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FACTORS RELATED TO PENDING CLAIM IN INDONESIAN NATIONAL HEALTH INSURANCE (JKN): A SYSTEMATIC REVIEW Semarajana, I Nyoman Gede; Soewondo, Prastuti
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: The number of Indonesian National Health Insurance (JKN) member is increasing every year. It is bringing impact to the hospital and Social Security Organizing Agency (BPJS) of health. The hospital finances will face problem if BPJS of health pending or giving a smaller number of claims paid to the hospital. The hospital will get problem with employee payroll, payment of specialist medical services, drugs availability, and maintenance of hospital facilities and medical equipment. This study aims to analyze factors related to pending BPJS claim in Indonesian National Health Insurance. Methods: This study was a systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews & Meta-Analyses) guidelines. Data obtained from journal database of Google Scholar that published between 2014-2019. The relevant studies must include factors related to pending claim in JKN. Results: The search found out 217 studies, of which 84 studies used English and Indonesia language and only 5 studies that eligible for this study. The 5 studies showed factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources factor more likely appeared as cause for pending BPJS claim. Conclusion: Factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources was the factor that most influenced for pending BPJS claim. The hospital must create strategies to overcome the factors that cause pending claim. The government should create a policy that can help BPJS of health overcome the deficit and protect the patients from facing decrease in the quality of hospital services.

FACTORS RELATED TO PENDING CLAIM IN INDONESIAN NATIONAL HEALTH INSURANCE (JKN): A SYSTEMATIC REVIEW I Nyoman Gede Semarajana; Prastuti Soewondo
Proceedings of the International Conference on Applied Science and Health No. 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: The number of Indonesian National Health Insurance (JKN) member is increasing every year. It is bringing impact to the hospital and Social Security Organizing Agency (BPJS) of health. The hospital finances will face problem if BPJS of health pending or giving a smaller number of claims paid to the hospital. The hospital will get problem with employee payroll, payment of specialist medical services, drugs availability, and maintenance of hospital facilities and medical equipment. This study aims to analyze factors related to pending BPJS claim in Indonesian National Health Insurance. Methods: This study was a systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews & Meta-Analyses) guidelines. Data obtained from journal database of Google Scholar that published between 2014-2019. The relevant studies must include factors related to pending claim in JKN. Results: The search found out 217 studies, of which 84 studies used English and Indonesia language and only 5 studies that eligible for this study. The 5 studies showed factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources factor more likely appeared as cause for pending BPJS claim. Conclusion: Factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources was the factor that most influenced for pending BPJS claim. The hospital must create strategies to overcome the factors that cause pending claim. The government should create a policy that can help BPJS of health overcome the deficit and protect the patients from facing decrease in the quality of hospital services.

FACTORS RELATED TO PENDING CLAIM IN INDONESIAN NATIONAL HEALTH INSURANCE (JKN): A SYSTEMATIC REVIEW I Nyoman Gede Semarajana; Prastuti Soewondo
Proceedings of the International Conference on Applied Science and Health No. 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: The number of Indonesian National Health Insurance (JKN) member is increasing every year. It is bringing impact to the hospital and Social Security Organizing Agency (BPJS) of health. The hospital finances will face problem if BPJS of health pending or giving a smaller number of claims paid to the hospital. The hospital will get problem with employee payroll, payment of specialist medical services, drugs availability, and maintenance of hospital facilities and medical equipment. This study aims to analyze factors related to pending BPJS claim in Indonesian National Health Insurance. Methods: This study was a systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews & Meta-Analyses) guidelines. Data obtained from journal database of Google Scholar that published between 2014-2019. The relevant studies must include factors related to pending claim in JKN. Results: The search found out 217 studies, of which 84 studies used English and Indonesia language and only 5 studies that eligible for this study. The 5 studies showed factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources factor more likely appeared as cause for pending BPJS claim. Conclusion: Factors related to pending claim in JKN were human resources, administration, regulation, facilities, external and evaluation factors. Human resources was the factor that most influenced for pending BPJS claim. The hospital must create strategies to overcome the factors that cause pending claim. The government should create a policy that can help BPJS of health overcome the deficit and protect the patients from facing decrease in the quality of hospital services. Keywords: Pending claim, BPJS, National Health Insurance (JKN)

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN TINGGINYA RUJUKAN KASUS NON SPESIALISTIK OLEH FASILITAS KESEHATAN TINGKAT PERTAMA DI ERA JAMINAN KESEHATAN NASIONAL: SYSTEMATIC REVIEW Semarajana, I Nyoman Gede; Suwedia, I Nyoman Gede Bayu Wiratama; Daruki, Maria Wahyu; Damayanti, Anak Agung Sri Stuti
Jurnal ARSI : Administrasi Rumah Sakit Indonesia Vol. 8, No. 3
Publisher : UI Scholars Hub

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The Primary Health Facility (FKTP) in the era of National Health Insurance (JKN) must behave effective and efficiently in serving patients. Referring patients as indicated is an effort to achieve this. The research shows that optimizing primary services has the potential to save on health costs from the Social Security Agency of Health (BPJS) source of 49.1 billion per year. BPJS data also shows the high number of referrals for non- specialist cases, namely 714 thousand cases during 2014-2017. This study aims to find out the factors that are related to the high number of non-specialist cases referral by FKTP in the JKN era. The PRISMA protocol (Preferred Reporting Items for Systematic Reviews & Meta-Analyses) is used to select articles in this study. This study aims to determine the factors associated with the high number of non-specialist case referrals by Higher Level Health Facilities (FKTPs) in the JKN era. It applied The Preferred Reporting Items for Systematic Reviews & Meta-Analyses (PRISMA) protocol to select articles for this study. The article search was conducted on Google Scholar from 2 – 6 December 2019, and five eligible articles were found in this study. The findings of this review study show that factors related to non-specialty referral cases include health workers, supporting facilities, administration and regulation, service management, FKTP location and distance to FKTL, and disease complications. Comprehensive handling and collaboration of various parties and relevant stakeholders are needed to reduce the referral rate for non-specialist cases.

ANALISIS STRATEGI PEMASARAN LAYANAN BABY CARE DI RSU BHAKTI RAHAYU DENPASAR TAHUN 2020 Semarajana, I Nyoman Gede; Maharjana, Ida Bagus Nyoman
Jurnal ARSI : Administrasi Rumah Sakit Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Baby massage has long been known to be beneficial in helping baby's growth and development and is a hereditary tradition. The benefits of baby massage have been shown in various studies, but the lack of mother's knowledge about how to properly massage a baby also encourages mothers to seek baby massage services to both shamans and baby spas. These factors enable Bhakti Rahayu Hospital to develop Baby Care services in 2020 as a form of continuity of services provided to post-partum mothers. The purpose of this study was to analyze the marketing strategy of Baby Care services at Bhakti Rahayu Denpasar Hospital in 2020. The research design used was descriptive with a cross-sectional approach. Analysis was carried out by segmenting, targeting, and positioning of the Baby Care service, followed by determining the 4P (Product, Price, Place, and Promotion) marketing mix. Baby Care service has eight products at affordable and competitive prices, and activities carried out at home will make it easier for mothers to get services. Promotion of Baby Care services needs to be expanded and further evaluation needs to be done so that it can be known about the utilization of Baby Care services at Bhakti Rahayu Hospital Denpasar

Fear of Missing Out (FoMO) and Its Correlation with Mental Health of Saraswati 1 Denpasar High School Students I Nyoman Gede Semarajana; Anak Agung Dwi Ratih Arningsih; I Gede Jenstin Prana Arsana
International Journal of Health and Medicine Vol. 2 No. 1 (2025): January : International Journal of Health and Medicine
Publisher : Asosiasi Riset Ilmu Kesehatan Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62951/ijhm.v2i1.207

This research explores the relationship between Fear of Missing Out (FoMO) and mental health among high school students at Saraswati 1 Denpasar High School, Bali. Employing a cross-sectional quantitative approach, the study assessed FoMO levels using the FoMO Scale by Przybylski et al., and mental health aspects—depression, anxiety, and stress—using the DASS-21 scale. A total of 236 students, selected through convenience sampling, participated in the study, with data analyzed using descriptive and correlation tests. The findings indicate that 40.7% of students experienced moderate levels of FoMO, while significant proportions reported severe or very severe anxiety (38.1%) and stress (37.3%). Correlation analyses using Spearman and Pearson tests revealed positive and significant relationships between FoMO and depression (r = 0.322, p < 0.01), anxiety (r = 0.361, p < 0.01), and stress (r = 0.404, p < 0.01). These results emphasize the influence of excessive social media use on adolescents' mental health, highlighting the importance of interventions like counseling and educational programs to address FoMO's psychological effects. The study's limitations include sampling constraints and absenteeism, indicating the need for future research with more comprehensive methods.

PELAYANAN KESEHATAN TRADISIONAL PADA KEJUARAAN TERBUKA ANTAR PELAJAR 2024 KELATNAS INDONESIA PERISAI DIRI Handrean, I Gede Eka; I Nyoman Gede Semarajana; Putu Setiani, M.Biomed; I G.N. Putra Eka Santosa
J-ABDI: Jurnal Pengabdian kepada Masyarakat Vol. 4 No. 9: Februari 2025
Publisher : Bajang Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53625/jabdi.v4i9.9461

Pengabdian masyarakat ini berfokus pada minimnya integrasi metode kesehatan tradisional dalam dukungan kesehatan olahraga kompetitif. bertujuan mengintegrasikan terapi uap panas dan boreh dalam event olahraga, melibatkan kolaborasi FK Unmas Denpasar dan RS Ari Canti Gianyar. Metode yang digunakan adalah observasi partisipatif dengan tahapan persiapan, sosialisasi, dan pelaksanaan terapi pada 20 atlet pelajar. Hasil menunjukkan 85% peserta mengalami penurunan nyeri otot dan peningkatan relaksasi. Program berhasil membuktikan efektivitas terapi tradisional dalam mendukung performa atlet dan memperkuat kolaborasi antar institusi kesehatan.

Traditional Meditation and Yoga Exercises as an Alternative Therapy for Insomnia Setiani, Putu; Setiabudi, Agung; Semarajana, I Nyoman Gede; Dusak, Kadek Ayu Meilinda; Mahadewi, Kadek Ayu Savitri
Eduvest - Journal of Universal Studies Vol. 5 No. 11 (2025): Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i11.52223

Insomnia is a sleep disorder that affects a person's quality of life, lowers daily performance, and is even associated with long-term health problems such as depression, anxiety, and heart problems. Nowadays, many individuals are looking for non-drug alternatives to overcome insomnia. One of the increasingly popular approaches is yoga and meditation. This study aims to find out the relationship between yoga practice and meditation on insomnia. A prospective cohort study in the population of DHSP Bali who experienced insomnia with an age range of 18–80 years during the period April to July 2025. The average age of the sample was 49.71 years (SD±12.95) (p = 0.084) with 16 males (57.1%) and 12 females (42.9%). The average ISI score before meditation and yoga was 15.21 (SD±4.55) (p = 0.090) and the ISI score after meditation and yoga was 12.14 (SD±4.56) (p = 0.067). There was an average mean difference of 3.071 points between the ISI scores before and after yoga and meditation practice for 3 consecutive months. An improvement in the average ISI score before and after intensive yoga and meditation practice twice every week for 3 months was shown to improve insomnia complaints. Regular yoga-meditation practice demonstrates statistically significant efficacy in reducing insomnia severity through mechanisms including parasympathetic activation, increased GABA levels, and positive neuroplastic changes in the prefrontal cortex and hippocampus, providing evidence-based support for integrative non-pharmacological insomnia management.

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