HARMONISASI POLA PENGELOLAAN KEUANGAN FASKES DI LINGKUNGAN KEMENTERIAN PERTAHANAN DAN TNI DENGAN UU NO. 44 TAHUN 2009 tentang RUMAH SAKIT

2019 ◽  
Vol 19 (2) ◽  
pp. 182
Author(s):  
Sutarno Sutarno
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
Health Facility ◽  
Health Facilities ◽  
Fundamental Change ◽  
Legal Research ◽  
Legal Rules ◽  
The Social ◽  
The Government

<em>Since the enactment of Law Number 24 of 2011 concerning the Social Security Organizing Agency, there has been a very fundamental change in terms of Health Services. Health facilities within the Ministry of Defense and TNI which also affect budget governance. This legal research is a normative law with sources of primary and secondary legal materials that aim to review and analyze the legal rules regarding the management of income income received by Health Facilities within the Ministry of Defense and the TNI based on Law Number 44 of 2009; and reviewing and analyzing conflicting norms for the use of the TNI Health Facility as of the enactment of Law Number 24 of 2011 concerning the Health Insurance Administering Body. The results showed that the TNI Hospital which is a health facility owned by the Government should be subject to the rules contained in RI Law No. 44 of 2009 concerning Hospitals.</em>

scholarly journals TINJAUAN YURIDIS PERTANGGUNG JAWABAN RUMAH SAKIT ATAS KE IKUT SERTAAN DALAM PROGRAM BADAN PENYELENGGARA JAMINAN SOSIAL (BPJS) KESEHATAN

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Ariawan Gunadi ◽  
Ida Nursida
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Health Services ◽  
Social Security ◽  
Service Providers ◽  
Good Health ◽  
Active Role ◽  
Insurance Company ◽  
The Social ◽  
The Government

The Social Security Administering Body (BPJS) is a public legal entity formed to organize a social security program. Social Security Agency can alleviate the burden of society in obtaining health services in hospitals or clinics. This is in accordance with Article 5 Paragraph (1) and Paragraph (2) of Law No.36 Year 2009 on Health. and Article 47 Regulation of Health BPJS No.1 Year 2014 on the implementation of Health Insurance. As an insurance company BPJS health ensures the implementation of health programsHospitals and Clinics as health service providers in demand by the government to play an active role in providing good health services to the community according to its function, in accordance with Law Number 44 Year 2009 on Hospital. But even if the hospital or health service supports the social health insurance program or BPJS is proved by the poster that the Hospital or Clinic receive BPJS patients, does not mean that the service received by the community is in line with expectations.

scholarly journals SOSIALISASI PROBLEM SOLVING KLAIM BPJS DI RUMAH SAKIT

2021 ◽  
Vol 1 (1) ◽  
pp. 217-221
Author(s):  
Harris Rambey ◽  
Irmayani Irmayani ◽  
Delita Br Panjaitan ◽  
Arif Sudjatmiko
Keyword(s):  
Health Insurance ◽  
Problem Solving ◽  
Social Security ◽  
Welfare State ◽  
Monitoring Program ◽  
Public Welfare ◽  
Legal Research ◽  
Conceptual Approach ◽  
The Subject ◽  
The Government

Indonesia as a welfare state aims to realize public welfare. This underlies the development of social security by the Indonesian government, which one is through health insurance. In Practice, the goal of creating BPJS is not compatible with reality, provable by a wide variety of issues that are difficult to solve. One of them is the problem with the management of claims for the BPJS. As for the subject of this study is health insurance, specifically management claims. The study uses normative legal research methods to adopt a statute approach, a conceptual approach, and a case approach. Studies have shown that despite efforts by the government to address the problem, but those efforts didn’t work because of some inhibitory factors. Needed solutions to the formation and application of the IMP (Identity Monitoring Program) concept and it is integrated with Disduk Capil to BPJS. The concept of IMP’s implementation is expected to a minimized deficit on BPJS and solving gone of the causes problems is claim management.

scholarly journals Faktor yang Berpengaruh terhadap Pemanfaatan Fasilitas Pelayanan Kesehatan Swasta

2018 ◽  
pp. 87-94
Author(s):  
Selma Siahaan
Keyword(s):  
Health Insurance ◽  
Qualitative Study ◽  
Health Services ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Public And Private ◽  
Reinforcing Factors ◽  
Quality Health ◽  
The Government ◽  
Quality Health Services

Abstrak Studi terhadap faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta dengan analisis lanjut terhadap data Riskesdas 2013 diikuti oleh studi kualitatif yaitu wawancara mendalam terhadap pengguna layanan rawat jalan di 7 fasilitas pelayanan kesehatan swasta masing-masing 5 orang di Kota Tangerang. Tujuan studi ini adalah untuk mengetahui faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta. Kerangka konsep mengikuti kerangka Green L, yaitu melakukan penilaian terhadap faktor predisposing, enabling dan reinforcing. Hasilnya adalah faktor yang berpengaruh signifikan terhadap pemanfaatan fasyankes swasta adalah usia, pekerjaan, kepemilikan asuransi dan untuk penyakit TB paru, diabetes, hepatitis dan hipertensi. Hasil studi kualitatif memperlihatkan faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta tidak berbeda dengan hasil analisis lanjut, yaitu: jarak (akses) dan kepemilikan asuransi kesehatan. Studi ini merekomendasikan bahwa pemerintah perlu intens mendorong peningkatan kualitas fasyankes baik fasyankes pemerintah maupun swasta agar sama-sama memenuhi ekspektasi dan kebutuhan masyarakat dan juga pengaturan, distribusi dan pembinaan terhadap fasyankes swasta. Kata kunci: fasyankes, rawat jalan, asuransi kesehatan, Riskesdas 2013 Abstract It has been conducted study about factors influencing the utilization of private health facilities by further analyses towards Riskesdas 2013 data and followed by qualitative study i.e in-depth interviewed on outpatients in 7 private health care facilities that 5 people respectively in Tangerang city. The aim of this study was to find out factors that influence significantly to the utilization of private health services facilities. Conceptual framework followed Green L concept that is assessment to predisposing, enabling dan reinforcing factors. The results was that ages, occupation and having health insurance were factors that influencing significantly to th the utilization. In addition, TB pulmonary, diabetes, hepatitis and hypertension diseases was also significant. The qualitative study showed factors that influence the utilization of private health services facilities were not far different with the results of further study of Riskesdas 2013 i.e. access (distance) and having health insurance. This study recommended that government should push intensively the improvement of quality health services in public and private health facilities to fulfilled expectation and need of people. In addition, the Government should also continuing to regulate and to guidance private health facilities. Keywords: health services facilities, outpatients, health insurance, Riskesdas 2013

scholarly journals Consumer choice of health facility among the lowest socioeconomic group in newly established demand-side health-financing scheme in Khyber Pakhtunkhwa, Pakistan

2021 ◽  
Author(s):  
Sidra Malik ◽  
Naveed Sadiq ◽  
Saeed Anwar ◽  
Umair Qazi
Keyword(s):  
Health Services ◽  
Private Sector ◽  
Health Facility ◽  
Consumer Choice ◽  
Geographic Location ◽  
Health Facilities ◽  
Health Protection ◽  
Social Health ◽  
Socioeconomic Group ◽  
The Social

Background: The Social Health Protection Initiative was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage. Aims: To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in Social Health Protection Initiative. Methods: We used secondary data of availed health services from February 2016 to September 2017 under the Social Health Protection Initiative. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20. Results: Most beneficiaries chose private over public health facilities (90.25%). However, adjusted odds of visiting a public sector health facility for surgical and gynaecological services were 0.12 [95% confidence interval (CI): 0.10–0.16] and 0.11 (95% CI: 0.09–0.14) respectively, when compared to medical services. Conclusion: Social Health Protection Initiative beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.

Revenue and financing of patients with national health insurance by the social security organizing agency to improve health services

2020 ◽  
Vol 30 ◽  
pp. 276-279
Author(s):  
Syarifuddin Yusuf ◽  
Nuzul Achmar ◽  
Haniarti ◽  
Hasdiana ◽  
Mahkrajani Madjid ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
The Social ◽  
Improve Health

scholarly journals Policy Implementation of Health Coverage for Indonesian Migrant Workers

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Risky Kusuma Hartono ◽  
Budi Hidayat ◽  
Pujiyanto Puji
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Policy Implementation ◽  
Migrant Workers ◽  
Social Aspect ◽  
Health Coverage ◽  
Insurance Policy ◽  
The Social ◽  
Bilateral Cooperation ◽  
The Government

Abstract. The purpose of this research is to analyze the policy implementation of health coverage for TKI. This research uses a qualitative method with in-depth interview. The framework of this research consists of the aspect of the advisable policy, the implementation factors, and the schematic representation of the problem by using SWOT. The result of this research is the health insurance owned by TKI comes from TKI insurance, the membership of JKN, and insurance during their employment abroad. TKI insurance policy is the instruction of Law No. 39 of 2004 which regulates the obligation of the ownership of the social security and or insurance policy for TKI. However, TKI insurance has not been involved with the social aspect because the agency commercializes the coverage of TKI and it is not included a social security. The change of consortium may have decreased the ratio of claim’s values to the annual premium which is attributable to the decreasing complaint cases from TKI. In the implementation, TKI insurance has been assisted by a lot of agencies. However, the bilateral cooperation related to the coordination of health coverage among countries has not been maximized. This research concludes that the coverage of health insurance for TKI is still lower (curative) and the government's attempt to integrate the social security for TKI is important. The researcher suggests the government should comprehensively implement the health coverage for TKI by incorporating the principle of promotion and prevention. Keywords: TKI Insurance, Consortium, Law No. 39 of 2004, SWOT, Bilateral Cooperation

scholarly journals Kualitas Pelayanan BPJS Pada Klinik Di Kota Pekanbaru

2015 ◽  
Vol 1 (1) ◽  
pp. 99-109
Author(s):  
Hadiyati Hadiyati
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Social Security ◽  
Low Cost ◽  
Medical Needs ◽  
The Social ◽  
The Government ◽  
The Right ◽  
Social Security Agency

Abstract: Abstract: Ministry of Social Security Agency (BPJS) is the Social Security Agency established by the government to provide for Public Health Insurance, National Health Insurance (JKN) is a public health program to realize the health services in accordance with medical needs. BPJS Health Care not for all Indonesian people. Public complaints against the service based on the results of the study proved to be due for service procedures that are less well applied and also because of the service provided is not using the right people and facilities are also incomplete, although the specified low cost but not efficient in making the community recover of the disease.   Keywords: Quality of Service, BPJS

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Self-employed surfers, universal credit and the minimally decent life

Legal Studies ◽  
2021 ◽  
pp. 1-18
Author(s):  
Christopher Rowe
Keyword(s):  
Social Security ◽  
Low Income ◽  
Judicial Review ◽  
The Self ◽  
Tax Credits ◽  
Minimum Income ◽  
Wage Labour ◽  
The Social ◽  
Decent Life ◽  
The Government

Abstract As part of its response to Covid-19 the government paused the use of the ‘Minimum Income Floor’ (MIF), which restricts the Universal Credit (UC) entitlement of the self-employed. This paper places the MIF in the wider context of conditionality in the social security system and considers a judicial review which claimed that the MIF was discriminatory. The paper focuses on how UC affects the availability of real choices for low-income citizens to limit or escape from wage labour, with two implications of the move to UC highlighted. First, the overlooked labour decommodifying aspect of tax credits, which provided a minimum income guarantee and a genuine alternative to wage labour for people who self-designated as ‘self-employed’, even if their earnings were minimal or non-existent, has been removed. Secondly, UC has in some respects improved the position of low-paid wage labourers in ‘mini-jobs’, who are not subject to conditionality once they work for the equivalent of approximately nine hours a week on the minimum wage.

BPJS Kesehatan Memberikan Jaminan Kesehatan Terhadap Pasien Atau Masyarakat

2021 ◽  
Vol 7 (2) ◽  
pp. 146-154
Author(s):  
Aidha Puteri Mustikasari
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
The State ◽  
Universal Health Care ◽  
Universal Health Insurance ◽  
Universal Health ◽  
Provide Health Insurance

Abstrak. Kepesertaan BPJS Kesehatan pada tahun 2020 tidak akan mencakup 90% penduduk Indonesia, namun rencana Universal Health Care Implementation (UHC) telah direncanakan sejak tahun sebelumnya. Di masa pandemi Covid, sejumlah besar status kepesertaan BPJS Kesehatan  dicabut karena terlambat, padahal masyarakat membutuhkan layanan kesehatan dan asuransi dengan kondisi yang ada. Kajian ini bersifat norma deskriptif , dibahas dalam konteks kepesertaan BPJS kesehatan, dan cukup  menggunakan prinsip asuransi dengan hanya memberikan jaminan kepada peserta, tetapi negara mengikuti kewajiban UUD 1945 yaitu memberikan jaminan kesehatan dan pelayanan kepada warga negara. Untuk mendukung keberadaan jaminan kesehatan universal, Indonesia perlu menerapkan formulir kepesertaan dan  sanksi untuk ketentuan wajib  peserta jaminan sosial yang efektif dan efisien. Abstract. BPJS Health membership in 2020 will not cover 90% of Indonesia's population, but the Universal Health Care Implementation (UHC) plan has been planned since the previous year. During the Covid pandemic, a large number of BPJS Health membership statuses were revoked because they were late, even though people needed health services and insurance with the existing conditions. This study is descriptive in nature, discussed in the context of BPJS health participation, and it is sufficient to use the insurance principle by only providing guarantees to participants, but the state follows the obligations of the 1945 Constitution, namely to provide health insurance and services to citizens. To support the existence of universal health insurance, Indonesia needs to implement an effective and efficient membership form and sanctions for mandatory provisions for social security participants.

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