scholarly journals The Implementation of Minister of Health Regulation Number 001 Year 2012 Concerning Individual Health Service Referral System for National Health Insurance Patients InBirobuli Public Health Center, Palu City

2021 ◽  
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Health Service ◽  
Health Center ◽  
National Health Insurance ◽  
National Health ◽  
Referral System ◽  
Public Health Center ◽  
Individual Health ◽  
Service Referral

Enhancing the Role of Public Health Center as Gatekeeper on the National Health Insurance

2019 ◽  
Vol 10 (4) ◽  
pp. 353
Author(s):  
Betri Anita ◽  
Henni Febriawati ◽  
Desri Suryani ◽  
Yandrizal ◽  
Bintang Agustina Pratiwi ◽  
...  
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Health Center ◽  
National Health Insurance ◽  
National Health ◽  
Public Health Center

scholarly journals Physicians’ Behavior in Referring National Health Insurance Patients to Hospital

2022 ◽  
Vol 6 (2) ◽  
Author(s):  
Natalia Natalia ◽  
Haerawati Idris
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Qualitative Method ◽  
Severe Disease ◽  
Health Centers ◽  
Referral System ◽  
Primary Health ◽  
Icd 10

Physicians’ decision to refer patients in primary health care is vital in supporting the referral system. The increase of referral cases impacted the claims cost and hospital workload. This study aimed to analyze the physicians’ behavior in referring National Health Insurance (NHI) patients to hospitals. This study employed a qualitative method; 18 informants were selected using purposive sampling and analyzed using content analysis. The data were validated by triangulating method, source, and data. Physicians referred patients when the cases could not be handled; there were indications of severe disease and required further examination. The obstacles in the referral system were pressure from NHI patients that wanted to be referred and diagnosed differently from ICD 10. In referring NHI patients, physicians had followed referral procedures and criteria. High referrals were caused by patients being forced to be referred, coming with complaints of severe disease, having examined in a hospital, and some cases should not be referred to but still referred by entering a similar diagnosis into the ICD 10. It is expected that public health centers will educate NHI patients related to tiered referral procedures in health services.

scholarly journals The Impact of National Health Insurance Policy to the Implementation of Health Promotion Program on Public Health Center in Indonesia

2017 ◽  
Vol 11 (3) ◽  
Author(s):  
Mochamad Iqbal Nurmansyah ◽  
Bulent Kilic
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Health Insurance ◽  
Health Center ◽  
National Health Insurance ◽  
National Health ◽  
Health Promotion Program ◽  
Promotion Program ◽  
Health Promotion Programs ◽  
The Impact

National Health Insurance (NHI) Program has been implemented in Indonesia on January 2014. That program definitely brings some changes into managerial aspect in public health center (PHC). This study aimed to determine an impact of NHI policy in the implementation of health promotion programs at PHC in South Tangerang City, Indonesia. This study was conducted using qualitative method during February and March 2016. The impact of NHI is seen on policy, budget, equipment, human resource and implementation of health promotion program. With purposive sampling method, six policy makers, eight service providers and eight service users were selected for in-depth interview. As many as 17 documents were analyzed. Observation conducted at four selected PHC. Data analysis used thematic content analysis. There was no difference of PHC’s functions before and after NHI period. Budget expended for health promotion programs had increased after NHI implemented which it could be opportunity for PHC to make innovations, procure materials and implement better health promotion programs. Capitation budget which could be used for executing health promotion program and some recently implemented health promotion programs in NHI era becomes an evidence that NHI policy has a positive impact in the implementation of health promotion program at PHCAbstrakJaminan Kesehatan Nasional (JKN) telah diimplementasikan di Indonesia pada 1 Januari 2014. Hal tersebut membawa beberapa perubahan pada aspek manajerial pada pusat kesehatan masyarakat (puskesmas). Penelitian ini bertujuan untuk mengidentifikasi dampak dari kebijakan JKN terhadap implementasi program promosi kesehatan di puskesmas di Kota Tangerang Selatan, Indonesia. Penelitian menggunakan metode kualitatif. Data dikumpulkan pada Februari – Maret 2016. Dampak program dilihat dalam hal kebijakan, pendanaan, fasilitas, sumber daya manusia dan pelaksanaan program promosi kesehatan. Dengan menggunakan metode purposive sampling, enam pengambil kebijakan, delapan pemberi layanan dan delapan penerima layanan diambil sebagai informan dalam penelitian ini. Pada analisis dokumen, 17 dokumen telah dianalisis. Observasi dilakukan dengan melihat kegiatan yang dilakukan di empat puskesmas. Analisis data menggunakan analisis konten tematik. Tidak terdapat perbedaan dari fungsi puskesmas sebelum dan setelah adanya JKN. Dana yang digunakan untuk kegiatan promosi kesehatan telah mengalami peningkatan setelah implementasi kebijakan JKN dimana dana tersebut dapat digunakan untuk berinovasi, memberi peralatan dan melakukan promosi kesehatan dengan lebih baik. Dana kapitasi yang dapat digunakan untuk melaksanakan program promosi kesehatan dan beberapa kegiatan promosi kesehatan yang baru dilaksanakan pada saat era JKN menjadi bukti bahwa kebijakan JKN memiliki dampak positif terhadap pelaksanaan program promosi kesehatan di puskesmas.

scholarly journals Analisis Pelaksanaan Sistem Rujukan Berjenjang Bagi Peserta JKN di Puskesmas X Kota Surabaya

2018 ◽  
Vol 5 (2) ◽  
pp. 145
Author(s):  
Dwi Ratnasari
Keyword(s):  
Public Health ◽  
Informed Consent ◽  
Health Center ◽  
National Health ◽  
Observational Research ◽  
Referral System ◽  
Referral Letter ◽  
Cross Sectional ◽  
Health Security ◽  
Public Health Center

The era of National Health Security (NHS) enacted tiered referral system start in primary health care. High number of referrals at Public Health Center (PHC) X indicates that the implementation of referral system did not go well. The objectives of this study is to confirm implementation of refferal system in PHC in the era NHS based on the regulations and policies. This was descriptive observational research and cross sectional design with implementation research method. This research used triangulation to get deep information toward referral documents include referral data, registration book, medical records, referral letter, interview with refferal officer, and observation without intervention. This research was conducted at PHC X Surabaya on the Februari-March 2017. The results showed implementation of refferal system has appropriate with the regulations and the guidelines. The implementation has appropriate with 7 section on The Regulation of Health Minister No.1 of 2012. The implementation has appropriate with Guidelines of National Health Refferal include requirement to refer patient, refferal clinical procedure, and refferal administrative procedure, however there is not appropriate implementation: informed consent, contact to refferal destination healthcare, and print out of refferal paper. Recommendation for PHC is to do informed consent and print refferal letters 2 copies.Keywords: national health security, public health center, refferal system

Effectivity of National Health Insurance on Maternal Health in Developing Countries: A Systematic Review

2020 ◽  
Author(s):  
Eva Nur Octavia ◽  
◽  
Pandu Riono ◽  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Developing Countries ◽  
Health Insurance ◽  
Maternal Health ◽  
National Health Insurance ◽  
National Health ◽  
Population Studies

Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Indonesia

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.

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