcoding and disadvantage of the hospital. Efforts to prevent these differences are by adding officers, training coding, making and multiplying algorithm of clinical pathway, forming a team of Clinical Micro System, and monitoring and evaluating medical services.

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.

scholarly journals International Constructions of Social Security and Public Health: Policy Intersections 1920–1970

Gesnerus ◽  
2017 ◽  
Vol 74 (2) ◽  
pp. 205-215
Author(s):  
James A. Gillespie
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Social Insurance ◽  
Early Years ◽  
Health Security ◽  
Global Health Policy ◽  
The Social

The problems of national health insurance played a prominent, but shifting role in the formation of global health policy. This paper uses the work of Geneva based organizations from the end of the First World War to the 1970s to explore the crossing points between health policy and social security. From its formation the League of Nations Health Organisation had an uneasy dialogue with the social insurance and security approaches adopted by the International Labour Organization and the International Social Security Association. When the social insurance concerns of the interwar year broadened into ‘social security’, largely led by the ILO, this debate spilled over into conflicts over the leadership of global social policy and carried over into the early years of WHO. Conflicts centred on the difficult relationship between national health insurance and the other elements of what became the welfare state. The paper identifies the difficulties of constructing a global policy space for action on health security.

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