scholarly journals The Analysis of Differences in Hospital Rill Rates and INA-CBG's Rate on Sectio Caesare Action in RSU. Imelda Pekerja Indonesia Medan 2019

2021 ◽  
Vol 3 (2) ◽  
pp. 121-130
Author(s):  
Marta Simanjuntak ◽  
Destanul Aulia ◽  
Zulfendri
Keyword(s):  
Claim Data ◽  
Sectio Caesarea ◽  
Financial Risks ◽  
Service Package ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Qualitative Descriptive ◽  
The Difference ◽  
Total Difference ◽  
Depth Interviews

The Indonesian government has developed a Health Insurance program National Social Security Administering Bodies (BPJS) Health. One of the ways to pay for health services for hospitals in Era JKN is the Indonesian Case Base Groups (INA-CBG's) payment system, namely the amount of claim payment by BPJS Health to the hospital for the package services based on diagnosis of disease and procedures. This study aims to analyze hospital real rates and INA CBG rates on the action of sectio caesarea and to find out the efforts made hospitals to cover INA-CBG's shortfall in claims costs. Types of research Qualitative descriptive conducted by in-depth interviews. Research sites at the hospital. Imelda Indonesian Worker having his address at Jalan Bilal No. 24 Kelurahan Pulo Brayan Darat I, East Medan District. The research was carried out since months January 2019 until finished. The population in this study is claim data delivery of inpatients who performed sectio casearea at month March and April as many as 143 cases The samples in this study were all population of 143 cases. The results showed that the difference in real rates hospital and INA-CBG rates on Sectio Caesaria at RSU. Imelda Worker Indonesia Medan in 2019 amounted to 73% of the real hospital rates exceeding the tariff INA-CBG's with a total difference in costs reaching IDR 199,661,028. and 39% real hospital fee less than INA-CBG's package rate. Efforts are conducted by the RSU. Imelda Indonesian workers to cover the shortage of costs INA-CBG's claims include using students who come from schools Imelda's own foundation, set the Sectio Caesare service package on general patients and providing supporting facilities. Suggested to RSU. Imelda Indonesian workers evaluate the financial risks received from services Sectio Caesare and evaluating the distribution of INA-CBG's claim costs for services Sectio Caesare is up to standard.

scholarly journals National Health Insurance Deficit in Indonesia: Identification of Causes and Solutions for Resolution

2020 ◽  
Vol 12 (13) ◽  
pp. 58
Author(s):  
Wahyu P. Nugraheni ◽  
Asri Hikmatuz Zahroh ◽  
Risky Kusuma Hartono ◽  
Ryan Rachmad Nugraha ◽  
Chang Bae Chun
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Short And Long Term ◽  
The Government ◽  
Catastrophic Disease ◽  
Depth Interviews

INTRODUCTION: Since it was implemented in 2014, National Health Insurance Program (JKN) in Indonesia experienced a financial deficit. JKN recorded a deficit of 9.7 trillion, 9.75 trillion and 10.98 trillion rupiah from 2016-2018, respectively. The deficit is estimated to still continue in the upcoming years. Systemic solutions are needed to bring JKN improvement in the future. METHODS: Data was collected from June to December 2019 by in-depth interviews with selected informants and literature review, which later was analyzed by content and with data triangulation. RESULT: The results of in-depth interviews and a review of some of the literature shows that there are four main factors that causes JKN deficit, which are capitation payment system to provider, the alleged fraud, lag of backed-referral system, and catastrophic disease. CONCLUSION: This study provides a solution to the handling of JKN deficits in the short and long term in accordance with problems in terms of funding and JKN expenditure. The solution can be an alternative policy that can be implemented by the Government of Indonesia to deal with the JKN deficit.

scholarly journals Legal Protection for Patient of Independent National Health Insurance’s Participant: Restriction on Hospitalization Upgrade

2020 ◽  
Vol 7 (2) ◽  
pp. 111-117
Author(s):  
I Nyoman Sudastra ◽  
Mokhamad Khoirul Huda ◽  
Asmuni
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Legal Protection ◽  
Comparative Approach ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Supreme Court ◽  
Social Security Act ◽  
The Difference ◽  
The Government

The government issued Regulation of the Minister of Health Number 51 of 2018 which regulates the increase in inpatient classes which are difficult to understand. After the issuance of the Minister of Health's regulation regarding the imposition of fees and the difference in costs in the Health Insurance program, causing confusion in the community. This study aims to analyze the legal protection for independent national Health Insurance Participants after the issuance of the Minister of Health Regulation concerning imposition of cost and difference in the health insurance Program. In addition, to analyze the existence of a norm conflict between the Minister of Health Regulation about Imposition of cost and Difference in cost toward the laws and regulations above. This study uses a statutory, conceptual and comparative approach. The type of research used in this study is normative legal research. The results showed that the legal protection of JKN participants independently after the enactment of Permenkes Number 51 of 2018 regarding the Imposition of Costs and Difference in Costs in the Health Insurance Program was unclear and caused legal uncertainty. Besides that, it turns out there has been a norm conflict between the Minister of Health Imposition of Imposition of costs and costs difference in Health Insurance with the Perpres Health Insurance, the National Social Security Act, the Consumer Protection Law and Human Rights. Settlement that can be taken to harmonize the norm conflict is to revoke Article 10 paragraph (5) Permenkes Number 51 of 2018, set aside the Article and conduct a judicial review to the Supreme Court.

PENGARUH KUALITAS PELAYANAN BPJS KESEHATAN TERHADAP KEPUASAN PENGGUNA PERSPEKTIF DOKTER RUMAH SAKIT HERMINA BOGOR

2017 ◽  
Vol 2 (1) ◽  
pp. 1-12
Author(s):  
Baby Silvia Putri ◽  
Lindawati Kartika
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Service Quality ◽  
Multiple Regression ◽  
National Health Insurance ◽  
Descriptive Analysis ◽  
National Health Insurance Program ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Health Service Quality

The study aimed to analyze the perceptions of the doctors of Hermina Hospital Bogor on BPJS health service quality and satisfaction level of the national health insurance program and to analyze the effects of service quality on the doctors’ satisfaction. Questionnaires were utilized to obtain the primary data, while literature reviews were conducted to obtain the secondary data. The data were analyzed by using descriptive analysis and multiple regression analysis. The results of this research, in reference to the descriptive analysis of the perceptions of the doctors in Hermina Hospital Bogor on satisfaction and quality service of the National Health Insurance program, indicated that the program is considered unsuitable in its implementation. The results of multiple regression showed that the variables of BPJS service quality have influences on the satisfaction of the doctors of Hermina Hospital Bogor. Keywords: health service quality, satisfaction, hospital

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