BPJS Kesehatan Memberikan Jaminan Kesehatan Terhadap Pasien Atau Masyarakat

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.

Using Taiwanese Universal Health Insurance Data to Estimate LTC Needs with Machine Learning

One of the core issues in long-term care (LTC) policy is the growing imbalance between demand and supply of LTC services due to aging population. To estimate the imbalance and allocate LTC resources, the government regularly conducts surveys. These surveys are expensive given the sample size requirements and imprecise given their subjective nature. This study links the administrative records of the universal health insurance database with LTC program usage records in Taiwan to explore this issue. Machine learning algorithms are used in projecting LTC needs from administrative records. LTC program usage records provide detailed LTC needs information and the amount of service each individual used. In addition, health insurance claim data provides rich health information. Specific LTC needs are predicted for each individual. By further extrapolating to future demographics, long-term LTC needs could be projected. There are several findings in this study. Prediction of difficulties in activities of daily livings (ADL), measured by Barthel index, works best using the Gradient Boosting algorithm. The mean absolute error is 17.67 out of a 0 to 100 scale. In addition to dementia and stroke, diagnosis of pressure ulcer (ICD 10 code: L89) and pneumonia (ICD 10 code: J18) have high predictive power for LTC needs. Prediction of Instrumental ADL (IADL) also performs well with a mean absolute error 1.31. The prediction model suggests high LTC needs and excess demand as the demographics changing. Our study provides a reliable way of using rich information to estimate future LTC needs without conducting additional costly surveys.

Initial assessment of a cancer genomic profile test for patients with metastatic breast cancer: a retrospective study

Comprehensive cancer genomic profile (CGP) tests are being implemented under Japanese universal health insurance system. However, the clinical usefulness of CGP test for breast cancer patients has not been evaluated. Of the 310 patients who underwent CGP testing at our institution between November 2019 and April 2021, 35 patients with metastatic breast cancer whose treatment strategy was discussed by our molecular tumor board within the study period were investigated after exclusion of 2 cases that could not be analyzed. The turn-around time, drug accessibility, and germline identification detection were evaluated. The subtype was luminal in 20 patients (57.1%), triple-negative in 12 patients (34.3%), and luminal-HER2 in 3 patients (8.6%). Actionable gene mutations were detected in 30 patients (85.7%), and 7 patients (20.0%) were recommended for clinical trial participation, with the drug administered to 2 patients (5.7%). Three patients (8.6%) died due to disease progression before the test results were disclosed. We report the results of an initial assessment of the utility of CGP testing for patients with metastatic breast cancer under Japanese universal health insurance system. Conducting CGP tests at a more appropriate time could provide patients with greater benefit from treatments based on their specific gene mutations.

The Challenges of Universal Health Insurance in Developing Countries: Experimental Evidence from Indonesia’s National Health Insurance

To investigate barriers to universal health insurance in developing countries, we designed a randomized experiment involving about 6,000 households in Indonesia who are subject to a government health insurance program with a weakly enforced mandate. Time-limited subsidies increased enrollment and attracted lower-cost enrollees, in part by reducing the strategic timing of enrollment to correspond with health needs. Registration assistance also increased enrollment, but increased attempted enrollment much more, as over one-half of households who attempted to enroll did not successfully do so. These findings underscore how weak administrative capacity can create important challenges in developing countries for achieving widespread coverage. (JEL D82, G22, H51, I13, I18, O15)

Social and Structural Determinants of Health Inequities: Socioeconomic, Transportation-Related, and Provincial-Level Indicators of Cost-Related Forgone Hospital Care in China

Despite near universal health insurance coverage in China, populations with low incomes may still face barriers in access and utilization of affordable health care. We aimed to identify the likelihood of forgone medical care due to cost by surveying individuals from the community to assess: (1) The percent with forgone medical care due to cost; and (2) Factors associated with forgone medical care due to cost. Surveys conducted (2016–2017) in Mandarin included demographic and medical care utilization-related items. Theoretically-informed, fully-adjusted analyses were employed. Approximately 94% of respondents had health insurance, which is somewhat similar to national estimates. Overall, 24% of respondents resided in rural areas, with 18% having less than a high school education, and 49% being male. More than 36% reported forgone medical care due to cost in the past 12 months. In fully-adjusted analyses, having lower education, generally not being satisfied with the commute to the hospital, and being a resident of a province with a lower density of physicians were associated with forgone medical care. Cost-related disparities in the access and utilization of needed medical care persist, even with near universal health insurance, which may be due to one’s satisfaction with travel time to healthcare and other community assets.